Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 17

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C. Nikamp et al.
delayed) were included in the analysis. Six subjects
(1 early, 5 delayed) did not complete the study (drop-
out after T1 or T2). They were not included in the
analysis since their data was insufficient to answer the
research questions (missing T4). One additional subject
(delayed) was excluded, since it was not possible to
perform the measurements (measurements were too
tiring). Of the included 26 subjects, 5 (1 early, 4 de-
layed) were not able to perform T1, as they were not
able to walk without physical support from another
person and/or had insufficient endurance to complete
T1. In 19 of the 21 subjects who were able to perform
T1, measurements had to be postponed with 1–5 weeks,
resulting in T1 being performed approximately 51 days
after stroke (see Table I). In general, measurements T2,
T3 and T4 could be performed as planned. Data for 1
subject (early) is missing at T3 because no laboratory
space was available.
Table I shows the subject characteristics. No statis-
tically significant differences were found between the
groups at inclusion. The type of AFO provided, and
whether subjects use their AFO in daily life was regis-
tered. Most subjects were provided with a flexible type
of AFO (Table I). One subject (early) changed from a
flexible to a semi-rigid AFO between T1 and T2, as the
rehabilitation physicians judged that the flexible AFO
did not provide enough support any longer. All subjects
used their AFO daily at the time of the measurements
at T1, T2, T3 and T4, except for 3 subjects (2 early, 1
delayed) at T4. These 3 subjects used their AFO during
some days of the week at T4, mainly during walking
outdoors for longer distances. These subjects were
measured both with and without AFO at T4.
The median number of gait cycles used to calculate
the average AUC per sub-phase was ≥ 9 for each mea-
surement and group. Baseline comparison at T1 did not
reveal significant differences in TA muscle activity wit-
hout AFO (n = 14 early; n = 7 delayed), except for TA
muscle activity during the second double support phase
(p = 0.016). No differences in walking speed without
an AFO were found at baseline (0.37 vs 0.39 m/s for
the early and delayed group, respectively, p = 0.804).
Effects on TA muscle activity during a 26-week period
Table II and Fig. 2 show the median AUC for TA acti-
vity of the early and delayed group at T1, 2, 3 and 4 for
the different phases in gait. The original data without
logarithmic transformation are shown.
No changes in TA muscle activity were found during
the 26-week period in SW without AFO in both groups
(mixed-model repeated measures analysis within-groups
p = 0.420 and p = 0.282 for the early and delayed group,
respectively). During the other sub-phases of gait, sig-
nificant changes were found only for DS1 and SS in the
delayed group (p = 0.013 and p = 0.007, respectively).
Table I. Subject characteristics
Total (n  = 26) Early (n  = 15) Delayed (n  = 11)
17/9 10/5 7/4
56.4 (9.8) 57.0 (9.9) 55.6 (10.1)
174.0 (169.8; 179.0) 174.0 (169.0;179.0) 171.0 (170.0;178.0)
Time since stroke at inclusion, days b , mean (SD) 81.1 (12.5) 84.4 (11.4) 76.5 (12.8)
30.4 (6.3) 29.1 (6.5) 32.2 (6.0)
Type of stroke (ischaemic/haemorrhagic) a , n 16/10 8/7 8/3
22/4 14/1 8/3
23/0/3 13/0/2 10/0/1
, n
a
Sex (male/female)
Age, years b , mean (SD)
Height, cm c , median (IQR)
Weight, kg b , mean (SD)
Affected body side (left/right) a , n
Type of AFO (flexible/semi-rigid/rigid) a , n
Sensation d
Tactile (normal/impaired/absent) a , n
Propriosepsis (normal/impaired/absent) a , n
Mini-Mental State Examination c , median (IQR)
Motricity Index c total lower limb, median (IQR)
Ankle
Knee
Hip
Time since stroke at gait analysis, days, mean (SD)
T1 b
T2 b
T3 b
b
T4
21/2/3 12/1/2 9/1/1
21/4/1 12/2/1 9/2/0
27.0 (24.8;28.0) 27.0 (25.0;28.0) 28.0 (24.0;28.0)
39.5 (10.5;42.0)
9.0 (0.0;14.0)
14.0 (6.8;14.0)
14.0 (0.0;14.0) 37.0 (18.0;42.0)
9.0 (0.0;14.0)
14.0 (14.0;14.0)
14.0 (9.0;14.0) 42.0 (0.0;42.0)
9.0 (0.0;14.0)
14.0 (0.0;14.0)
14.0 (0.0;14.0)
51.6 (15.3), ( n  =  21) 51.3 (16.1), ( n  =  14) 52.1 (14.9), ( n  =  7)
90.8 (7.4), ( n  =  26) 90.1 (6.5), ( n  =  15) 91.8 (8.7), ( n  =  11)
146.0 (6.5), ( n  =  25) 146.8 (7.4), ( n  =  14) 145.1 (5.5), ( n  =  11)
209.7 (7.0), ( n  =  26) 209.4 (7.4), ( n  =  15) 210.1 (6.6), ( n  =  11)
a
fisher exact test (2-tailed); b independent samples t-test; c Mann-Whitney U test; d tested with Erasmus MC modifications to the Nottingham Sensory Assessment,
lower limb part.
Gait analysis were planned in week 1 (T1), 9 (T2), 17 (T3), and 26 (T4) of the study, but measurements were postponed in case subjects were not able to walk
without physical support of another person and/or had insufficient endurance to complete a gait analysis measurement. The time since stroke (days) at which
gait analysis was performed was reported.
AFO: ankle-foot orthosis; SD: standard deviation; IQR: interquartile range.
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