(Research Hub Theater) Hemiplegic Circumduction Gait Mechanics and the Impact of Ankle Foot Orthoses: An Artistic Visual Analysis

Objective: Post-stroke hemiplegia dramatically alters gait. This study aims to investigate hemiplegic circumduction (HC) gait timing in double support phases (DSPs), swing, and stance phases and to investigate the impact of an ankle foot orthoses (AFO) on those measurements. Here, we depict HC gait timing and mechanics in hand-drawn illustrations.

Design: Case control study.

Setting: Data collected from YouTube videos. Statistical analyses were conducted using Microsoft Excel.

Participants: 11 individuals with normal gait, 23 with HC gait, 10 with HC gait with an AFO.

Interventions: Not applicable.

Main Outcome Measures: Percentage of time in DSPs, swing phase, and stance phase on each limb during one gait cycle.

Results: Individuals with HC gait spent 18.3% more time in DSPs than normal gait (p < 0.001). They spent 16.2% more time in stance phase on the unaffected limb compared to the hemiparetic limb (p < 0.001). The swing phase of their unaffected limb was 16.2% shorter than the hemiparetic limb (p < 0.001). The use of AFOs reduced the time spent in DSPs by 8.0% (p < 0.05). However, within the individuals whose HC gait was analyzed with and without an AFO, the AFOs did not significantly decrease the asymmetry in the stance and swing phases between both limbs (10% reduction, p>0.1).

Conclusions: Patients with HC gait minimize weight-bearing on their affected leg by increasing stance phase on the unaffected leg and shortening the swing phase of the unaffected leg. While previous studies have investigated biomechanics of post-stroke hemiplegia, these findings provide specific insights into HC gait timing metrics. Our study shows that AFOs reduce time spent in DSPs by decreasing affected leg length in swing phase. The AFOs did not fully address gait asymmetries; however, further analysis with a larger sample size is needed to evaluate the effect of AFOs on gait asymmetries. We also provide novel illustrations with timing of the HC gait cycle.