The abnormal posture of foot drop and foot inversion often occurs in the lower extremities of stroke patients during functional recovery, delaying walking training. Although the patient cannot control the movement of the foot, the therapist can use an elastic bandage firmly wrapped around the outside of the patient’s shoe to keep the ankle in dorsiflexion and prevent inversion, thus allowing early walking training and preventing the occurrence of ankle sprains. This study investigated the effect of the bandage on the patient’s walking ability by using the bandage to control the ankle joint for rehabilitation training. Zhang Wei, Rehabilitation Center, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
1 Subjects and methods
1.1 Subjects 80 patients with stroke hemiplegia who were hospitalized in our department from January 2010 to January 2011 were all patients with chronic hemiplegia within 1-3 months of their first stroke and met the diagnostic criteria of the 4th Cerebrovascular Disease Conference [1], and were diagnosed with cerebral infarction or cerebral hemorrhage by CT or MRI. Inclusion criteria were: ability to achieve standing balance grade 1, exclusion of other neuromusculoskeletal disorders affecting walking ability such as Perkins’ disease, tremor, involuntary movements, osteoarthrosis, and exclusion of severe cardiopulmonary, hepatic and renal insufficiency as well as cognitive impairment and non-cooperation with the experiment. Patients or their families signed the informed consent form for the subjects. The 80 patients were randomly divided into the treatment group and the control group by lottery, with 40 patients in each group. See Table 1.
Table 1 Comparison of general information of patients in two groups
Group
Number of cases
Gender (cases)
Cerebral hemorrhage (cases)
Cerebral infarction (cases)
Mean age (years)
Male
female
Treatment group
40
26
14
18
22
57.4±(12.3)
Control group
40
28
12
17
23
56.3±(13.8)
1.2 Methods Both groups received regular training and daily life training based on motor relearning techniques [2], together with acupuncture, herbal fumigation and functional electrical stimulation, and the above treatments were given once a day for 40 min/time, 5 times/week, for a total of 8 weeks. In the treatment group, the ankle joint was controlled with a bandage during the training as follows: the patient sat on a chair with the knee joint at a right angle and the heel firmly placed on the floor, the therapist knelt in front of the patient to suppress the foot spasm and supported the patient’s toes with the knee to keep the ankle joint in the dorsal extension position, the therapist wrapped the bandage around the anterior part of the foot twice to make it well fixed, the direction of wrapping was from the medial side of the foot to the lateral side through the sole, and then from the lateral edge of the shoe upwards. Then tighten the bandage from the lateral edge of the shoe upward, across the front of the ankle and around the ankle joint, while pressing downward on the patient’s knee to prevent the heel from lifting off the ground, do not tighten the bandage when wrapping the ankle joint, only tighten it when wrapping the sole of the shoe, wrap the bandage continuously and expand along the sole from the level of the fifth toe bone to the heel, but do not cover the heel so that the bandage does not slip off.
1.3 Assessment criteria At the end of 8 weeks of rehabilitation training, the treatment and control groups were assessed by the Fugl-Meyer Assessment [3] (Fugl-Meyer Assessment) to assess the lower limb motor function score, Barthel Index assessment [4], 10-meter walking time assessment, and 10-meter walking time over 360 seconds was calculated. All assessments were made by one therapist.
1.4 Statistical analysis Statistical software spss17.0 was used for analysis, and independent sample t-test was performed, and P0.05 was considered as a significant difference.
2 Results After 8 weeks of treatment, there was a significant improvement in all assessments in both groups compared with the pre-treatment period, and the difference was significant (P0.01), and there was no significant difference in Barthel index between the two groups after treatment (P>0.05). 2.
Table 2 Comparison of assessment results between the two groups (±s)
Before treatment After treatment
Fugl-Meyer
Treatment group 9.53±6.37 24.26±11.59
Control group 10.09±5.17 18.78±10.03
Barthel
Treatment group 37.22±29.39 82.51±17.29
Control group 37.29±18.85 75.33±22.69
10m walking time
Treatment group 322.46±146.19 89.56±145.36
Control group 315.12±125.40 155.62±185.46
3 Discussion
With the improvement of medical treatment, the mortality rate of stroke patients has been significantly reduced, but the rate of disability is still high, in which impairment of walking ability is particularly common. It has been reported in the literature that more than half of stroke patients are left with varying degrees of functional impairment, which seriously affects the quality of survival of patients and places a heavy burden on patients, families and society[5] . Rehabilitation training can help patients improve their ability to live and work and reduce the degree of functional impairment so that they can return to their families and society. Early rehabilitation interventions can effectively improve the motor and ADL abilities of stroke patients[6-8] . Therefore, early training of patients’ walking ability can help improve their walking ability.
In order for patients to have a correct walking pattern, a certain degree of dorsiflexion of the ankle joint and toes is required, as well as the ability to inhibit the strong pull of the anterior tibial muscles to produce inversion of the dorsiflexion of the foot. During the rehabilitation process, each aspect of walking needs to be practiced separately to generally be able to overcome the barriers that exist and until the patient can adequately control it, the correct position of the foot must be maintained, otherwise the patient cannot walk freely and may be at risk of damaging the ankle joint. Without adequate active dorsiflexion of the ankle joint, the patient will hyperextend the entire hemiplegic leg, causing the toes to lift off the ground so that the swing period is distorted and the natural rhythm of walking is lost.
By using a bandage wrapped around the patient’s shoe to control the ankle joint, the affected foot can still have a normal walking experience inside the shoe, unlike the ankle-foot orthosis, which has direct contact with the foot. With the bandage control, patients in the treatment group were able to maintain correct position as early as possible, which effectively reduced inversion and foot drop in the ankle joint, and therefore allowed for faster walking training than patients in the control group, while effectively reducing the development of poor walking patterns. This study also demonstrated that by comparing the Fugl-Meyer index, Barthel index, and 10-meter walking time between the two groups before and after 8 weeks of treatment, the differences were significant, and the walking performance of the treatment group was significantly better than that of the control group.
In conclusion, the use of bandages to control the ankle joint during rehabilitation is significantly positive effect on the improvement of walking ability.
References
[1] National Conference on Cerebrovascular Diseases, Diagnostic points of various cerebrovascular diseases [J]. Chinese Journal of Neurology, 1996,29:379.
[2] Reed J.A., Wang T. Rehabilitation medicine [M]. Beijing: Science and Technology Press. 2002.265–268.
[3] Yin Xiuzhen, Huang Yongxi. Modern rehabilitation medicine treatment manual [M]. Beijing: Peking Medical University and China Union Medical College Joint Publishing House, 1995.1.
[4] Qian SH, Wang SHC, Chen ZY, et al. Effect of process-based rehabilitation on Barthel index in stroke patients[J].2005,9(5):152.
[5] Pang S, Chen HZ, Luo H, et al. Effect of early rehabilitation intervention on functional recovery in acute stroke patients[J]. Chinese Journal of Rehabilitation Medicine, 2008,23(6):546-547.
[6] Zhang DJ, Zhu SW, Cui GX, et al. A controlled study of the effects of early versus late rehabilitation on functional recovery in patients with cerebral infarction [J]. Chinese Journal of Rehabilitation Medicine, 2004,19(8):588-590.
[7] Zheng SH, Zhu SW, Li YZ, et al. Effect of early weight loss plate walking training on stroke patients with hemiplegia [J].