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European Journal of Physical and Rehabilitation Medicine 2017 October;53(5):735-43

DOI: 10.23736/S1973-9087.17.04480-X


language: English

Use of dynamic movement orthoses to improve gait stability and trunk control in ataxic patients

Mariano SERRAO 1, 2 , Carlo CASALI 1, Alberto RANAVOLO 3, Silvia MARI 4, Carmela CONTE 4, Giorgia CHINI 2, 3, Luca LEONARDI 1, Gianluca COPPOLA 5, Cherubino DI LORENZO 1, Mahmoud HARFOUSH 2, Luca PADUA 4, 6, Francesco PIERELLI 1, 7

1 Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy; 2 Movement Analysis Lab, Rehabilitation Center, Policlinico Italia Private Clinic, Rome, Italy; 3 Department of Occupational and Environmental Medicine, Epidemiology, and Hygiene, INAIL, Rome, Italy; 4 Don Gnocchi Foundation, Milan, Italy; 5 Department of Neurophysiology of Vision and Neuro-Ophthalmology, G.B. Bietti Foundation and Institute for Research and Care, Rome, Italy; 6 Department of Geriatrics, Neuroscience and Orthopedics, Sacro Cuore Catholic University, Rome, Italy; 7 Neuromed Institute for Research and Care, Pozzilli, Isernia, Italy


BACKGROUND: Patients with cerebellar ataxia show increased upper body movements, which have an impact on balance and walking.
AIM: In this study, we investigated the effect of using dynamic movement orthoses (DMO), designed as elastic suits, on trunk motion and gait parameters.
DESIGN: Longitudinal uncontrolled study.
SETTING: Outpatient rehabilitation unit.
POPULATION: Eleven patients (7 men, 4 women; mean age: 49.9±9.5 years) with degenerative cerebellar ataxia were enrolled in this study.
METHODS: Linear overground gait of patients was recorded by means of an optoelectronic gait analysis system before DMO use (DMO-) and during DMO use (DMO+). Time-distance parameters, lower limb joint kinematics, body sway, trunk oscillations, and gait variability (coefficient of variation [CV]) were recorded. Patient satisfaction with DMO device was measured using Quebec user evaluation of satisfaction with assistive technology.
RESULTS: When using the DMO, patients showed a significant decrease in stance phase duration, double support phase duration, swing phase CV, pelvic range of motion (ROM), body sway, and trunk ROMs. A significant increase was observed in the swing phase duration and knee joint ROM. Out of 11 patients, 10 were either quite satisfied (8 points) or very satisfied (2 points) with the assistive device.
CONCLUSIONS: The DMO reduce the upper body motion and in improve balance-related gait parameters.
CLINICAL REHABILITATION IMPACT: We propose use of DMO as an assistive/rehabilitative device in the neurorehabilitation of cerebellar ataxia to improve the trunk control and gait stability. DMO may be considered a prototype that can be modified in terms of material characteristics, textile layers, elastic components, and diagonal and lateral seams.

KEY WORDS: Orthotic devices - Rehabilitation - Walking - Postural balance - Gait ataxia

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