human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Ankle-foot orthoses ( AFOs ) are intended to improve toe clearance during swing and ankle position at initial contact ( IC ) and midstance . Changes that lead to improved ankle-foot kinematics may result in a more biomimetic roll-over shape  ( ROS ) . ROS is the effective geometry to which the ankle-foot complex conforms between IC and contralateral IC . An effective ROS during gait may facilitate forward progression . This study investigated the effect of an AFO on ROS in adults with hemiplegia following stroke .  Kinematic and force data were recorded from 13 people with hemiplegia and 12 controls . Hemiplegic subjects walked at a self-selected speed with and without an articulated AFO with plantar flexion stop . For the involved limb , the AFO significantly increased the ROS arc length ( from 32.6 % to 55.7 % of foot length [ FL ] ) and arc radius ( 67.4 % to 139.3 % of FL ) and significantly altered the sagittal plane location of the first center of pressure ( COP ) point , moving it posterior to the ankle center ( -1.2 % to -20 % of FL ) ( p < 0.002 for all comparisons ) . However , when hemiplegic patients walked with an AFO , their mean arc radius was greater , mean arc length less , and the first COP point further posterior than those of control subjects OBJECTIVE To measure walking speed and energy cost in patients with prior stroke with and without a carbon composite ankle foot orthosis .  DESIGN Within-group comparisons of 2 walking conditions . PARTICIPANTS Convenience sample of 10 hemiparetic patients with a stroke at least 6 months earlier ( average age 52 years ) habituated to a carbon composite ankle foot orthosis .  METHODS Subjects walked on a treadmill at self-selected speed both with and without ankle foot orthosis for 5 minutes on each occasion . Energy expenditure was measured by  breath-by-breath analysis and electrocardiography .  Main outcome measures were walking speed , oxygen consumption , heart rate and energy cost per metre . RESULTS Walking speed : without ankle foot orthosis 0.27 ( SEM + /- 0.03 ) m/s , with 0.34 ( + /- 0.06 ) m/s , difference 20 % . Oxygen consumption : without ankle foot orthosis 8.6 ( + /- 0.4 ) ml/kg/min , with 8.8 ( + /- 0.5 ) ml/kg/min . Energy cost : without ankle foot orthosis 0.58 ( + /- 0.07 ) ml/kg/m , with 0.51 ( + /- 0.06 ) ml/kg/m , difference 12 % . CONCLUSION Use of a carbon composite ankle foot orthosis in patients with stroke may increase speed and decrease energy cost during walking Objective : To investigate the short- and long-term effects of dynamic ankle foot orthoses on functional ambulation activities in chronic hemiparetic patients . Design : R and omized controlled trial . Setting : University ’s neurological rehabilitation outpatient clinic and orthotics department . Subjects : Twenty-eight chronic hemiparetic patients of level 3–5 according to Functional Ambulation Classification and with a maximum spasticity level of 3 according to Modified Ashworth Scale , were r and omly assigned to the study and control groups . Interventions : The control group ( n = 14 ) was assessed with tennis shoes whereas the study group ( n = 14 ) was assessed initially with tennis shoes and after three months with dynamic ankle foot orthosis . Measures : Functional Reach , Timed Up and Go , Timed Up Stairs , Timed Down Stairs , gait velocity and Physiological Cost Index . Results : In the initial assessment no difference was found between the groups for any of the measured parameters ( P > 0.05 ) . After three months , intergroup comparisons while the patients in the study group were wearing dynamic ankle-foot orthosis showed a significant difference in favour of the study group for Timed Up Stairs 12.00 ( 10.21 ) seconds study versus 15.00 ( 7.29 ) seconds control group ; for gait velocity 0.99 ( 0.45 ) m/s study versus 0.72 ( 0.20 ) m/s control group and for Physiological Cost Index 0.12 ( 0.06 ) beats/min study versus 0.28 ( 0.13 ) beats/min control group ( P < 0.05 ) . No difference was found between the groups for Functional Reach , Timed Up and Go , Timed Down Stairs ( P > 0.05 ) . Conclusion : Chronic hemiparetic patients may benefit from using dynamic ankle-foot orthosis Stroke survivors present a less efficient gait compared to healthy subjects due to abnormal knee flexion during the swing phase of gait , associated with spasticity of the rectus femoris muscle and overactivity of the ankle plantarflexors . It is relevant to underst and the effect of the ankle foot orthosis ( AFO ) on gait in individuals with plantarflexor spasticity . The aim of this study was to compare the knee kinematics with an AFO/footwear combination and barefoot in post-stroke subjects with plantarflexor spasticity . Ten subjects with chronic hemiplegia were measured . Two kinematic variables were assessed during the swing phase of the paretic limb : knee flexion angle at toeoff and peak knee flexion angle . We also analyzed gait speed and step length of the non-paretic limb . All variables were obtained with and without the orthosis . Kinematic data were acquired using a motion capture system ( ELITE ) . Subjects wearing an AFO showed significant improvements in gait speed ( 0.62 m/s ( 0.08 SD ) vs. 0.47 m/s ( 0.13 SD ) ( p=0.007 ) ) , step length of the non-paretic limb ( 42 cm ( 5.9 SD ) vs. 33.5 cm ( 6.6 SD ) ( p=0.005 ) ) and peak knee flexion angle during the swing phase : 30.7 ° ( 14.1 ° SD ) vs. 26.3 ° ( 11.7 ° SD ) p=0.005 . No significant differences were obtained in the knee flexion angle at toeoff between no AFO and AFO conditions . We described benefits with AFO/footwear use in the kinematics of the knee , the step length of the non-paretic limb , and the gait velocity in hemiplegic subjects after mild to moderate stroke . We conclude that the use of an AFO can improve the gait pattern and increase velocity in these subjects Background : Identifying and underst and ing the changes in transfer of momentum that are directly affected by orthotic intervention are significant factors related to the improvement of mobility in individuals with hemiplegia . Objectives : The purpose of this investigation was to use a novel analysis technique to objective ly measure weight transfer during double support ( DS ) in healthy individuals and individuals with hemiplegia secondary to stroke with and without an ankle foot orthosis .  Study design : Prospect i ve , Repeated measures , case-controlled trial . Methods : Participants included 25 adults with stroke-related hemiplegia > 6 months using a prescribed ankle foot orthosis and 12 age-matched healthy controls . Main outcome measures included the weight transfer point timing ( WTP , % DS ) , maximum total force timing ( MTF , % DS ) , timing difference between WTP and MTF ( MTF-WTP , % DS ) and the linearity of loading ( LOL , R2 ) during the DS phase of the gait cycle . Results : The WTP and LOL were significantly different between conditions with and without the ankle foot orthosis for the affected and unaffected limb in post-stroke individuals , p ≤ 0.01 . The MTF and difference in timing between MTF-WTP were significantly different during affected limb loading with and without the ankle foot orthosis in the stroke group , p ≤ 0.0001 and p = 0.03 , respectively . MTF , MTF-WTP and LOL were significantly different between individuals with stroke ( during affected limb loading ) and healthy controls ( during right limb loading ) . Conclusions : This research established a systematic method for analysing weight transfer during walking to evaluate the effect of an ankle foot orthosis on loading during double support in hemiplegic gait . This novel method can be used to eluci date biomechanical mechanisms behind orthosis-mediated changes in gait patterns and quantify functional mobility outcomes in rehabilitation . Clinical relevance This novel approach to orthotic assessment will provide the clinician with needed objective evidence to select the most effective orthotic intervention to maximize functional recovery for individuals with hemiplegia secondary to stroke OBJECTIVES To determine ( 1 ) whether use of an ankle-foot orthosis ( AFO ) by patients with ankle dorsiflexor paresis leads to decreased muscle activity , immediately or 6 weeks after AFO use , and ( 2 ) whether this decrease ( if present ) differs between healthy and paretic subjects . DESIGN Cross-sectional and longitudinal r and omized case-control study . SETTING Rehabilitation research center in the Netherl and s. PARTICIPANTS Fourteen healthy persons and 29 patients with foot drop . INTERVENTIONS  Muscle activity  was measured by surface electromyography . Electromyographic reproducibility was tested in 14 healthy volunteers walking with and without AFO .  Acute changes in muscle activity from AFO use were compared between the 14 healthy persons and the 29 patients with foot drop .  Adaptation effects of AFO use after 6 weeks were studied in 29 patients , r and omly chosen 16 of whom had started using an AFO at the first measurement . MAIN OUTCOME MEASURES Amount of change in mean rectified electromyographic activity ( delta value ) between walking with and without AFO .  Follow-up measurements were conducted after 3 and 6 weeks . RESULTS Correlation coefficients , reflecting within-subject reproducibility , varied between.68 and .96 ( mean,.86 ) . In patients and healthy subjects , tibialis anterior muscle activity decreased by 7 % and 20 % ( P = .01 , P = .04 ) , respectively , when using an AFO . In patients , this decrease was measured in the overall activity during the gait cycle ; in healthy subjects , it was measured in the first 15 % of the gait cycle . Overall electromyographic activity did not change during 6 weeks ; delta values per muscle did not change during follow-up in the AFO group . CONCLUSION AFO use immediately reduced muscle activity of the ankle dorsiflexors . However , using an AFO for 6 weeks did not lead to a generally lower electromyographic activity level nor did the amount of activity reduction accumulate in comparison with patients who did not use an AFO . It is , therefore , safe to use an AFO , even with recently paretic patients OBJECTIVE To evaluate the kinematic features of rear-foot motion during gait in hemiplegic stroke patients , using anterior ankle-foot orthoses ( AFOs ) , posterior AFOs , and no orthotic assistance . DESIGN Crossover design with r and omization for the interventions . SETTING A rehabilitation center for adults with neurologic disorders . PARTICIPANTS Patients with hemiplegia due to stroke ( n=14 ) and able-bodied subjects ( n=11 ) . INTERVENTIONS Subjects with hemiplegia were measured walking under 3 conditions with r and omized sequences : ( 1 ) with an anterior AFO , ( 2 ) with a posterior AFO , and ( 3 ) without an AFO . Control subjects were measured walking without an AFO to provide a normative reference . MAIN OUTCOME MEASURES Rear-foot kinematic change in the sagittal , coronal , and transverse planes . RESULTS In the sagittal plane , compared with walking with an anterior AFO or without an AFO , the posterior AFO significantly decreased plantar flexion to neutral at initial heel contact ( P=.001 ) and the swing phase ( P<.001 ) , and increased dorsiflexion at the stance phase ( P=.002 ) . In the coronal plane , the anterior AFO significantly increased maximal eversion to neutral ( less inversion ) at the stance phase ( P=.025 ) , and decreased the maximal inversion angle at the swing phase when compared with using no AFO ( P=.005 ) . The posterior AFO also decreased the maximal inversion angle at the swing phase as compared with no AFO ( P=.005 ) . In the transverse plane , when compared with walking without an AFO , the anterior AFO and posterior AFO decreased the adduction angle significantly at initial heel contact ( P=.004 ) . CONCLUSIONS For poststroke hemiplegic gait , the posterior AFO is better than the anterior AFO in enhancing rear-foot dorsiflexion during a whole gait cycle . The anterior AFO decreases rear-foot inversion in both the stance and swing phases , and the posterior AFO decreases the rear-foot inversion in the swing phase when compared with using no AFO Objective : To evaluate the immediate effects of individually design ed functional in-shoe ankle-foot orthoses ( AFO ) made of soft and hard cast on balance , st and ing , and gait parameters in hemiparetic patients . Design : Crossover design with r and omized order of the intervention . Setting : A rehabilitation centre for adults with neurological disorders . Subjects : Twenty-eight patients with hemiparesis due to stroke or traumatic brain injury . Measures : Postural sway , st and ing and gait parameters based on ground reaction forces in two conditions : Patients were r and omly assigned to varying sequences of wearing AFO in footwear or wearing footwear alone . Results : AFO significantly improved weight-bearing on the affected leg ( affected/ unaffected side symmetry : 2.259 ± 1.5 with AFO versus 3.49 ± 2.5 without AFO , P B ± 0.05 ) and 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Ankle-foot orthoses ( AFOs ) are intended to improve toe clearance during swing and ankle position at initial contact ( IC ) and midstance . Changes that lead to improved ankle-foot kinematics may result in a more biomimetic roll-over shape  ( ROS ) . ROS is the effective geometry to which the ankle-foot complex conforms between IC and contralateral IC . An effective ROS during gait may facilitate forward progression . This study investigated the effect of an AFO on ROS in adults with hemiplegia following stroke .  Kinematic and force data were recorded from 13 people with hemiplegia and 12 controls . Hemiplegic subjects walked at a self-selected speed with and without an articulated AFO with plantar flexion stop . For the involved limb , the AFO significantly increased the ROS arc length ( from 32.6 % to 55.7 % of foot length [ FL ] ) and arc radius ( 67.4 % to 139.3 % of FL ) and significantly altered the sagittal plane location of the first center of pressure ( COP ) point , moving it posterior to the ankle center ( -1.2 % to -20 % of FL ) ( p < 0.002 for all comparisons ) . However , when hemiplegic patients walked with an AFO , their mean arc radius was greater , mean arc length less , and the first COP point further posterior than those of control subjects OBJECTIVE To measure walking speed and energy cost in patients with prior stroke with and without a carbon composite ankle foot orthosis .  DESIGN Within-group comparisons of 2 walking conditions . PARTICIPANTS Convenience sample of 10 hemiparetic patients with a stroke at least 6 months earlier ( average age 52 years ) habituated to a carbon composite ankle foot orthosis .  METHODS Subjects walked on a treadmill at self-selected speed both with and without ankle foot orthosis for 5 minutes on each occasion . Energy expenditure was measured by  breath-by-breath analysis and electrocardiography .  Main outcome measures were walking speed , oxygen consumption , heart rate and energy cost per metre . RESULTS Walking speed : without ankle foot orthosis 0.27 ( SEM + /- 0.03 ) m/s , with 0.34 ( + /- 0.06 ) m/s , difference 20 % . Oxygen consumption : without ankle foot orthosis 8.6 ( + /- 0.4 ) ml/kg/min , with 8.8 ( + /- 0.5 ) ml/kg/min . Energy cost : without ankle foot orthosis 0.58 ( + /- 0.07 ) ml/kg/m , with 0.51 ( + /- 0.06 ) ml/kg/m , difference 12 % . CONCLUSION Use of a carbon composite ankle foot orthosis in patients with stroke may increase speed and decrease energy cost during walking Objective : To investigate the short- and long-term effects of dynamic ankle foot orthoses on functional ambulation activities in chronic hemiparetic patients . Design : R and omized controlled trial . Setting : University ’s neurological rehabilitation outpatient clinic and orthotics department . Subjects : Twenty-eight chronic hemiparetic patients of level 3–5 according to Functional Ambulation Classification and with a maximum spasticity level of 3 according to Modified Ashworth Scale , were r and omly assigned to the study and control groups . Interventions : The control group ( n = 14 ) was assessed with tennis shoes whereas the study group ( n = 14 ) was assessed initially with tennis shoes and after three months with dynamic ankle foot orthosis . Measures : Functional Reach , Timed Up and Go , Timed Up Stairs , Timed Down Stairs , gait velocity and Physiological Cost Index . Results : In the initial assessment no difference was found between the groups for any of the measured parameters ( P > 0.05 ) . After three months , intergroup comparisons while the patients in the study group were wearing dynamic ankle-foot orthosis showed a significant difference in favour of the study group for Timed Up Stairs 12.00 ( 10.21 ) seconds study versus 15.00 ( 7.29 ) seconds control group ; for gait velocity 0.99 ( 0.45 ) m/s study versus 0.72 ( 0.20 ) m/s control group and for Physiological Cost Index 0.12 ( 0.06 ) beats/min study versus 0.28 ( 0.13 ) beats/min control group ( P < 0.05 ) . No difference was found between the groups for Functional Reach , Timed Up and Go , Timed Down Stairs ( P > 0.05 ) . Conclusion : Chronic hemiparetic patients may benefit from using dynamic ankle-foot orthosis Stroke survivors present a less efficient gait compared to healthy subjects due to abnormal knee flexion during the swing phase of gait , associated with spasticity of the rectus femoris muscle and overactivity of the ankle plantarflexors . It is relevant to underst and the effect of the ankle foot orthosis ( AFO ) on gait in individuals with plantarflexor spasticity . The aim of this study was to compare the knee kinematics with an AFO/footwear combination and barefoot in post-stroke subjects with plantarflexor spasticity . Ten subjects with chronic hemiplegia were measured . Two kinematic variables were assessed during the swing phase of the paretic limb : knee flexion angle at toeoff and peak knee flexion angle . We also analyzed gait speed and step length of the non-paretic limb . All variables were obtained with and without the orthosis . Kinematic data were acquired using a motion capture system ( ELITE ) . Subjects wearing an AFO showed significant improvements in gait speed ( 0.62 m/s ( 0.08 SD ) vs. 0.47 m/s ( 0.13 SD ) ( p=0.007 ) ) , step length of the non-paretic limb ( 42 cm ( 5.9 SD ) vs. 33.5 cm ( 6.6 SD ) ( p=0.005 ) ) and peak knee flexion angle during the swing phase : 30.7 ° ( 14.1 ° SD ) vs. 26.3 ° ( 11.7 ° SD ) p=0.005 . No significant differences were obtained in the knee flexion angle at toeoff between no AFO and AFO conditions . We described benefits with AFO/footwear use in the kinematics of the knee , the step length of the non-paretic limb , and the gait velocity in hemiplegic subjects after mild to moderate stroke . We conclude that the use of an AFO can improve the gait pattern and increase velocity in these subjects Background : Identifying and underst and ing the changes in transfer of momentum that are directly affected by orthotic intervention are significant factors related to the improvement of mobility in individuals with hemiplegia . Objectives : The purpose of this investigation was to use a novel analysis technique to objective ly measure weight transfer during double support ( DS ) in healthy individuals and individuals with hemiplegia secondary to stroke with and without an ankle foot orthosis .  Study design : Prospect i ve , Repeated measures , case-controlled trial . Methods : Participants included 25 adults with stroke-related hemiplegia > 6 months using a prescribed ankle foot orthosis and 12 age-matched healthy controls . Main outcome measures included the weight transfer point timing ( WTP , % DS ) , maximum total force timing ( MTF , % DS ) , timing difference between WTP and MTF ( MTF-WTP , % DS ) and the linearity of loading ( LOL , R2 ) during the DS phase of the gait cycle . Results : The WTP and LOL were significantly different between conditions with and without the ankle foot orthosis for the affected and unaffected limb in post-stroke individuals , p ≤ 0.01 . The MTF and difference in timing between MTF-WTP were significantly different during affected limb loading with and without the ankle foot orthosis in the stroke group , p ≤ 0.0001 and p = 0.03 , respectively . MTF , MTF-WTP and LOL were significantly different between individuals with stroke ( during affected limb loading ) and healthy controls ( during right limb loading ) . Conclusions : This research established a systematic method for analysing weight transfer during walking to evaluate the effect of an ankle foot orthosis on loading during double support in hemiplegic gait . This novel method can be used to eluci date biomechanical mechanisms behind orthosis-mediated changes in gait patterns and quantify functional mobility outcomes in rehabilitation . Clinical relevance This novel approach to orthotic assessment will provide the clinician with needed objective evidence to select the most effective orthotic intervention to maximize functional recovery for individuals with hemiplegia secondary to stroke OBJECTIVES To determine ( 1 ) whether use of an ankle-foot orthosis ( AFO ) by patients with ankle dorsiflexor paresis leads to decreased muscle activity , immediately or 6 weeks after AFO use , and ( 2 ) whether this decrease ( if present ) differs between healthy and paretic subjects . DESIGN Cross-sectional and longitudinal r and omized case-control study . SETTING Rehabilitation research center in the Netherl and s. PARTICIPANTS Fourteen healthy persons and 29 patients with foot drop . INTERVENTIONS  Muscle activity  was measured by surface electromyography . Electromyographic reproducibility was tested in 14 healthy volunteers walking with and without AFO .  Acute changes in muscle activity from AFO use were compared between the 14 healthy persons and the 29 patients with foot drop .  Adaptation effects of AFO use after 6 weeks were studied in 29 patients , r and omly chosen 16 of whom had started using an AFO at the first measurement . MAIN OUTCOME MEASURES Amount of change in mean rectified electromyographic activity ( delta value ) between walking with and without AFO .  Follow-up measurements were conducted after 3 and 6 weeks . RESULTS Correlation coefficients , reflecting within-subject reproducibility , varied between.68 and .96 ( mean,.86 ) . In patients and healthy subjects , tibialis anterior muscle activity decreased by 7 % and 20 % ( P = .01 , P = .04 ) , respectively , when using an AFO . In patients , this decrease was measured in the overall activity during the gait cycle ; in healthy subjects , it was measured in the first 15 % of the gait cycle . Overall electromyographic activity did not change during 6 weeks ; delta values per muscle did not change during follow-up in the AFO group . CONCLUSION AFO use immediately reduced muscle activity of the ankle dorsiflexors . However , using an AFO for 6 weeks did not lead to a generally lower electromyographic activity level nor did the amount of activity reduction accumulate in comparison with patients who did not use an AFO . It is , therefore , safe to use an AFO , even with recently paretic patients OBJECTIVE To evaluate the kinematic features of rear-foot motion during gait in hemiplegic stroke patients , using anterior ankle-foot orthoses ( AFOs ) , posterior AFOs , and no orthotic assistance . DESIGN Crossover design with r and omization for the interventions . SETTING A rehabilitation center for adults with neurologic disorders . PARTICIPANTS Patients with hemiplegia due to stroke ( n=14 ) and able-bodied subjects ( n=11 ) . INTERVENTIONS Subjects with hemiplegia were measured walking under 3 conditions with r and omized sequences : ( 1 ) with an anterior AFO , ( 2 ) with a posterior AFO , and ( 3 ) without an AFO . Control subjects were measured walking without an AFO to provide a normative reference . MAIN OUTCOME MEASURES Rear-foot kinematic change in the sagittal , coronal , and transverse planes . RESULTS In the sagittal plane , compared with walking with an anterior AFO or without an AFO , the posterior AFO significantly decreased plantar flexion to neutral at initial heel contact ( P=.001 ) and the swing phase ( P<.001 ) , and increased dorsiflexion at the stance phase ( P=.002 ) . In the coronal plane , the anterior AFO significantly increased maximal eversion to neutral ( less inversion ) at the stance phase ( P=.025 ) , and decreased the maximal inversion angle at the swing phase when compared with using no AFO ( P=.005 ) . The posterior AFO also decreased the maximal inversion angle at the swing phase as compared with no AFO ( P=.005 ) . In the transverse plane , when compared with walking without an AFO , the anterior AFO and posterior AFO decreased the adduction angle significantly at initial heel contact ( P=.004 ) . CONCLUSIONS For poststroke hemiplegic gait , the posterior AFO is better than the anterior AFO in enhancing rear-foot dorsiflexion during a whole gait cycle . The anterior AFO decreases rear-foot inversion in both the stance and swing phases , and the posterior AFO decreases the rear-foot inversion in the swing phase when compared with using no AFO Objective : To evaluate the immediate effects of individually design ed functional in-shoe ankle-foot orthoses ( AFO ) made of soft and hard cast on balance , st and ing , and gait parameters in hemiparetic patients . Design : Crossover design with r and omized order of the intervention . Setting : A rehabilitation centre for adults with neurological disorders . Subjects : Twenty-eight patients with hemiparesis due to stroke or traumatic brain injury . Measures : Postural sway , st and ing and gait parameters based on ground reaction forces in two conditions : Patients were r and omly assigned to varying sequences of wearing AFO in footwear or wearing footwear alone . Results : AFO significantly improved weight-bearing on the affected leg ( affected/ unaffected side symmetry : 2.259 ± 1.5 with AFO versus 3.49 ± 2.5 without AFO , P B ± 0.05 ) and 
    Output:
    