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Objectives: This study aimed to demonstrate the therapeutic effect of gait training using ankle-foot orthoses (AFOs) on the gait of stroke patients when not wearing AFOs with two different types of AFO, an AFO with an oil damper (AFO-OD) that resists plantarflexion and an AFO with a plantarflexion stop (AFO-PS), and to display the possible differences between the AFO types. Patients and methods: Forty-two patients (38 males, 4 males, mean age: 59.7±10.9; range, 38 to 81 years) with subacute stroke were randomized to either an AFO-PS or an AFO-OD group. Participants were given gait training in a two-week period by physiotherapists wearing their allocated AFO. Nineteen patients were assigned to the AFO-PS group and 20 to the AFO-OD group. Patients' gait without an AFO before gait training and then after two weeks of training wearing allocated AFOs was recorded through a three-dimensional movement capture system. Results: A therapeutic effect through two weeks of continuous use of AFOs and gait training was found in both AFO groups (main effect of time) in the spatiotemporal factors, ankle joint moments, ankle power generation, shank-to-vertical angle, and center of gravity velocity throughout the stance phase, pre-swing knee angular velocity, and hip flexion moment in pre-swing. The results did not show a large interaction between two AFOs group. Conclusion: These findings reveal that both AFOs had significant therapeutic effects on stroke gait. There was no significant difference between the two AFO groups. Further studies with a control group representing the effects of gait training without wearing an AFO are needed.

Objectives: This study aims to evaluate the effect of two ankle-foot orthoses (AFOs), AFO with plantar flexion stop (AFO-PlfS), and AFO with plantar flexion resistance (AFO-PlfR), while wearing standard shoes and rocker-sole shoes. Patients and methods: Between November 2017 and July 2018, in this randomized-controlled study, a total of 20 stroke patients (8 males, 12 females; mean age: 48.1 years; range, 33 to 65 years) in chronic phase were randomized to AFO groups (AFO-PlfS group, n=10 and AFO-PlfR group, n=10). Each group received the allocated AFO along with two kinds of shoes (standard shoe and rocker shoe) for a two-week adaptation. Two effects were separately evaluated: The orthotic effect and rocker shoe effect were defined as the evaluation of using an AFO wearing standard shoe compared to only standard shoe, and evaluation of using an AFO wearing rocker shoe compared to an AFO wearing standard shoe, respectively. The gait of each group was measured by three-dimensional motion analysis. Results: A significant orthotic effect was found in both AFO groups in spatiotemporal parameters and maximum ankle dorsiflexion in the single-support phase. Additionally, the AFO-PlfR group showed a significant improvement in the parameters related to the first rocker of gait, but not for AFO-PlfS group concerning the orthotic effect. The rocker shoe effect was found in significant reduction of peak ankle plantar flexor moment and power ankle generation during preswing for both AFO groups. Conclusion: According to the orthotic effect, an AFO-PlfR can create better function in the improvement of parameters related to the first rocker. Although a rocker shoe can facilitate rollover for weight progression in the third rocker of gait, it cannot make a strong push-off function in stroke survivors.

Background: In the rehabilitation for patients with spinal cord injury, we often use developmental movement patterns of infants and Activity-Based Therapy. They include quadruped movement, but no reports of movement analysis on quadruped movement in patients with spinal cord injury. Objective: This study aimed to analyze quadruped movement in patients with paraplegia, and to summarize its characteristics. Methods: The quadruped movement of 3 patients with complete paraplegia were measured using a three-dimensional motion analyzer, and their characteristics were summarized. Results: All cases showed an ipsilateral rotation of the pelvis when moving the lower limbs. Case A rose the contralateral upper and lower limbs simultaneously. Cases B and C moved one limb at a time. Conclusions: Our results suggested that patients with spinal cord injury have an ipsilateral rotation of the pelvis when moving the lower limbs in quadruped movement. Also, it seems that, depending on the degree of disability, some cases were able to move the contralateral upper and lower limbs simultaneously, while others moved one limb at a time

Purpose: This systematic review is aimed at evaluating the efficacy of AFO types and comparison between them on the energy expenditure metrics of walking in individuals who had suffered a stroke with (sub)acute or chronic evolution.Methods: The following databases were searched; PubMed, Scopus, ISI Web of Knowledge, Embase and Cochrane Library based on the population intervention comparison outcome (PICO) method.Results: A total of 15 trials involving 195 participants were selected for the final evaluation. All trials, except one, examined individuals in chronic phase. Although the evidence from the selected studies was generally weak, the consensus was that an AFO may have a positive immediate effect on the energy expenditure metrics including energy cost, physiological cost index, mechanical work and vertical center of mass trajectory on the affected leg, in both overground walking and treadmill walking in adults with chronic stroke. There were insufficient studies to evaluate the medium term efficacy of wearing an AFO combined with gait training on metabolic cost parameters during ambulation. There were also insufficient studies for comparison among different designs of AFOs.Conclusions: An AFO can immediately improve energy expenditure metrics of walking in stroke survivors. There is a need for further well-designed randomized trials to evaluate long-term effect of gait training using AFOs and comparison among the different types of orthoses.IMPLICATIONS FOR REHABILITATIONAn AFO can immediately improve the energy expenditure metrics during walking after stroke.Measurement of energetic parameters of walking wearing a orthotic device such as an AFO can evaluate gait economy in stroke populations.

Ankle-foot orthoses (AFOs) have been described to have positive effects on the gait biomechanics in stroke patients. The plantarflexion resistance of an AFO is considered important for hemiplegic patients, but the evidence is still limited. The purpose of this case series was to design and evaluate the immediate effect of an articulated AFO on kinematics and kinetics of lower-limb joints in stroke patients. The articulated AFO with the adjustment of plantarflexion resistance was designed. The spring generates a plantarflexion resistance of the ankle joint at initial stance phase. The efficacy of orthosis was evaluated on two stroke patients in 2 conditions: without an AFO and with the AFO. Results showed the immediate improvements for walking speed, stride length and angular changes of dorsiflexion of the paretic ankle joint during a gait cycle of both subjects using the AFO compared with barefoot walking. The AFO also was able to reduce the paretic knee extension in the single-support phase of the stance and increase the vertical COM displacement during stance phase on the affected leg. In conclusion, the designed AFO affect not only the movement of the ankle joint but also the movements of the knee joint and the vertical COM height. These changes indicate improvement of the first and the second rockers and swing phase gait but not third rocker function. Further investigation is recently underway to compare its effect compared with other AFOs on the gait parameters of hemiplegic patients.

To determine and compare the effect of ankle-foot orthosis (AFOs) types on functional outcome measurements in individuals with (sub)acute or chronic stroke impairments. PubMed, Web of Knowledge, Embase, Scopus, ProQuest, and Cochrane were searched from inception until September 2020. Methodological quality assessment of 30 studies was conducted based on the Downs and Black checklist. Functional indices were pooled according to their standardized mean difference (SMD) and 95% confidence intervals (CI) in a random-effect model. A narrative analysis was performed where data pooling was not feasible. Overall pooled results indicated improvements in favor of AFOs versus without for the Berg Balance Scale (SMD: 0.54, CI: 0.19–0.88), timed-up and go test (SMD: −0.45, CI: −0.67 to −0.24), Functional Ambulatory Categories (SMD: 1.72, CI: 1.25–2.19), 6-Minute Walking Test (SMD: 0.91, CI: 0.53–1.28), Timed Up-Stairs (SMD: −0.35, CI: −0.64 to 0.05), and Motricity Index (SMD: 0.65, CI: 0.38–0.92). Heterogeneity was non-significant for all outcomes (I2 < 50%, p > 0.05) except the Berg Balance Scale and Functional Ambulatory Categories. Additionally, there was not sufficient evidence to determine the effectiveness of specific orthotic designs over others. An AFO can improve ambulatory function in stroke survivors. Future studies should explore the long-term effects of rehabilitation using AFOs and compare differences in orthotic designs.IMPLICATIONS FOR REHABILITATIONAn AFO can improve functional performance and ambulation in survivors of strokes.Wearing an AFO in rehabilitation care during the subacute phase post stroke may have beneficial effects on functional outcomes measured.There was no evidence as to the effectiveness of specific AFO designs over others. An AFO can improve functional performance and ambulation in survivors of strokes. Wearing an AFO in rehabilitation care during the subacute phase post stroke may have beneficial effects on functional outcomes measured. There was no evidence as to the effectiveness of specific AFO designs over others.

Background Gait improvement in patients with stroke has been examined in terms of use or non-use of an ankle–foot orthosis (AFO), but the effects of different kinds of AFOs remain unclear. In this study, the effect on gait of using an AFO with an oil damper (AFO-OD), which has plantarflexion stiffness without dorsiflexion resistance, was compared with a nonarticulated AFO, which has both dorsiflexion and plantarflexion stiffness, in a randomized controlled trial. Methods Forty-one patients (31 men, 10 women; mean age 58.4 ± 11.3 years) in the subacute phase of stroke were randomly allocated to two groups to undergo gait training for 1 h daily over 2 weeks by physiotherapists while wearing an AFO-OD or a nonarticulated AFO. A motion capture system was utilized to measure shod gait without orthosis at baseline and after training with the allocated AFO. Data analysis focused on the joint kinematics and kinetics, spatial and temporal parameters, ground reaction force, and shank-to-vertical angle. Unpaired t-test or Mann–Whitney U test was performed to clarify the difference in gait with an AFO between the two AFO groups after training, with a significance level of p = 0.05. Results Thirty-six patients completed the study (17 in the AFO-OD group and 19 in the nonarticulated AFO group). The ankle joint was more dorsiflexed in single stance (p = 0.008, effect size r = 0.46) and peak ankle power absorption was larger in stance (p = 0.007, r = 0.55) in the AFO-OD group compared with the nonarticulated AFO group. Peak power absorption varied among patients in the AFO-OD group. Increased dorsiflexion angles were also found at initial contact (p = 0.008, r = 1.51), pre-swing (p = 0.045, r = 0.91), and the swing phase (p = 0.045, r = 0.91) in the AFO-OD group. There was no difference in peak plantarflexion moment, ankle power generation, spatial or temporal parameters, ground reaction force, or shank-to-vertical angle between the two groups. Conclusions The results of this study showed that an AFO with plantarflexion stiffness but without dorsiflexion resistance produced greater improvement in ankle joint kinematics and kinetics compared with the nonarticulated AFO, but the results of peak power absorption varied greatly among patients. Trial registration UMIN000028126, Registered 1 August 2017, https://upload.umin.ac.jp/cgi-bin/icdr/ctr_menu_form_reg.cgi?recptno=R000032197

[Purpose] We need to regularly evaluate motor function to sustain the health of community-dwelling older adults. Our study aimed to identify the kinematic characteristics of healthy older adults in the Timed Up and Go test because the criteria for assessing the motor function of healthy older adults are unclear in the widely used clinical simple methods. [Participants and Methods] In total, 22 healthy younger and 28 healthy older adults participated in this study. Using a 3D motion analysis system, we measured the time ratios, trajectories, trajectory length per unit time, and body inclination angles during the Timed Up and Go test. We compared the kinematic characteristics of the older and younger adults. [Results] The older adults required a longer time ratio to complete the turn and sit subtasks. The trajectory of the older adults' turn subtask was longer than that of the younger adults. Older adults' body inclination angles during the turn subtask were smaller than that of the younger adults. [Conclusion] Healthy older adults had a different kinematic index from younger adults during the Timed Up and Go turn subtask. Therefore, we suggest the kinematic index of posture and turning radius be used to measure Timed Up and Go as a clinically useful index for understanding the motor characteristics of older adults.

Sit-to-walk is an asymmetric task that is challenging for individuals with stroke, and paretic limb loading at seat-off and movement fluidity may change according to whether the non-paretic or paretic leg is used as the leading limb. This study aimed to investigate differences in paretic limb loading and fluidity depending on whether the non-paretic limb or paretic limb was used as the leading limb.Thirty-eight individuals with stroke performed sit-to-walk with each leg as the leading limb, and their movements were measured using a 3D motion analysis system. The paired t-test or Wilcoxon signed-rank test was used to assess differences according to limb selection in paretic limb loading ratio at seat-off and fluidity (Fluidity Index: ratio of the lowest to peak forward velocity before first initial contact).Twenty-two of 38 participants preferred to use the paretic limb as the leading limb. When leading with the paretic limb, the paretic limb loading ratio was significantly larger (p = 0.002), and the Fluidity Index was lower (p = 0.007).Sit-to-walk with the paretic leading limb seems to be an adaptive movement because many participants preferred leading with the paretic limb. However, selection of the leading limb in sit-to-walk involves a biomechanical tradeoff between paretic limb loading at seat-off and movement fluidity in individuals with stroke. Use of the paretic leading limb requires loading capacity of this limb, and the non-paretic leading limb must have high balance ability to merge sit-to-stand and gait initiation.

[Purpose] This study aimed to elucidate the dynamics of the kinematic chain of shank rotation accompanying calcaneal pronation/supination during weight-bearing changes associated with ankle positions during plantar/dorsiflexion and whether this biomechanical phenomenon is affected by age. [Participants and Methods] The study included 54 participants (108 legs, 25 young and 29 old participants). A 3-dimensional motion analysis system measured the calcaneal pronation/supination and the shank rotation angles during pronation/supination of the foot when upright. The kinematic chain ratio was defined as the linear regression coefficient (shank rotation angle/calcaneal pronation/supination angle). The kinematic chain ratio was measured during plantar flexion, in an intermediate position, and dorsiflexion. [Results] Significant differences in the kinematic chain ratio were related to ankle position but not age. The mean kinematic chain ratio in all participants was 0.9 ± 0.3 for plantar flexion, 1.0 ± 0.2 for an intermediate position, and 1.3 ± 0.4 for dorsiflexion, showing significant differences between the 3 ankle positions. [Conclusion] During dorsiflexion, the long axis of the shank and that of the subtalar joint are nearly parallel; thus, shank rotation increases (larger kinematic chain ratio). During plantar flexion, a larger angle is created; thus, shank rotation decreases (smaller kinematic chain ratio). When analyzing the kinematic chain between calcaneal pronation/supination and shank rotation, it is essential to consider the ankle position during plantar/dorsiflexion.

[Purpose] This study aimed to identify factors that determine the kinematic coupling behavior of calcaneal pronation/supination and shank rotation in a standing position. [Participants and Methods] Study participants included 15 healthy adults (30 legs). Kinematic coupling behavior was quantified as the linear regression coefficient (kinetic chain ratio [KCR]) of the angle of shank rotation against the angle of calcaneal pronation-to-supination measured using a 3-dimensional motion analysis system during pronation and supination of both feet while standing. The relationship between the KCR and the foot bone alignment was also analyzed using 35 parameters that were evaluated based on plain radiography. [Results] Greater the height of the medial longitudinal arch, and greater the backward tilt of the long axis of the talus and the backward tilt of the talar articular surface of the calcaneus, larger the KCR. This alignment differed between the genders. [Conclusion] This study suggested that the KCR increases as the subtalar joint axis approaches the long axis of the shank secondary to the lifting of the medial longitudinal arch of the foot and decreases as the subtalar joint axis approaches the long axis of the foot secondary to the lowering of the medial longitudinal arch of the foot.

Transgenic chrysanthemum plants harbouring the genes producing small interfering RNAs (siRNAs) whose sequence was designed based on the chrysanthemum stunt viroid (CSVd) genome were established. The siRNAs are expected to target and decompose CSVd RNA through a silencing mechanism. The CSVd-infected plants were grafted as scions onto the stocks of either non-transgenic or transgenic plants, and axial shoots that elongated from the stocks were rooted and grown to investigate if the plants are resistant to CSVd under greenhouse conditions. The non-transgenic plants infected with CSVd showed severe disease symptoms, i.e. stunted growth and spotty chlorotic lesions on leaves, but no such symptoms were observed in the transgenic plants. The real-time quantitative reverse transcription PCR for monitoring the amounts of CSVd indicated that CSVd equally accumulated in both non-transgenic and transgenic plants. The present results suggest that the resistant feature of the transgenic plants to CSVd was due ...

Objective: Previous studies have suggested that the use of an ankle–foot orthosis may cause disuse atrophy of the tibialis anterior muscle. The objective of this study was to explore gait and muscle activity changes in patients in the recovery phase of stroke with 2-month use of an ankle–foot orthosis that provided plantarflexion resistance. Methods: The participants were 19 patients in the recovery phase of stroke who were prescribed an ankle–foot orthosis that provided plantarflexion resistance. We measured ankle and shank tilt angles as well as electromyography activity of the tibialis anterior and the soleus during 10-m walk tests. Measurements were taken on three occasions. The first was 2 weeks after delivery of the orthosis, 1 and 2 months after the initial measurement, and the third 2 months later. Changes in gait parameters were analyzed between the first and second measurements and between the second and third measurements. Results: Between the second and third measurements, significant increases were observed in plantarflexion and shank forward tilt angles and the activity ratio of the tibialis anterior during loading response compared with other phases. Conclusions: Plantarflexion movement induced by an ankle–foot orthosis with plantarflexion resistance could increase the activity ratio of the tibialis anterior during loading response.

The effect of plantar flexion resistance of ankle-foot orthoses on the ankle and knee joints is well known, but its effect on the hip joint and upper body movement during the gait of stroke patients remains unclear.To compare the effect of an ankle-foot orthosis with plantar flexion stop and an ankle-foot orthosis with plantar flexion resistance on the gait of stroke patients in the subacute phase.Randomized controlled trial.A total of 42 stroke patients (mean age = 59.9 ± 10.9 years, 36 men and 4 women) in the subacute phase were randomized to each ankle-foot orthosis group in a parallel controlled trial with no blinding. Patients received gait training from physiotherapists using the specified ankle-foot orthosis for 2 weeks. Shod gait without an ankle-foot orthosis before training and gait with an ankle-foot orthosis after training were measured by three-dimensional motion analysis.A total of 20 patients were analyzed in each group. Significant differences were found in pelvic and thoracic tilt angles between the two groups. Compared with the gait without an ankle-foot orthosis, the pelvis showed forward tilt when patients walked with an ankle-foot orthosis with plantar flexion stop, and the thorax showed decreased forward tilt when the patients walked with an ankle-foot orthosis with plantar flexion resistance.The difference in ankle-foot orthosis function in sagittal plantar flexion resistance affected the alignment of the upper body and the pelvis during the gait of stroke patients in the subacute phase. Clinical relevance Maintaining upright posture is important in gait rehabilitation. The findings of this study suggest that the ankle-foot orthosis with plantar flexion resistance facilitated better alignment of the upper body and pelvis during the gait of stroke patients in subacute phase. This type of ankle-foot orthosis could be beneficial for patients with malalignment of the upper body and pelvis.

Background: Although the kinematic coupling of calcaneus and shank is important for optimizing the pathological movement of the lower extremity, it is not sufficiently clarified. The objective of this study was to represent the kinematic coupling behavior of calcaneal pronation/supination and shank rotation quantitatively while standing and to identify the extent of the individual, age, gender and laterality differences in these measurements. Methods: This study was a cross-sectional study that subjects were 25 healthy young people (17 men and eight women) and 29 healthy elderly people (15 men and 14 women). Kinematic coupling behavior was quantified as the linear regression coefficient (kinetic chain ratio: KCR) of the angle of shank rotation against the angle of calcaneal pronation-to-supination measured using a 3D motion analysis system during pronation and supination of both feet while standing. Individual differences in the KCR, which is an outcome, were also investigated with regard to differences in age, gender, and laterality. Results: The mean KCR in all subjects was 1.00 ± 0.23. In addition, the coefficient of variation (CV) was 22.9%, with individual results varying from a maximum of 1.6 to a minimum of 0.4. The KCR was also larger in men than in women (p

Few studies have examined the efficacy of trunk orthoses that support the upper trunk and a paretic limb in stroke patients. To improve stability and alignment of the trunk and pelvis in hemiparetic patients, we developed a newly designed trunk orthosis that provides resistive force through spring joints.This study aimed to determine the newly designed trunk orthosis's biomechanical effects during level walking.Before-after trials must be better.Measurements were taken for nine chronic-phase (2 years post-onset) stroke patients using a three-dimensional motion capture system and force plates under three experimental conditions: self-selected gait speed without the newly designed trunk orthosis, with the newly designed trunk orthosis, and after newly designed trunk orthosis removal. We analyzed and compared spatiotemporal and kinetic parameters of the paretic and non-paretic limbs and kinematic parameters of the trunk and bilateral limbs.Several pre-swing gait parameters (e.g. hip joint flexion moment and ankle joint plantar flexion angle) after newly designed trunk orthosis removal were significantly increased compared to those without newly designed trunk orthosis. Step length of the paretic limb tended to increase after newly designed trunk orthosis removal.The newly designed trunk orthosis effectively modified trunk alignment, but larger improvements in kinetic and kinematic parameters were observed in the bilateral limbs after newly designed trunk orthosis removal than with the newly designed trunk orthosis.Stroke patients improved only trunk malalignment while wearing the newly designed trunk orthosis. Gait after newly designed trunk orthosis removal was better than with the newly designed trunk orthosis. Positive changes after removal were mostly observed in pre-swing of the hemiparetic limb. The newly designed trunk orthosis might be effective for gait training in stroke patients.

This research examines the difficulties faced by children of recent migrants from mainland China to France in Paris schools, and explains the underlying factors. It is based on fieldwork in Paris schools from 2005 to 2013. Other long-established Chinese communities in France consist mainly of Indo-Chinese refugees of Chinese descent. Their children were born in France and have adjusted to French schools; in contrast, some children of new Chinese immigrants (mainly from Wenzhou) do not attend school regularly and often drop out. My findings show that formation of the folk theory of success that values school education — which explains school success among Indo-Chinese refugee children — is hampered by institutional constraints resulting from parents’ status as illegal immigrants, and unstable parent-child relationships due to the family’s immigration arrangements. This paper reveals the limitations of conventional explanations for Chinese immigrants’ school success and failure based on cultural values.

Junji Katsuhira,1,2 Sumiko Yamamoto,3 Nodoka Machida,4 Yuji Ohmura,5 Masako Fuchi,6 Mizuho Ohta,7 Setsuro Ibayashi,7 Arito Yozu,8 Ko Matsudaira2 1Department of Prosthetics and Orthotics and Assistive Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, 2Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, 3Graduate School of International University of Health and Welfare, Tokyo, 4International University of Health and Welfare, School of Health Sciences at Narita, Department of Physical Therapy, Chiba, 5International University of Health and Welfare, School of Health Sciences at Odawara, Department of Physical Therapy, Kanagawa, 6Department of Occupational Therapy, Kyusyu Nutrition Welfare University, Fukuoka, 7Seiai Rehabilitation Hospital, Fukuoka, 8Center for Medical Sciences, Ibaraki Prefectural University of Health Science, Ibaraki, Japan Purpose: The synergistic effects of a trunk orthosis and an ankle–foot orthosis (AFO) in stroke patients with a hemiplegic gait are unclear. We previously developed a trunk orthosis with joints providing resistive force (TORF) to modify malalignment of the trunk and pelvis and confirmed its positive effects in stroke patients during level walking without an AFO. The aim of the present study was to determine if this trunk orthosis and an AFO have synergistic effects during level walking in community-dwelling patients with chronic stroke. Methods: Twenty-eight community-dwelling stroke patients performed level walking at a self-selected speed with an AFO and again while wearing a TORF (TORF group) or a corset (control group). Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. Results: When compared with the control group, the TORF group showed significant increases in walking speed, number of steps on the paretic leg per minute, and peak ankle plantar flexion moment during the single stance phase. Conclusion: The TORF increased the ankle joint plantar flexion moment at the end of the single stance phase during level walking in stroke patients, leading to an increase in their gait speed because of the modified trunk and pelvis alignment. Keywords: biomechanics, orthosis, gait, stroke, joint moment, motion analysis

Purpose: Generally, stroke patients can walk and stand up fluidly but fulfill the sit-to-walk (STW) task with difficulty. The purpose of this study was to investigate the relationship between movement fluidity and motor strategy in the initial contact of the STW task. Method: Thirty stroke patients and ten healthy subjects performed the STW task from a sitting position, and their movement was measured by a motion analysis system. The differences in data between patients and healthy subjects were analyzed using the Mann-Whitney U test. The relationship between fluidity index (FI) and other indices (kinetic and kinematic data in STW, functional independence measure [FIM], and Fugl-Meyer Assessment [FMA]) were analyzed using Spearman's rank correlation coefficient. Results: The stroke patients had lower FI values than the healthy subjects and exhibited shortened step length and prolonged duration from onset to the first stance leg off. FI values correlated with trunk flexure angle at initial contact, first step length, and maximum vertical floor reaction force. The independent level of the FIM of stair climbing and walking ability and the FMA of balance also correlated with FI. Conclusion: There is a possibility that poor balance is one of the reasons why stroke patients are unable to start walking fluently from the sitting position. To perform the STW fluidly, patients must start walking before the trunk extension is fully completed. The relationship between FI and indices of physical ability, namely stair climbing and balance, may have therapeutic benefits for coaching the STW task to stroke patients.

[Purpose] This study sought to ascertain whether, in hemiplegic patients, the effect of a wheelchair cushion to suppress pelvic posterior tilt when initiating wheelchair propulsion would continue in subsequent propulsions. [Subjects] Eighteen hemiplegic patients who were able to propel a wheelchair in a seated position participated in this study. [Methods] An adjustable wheelchair was fitted with a cushion that had an anchoring function, and a thigh pad on the propulsion side was removed. Propulsion movements from the seated position without moving through three propulsion cycles were measured using a three-dimensional motion analysis system, and electromyography was used to determine the angle of pelvic posterior tilt, muscle activity of the biceps femoris long head, and propulsion speed. [Results] Pelvic posterior tilt could be suppressed through the three propulsion cycles, which served to increase propulsion speed. Muscle activity of the biceps femoris long head was highest when initiating propulsion and decreased thereafter. [Conclusion] The effect of the wheelchair cushion on suppressing pelvic posterior tilt continued through three propulsion cycles.