RU222346U1 - Device for restoring walking function in patients with central hemiparesis - Google Patents

Abstract

The utility model relates to medicine, neurology and neurorehabilitation, and can be used to restore walking function in central hemiparesis of post-stroke origin. The device can be used by neurologists, physical therapists, physical therapists, exercise therapy instructors at the stage of inpatient and outpatient rehabilitation after acute cerebrovascular accident in patients with central hemiparesis, whose main gait defect is impaired extension of the paretic lower limb. The technical result from the use of the utility model is to improve walking function by increasing the length of the anterior half-step of a paretic limb, restoring the symmetry of the step, increasing walking speed, and reducing the risk of falling. The technical result is achieved through the use of rehabilitation shoes with a shifted center of gravity. A device for restoring walking function in case of central hemiparesis is made in the form of a boot, containing a sock, a vamp, a boot, a heel made of thickened leather, and an insole. The inner area of the toe of the boot is made in the shape of a semicircle and for a paretic lower limb it is filled with a load, and for an intact limb the boot does not have a load. The parts are connected to each other by stitching and gluing with shoe glue. Shoes for intact and paretic limbs are the same in design, insole size and size of the shoe itself and differ only in the presence or absence of a load.

Description

The utility model relates to medicine, neurology and neurorehabilitation, and can be used to restore walking function in central hemiparesis of post-stroke origin.

The device can be used by neurologists, physical therapists, physical therapists, exercise therapy instructors at the stage of inpatient and outpatient rehabilitation after acute cerebrovascular accident in patients with central hemiparesis whose main gait defect is impaired extension of the paretic lower limb.

In case of central hemiparesis syndrome after a stroke, various pathological gait stereotypes can be formed in the process of restoring motor function. Each of them is caused by the presence of a certain central defect in the biomechanics of the step, due to which the function of walking and balance in general is impaired.

One of these pathological gait stereotypes is walking with an “extra step”, which is formed due to a violation of the forward movement of the paretic leg. This defect is caused by the presence of asymmetrically reduced muscle strength in various muscle groups of the lower limb. As a result, the anterior half-step of the paretic limb is shortened at the end of the swing period, asymmetrical walking is formed, walking speed decreases, and the risk of falling increases.

A device and methods for the treatment of neurological disorders are known from the prior art (RF Patent No. 2630613, published on September 11, 2017, application number No. 2014125155), which is an orthosis with an anterior and posterior bulbous protrusion in the sole area. Calibrating the height, position, weight and other parameters of these protrusions allows you to give different positions to the foot while walking. With a certain calibration of the protrusions, an increase in step length was noted after training using this device.

The disadvantage of the known device is that the step length increases due to changes in the support of various points of the foot, and not due to an increase in the extension of the paretic leg forward.

A simulator for restoring walking after a stroke is known (RF Patent No. 216819, published 03/02/2023, application number No. 2022134407). The device consists of a belt adjustable in length with a buckle for fastening on the patient’s body, with a convex metal plate attached to the belt on the rear outer side. There is a connector on one edge of the plate and a carabiner on the other. A metal rod of adjustable length, horizontally located in the direction of movement of the patient, is attached to the connector at one end, and an elastic harness is attached to the other end of the rod, diagonally connecting the end of the rod to the front of the patient’s foot on the little toe side. Another elastic tourniquet is attached to a carabiner, runs along the outside of the patient's leg and is attached to the patient's foot. The technical result is the restoration of the patient's walking skills due to the forced force exerted by the device on the patient's lower limb and leading to the correct positioning of the foot when walking.

The disadvantage of this device is the bulkiness of the structure, the need to use fastening elements in the belt area and various components that will be subject to mechanical stress during walking training.

There is a known method for correcting walking with the transformation of a paretic leg into a leading one (RF Patent No. 2548514, published on April 20, 2015, application number No. 2014103235/14). The method involves fixing the patient's intact limb in a hip joint apparatus with a locking joint. In this case, the knee joint is fixed with fastenings so that bending in it is impossible. After fixation, the patient moves under the supervision of an instructor. The lesson lasts 10-15 minutes, during which time the patient walks 20-30 meters. Classes are held daily for two weeks; and the distance traveled is gradually increased to 50 meters. Thanks to rehabilitation using this method, the length of the front half-step of the paretic limb increases and the symmetry of the step is restored.

The disadvantage of this method is the need to use a complex, massive structure to immobilize a healthy limb, as a result of which for a number of patients with severe impairment of the motor function of a paretic limb, this method is not available, and also that the use of this device is time-consuming and cannot be used by the patient himself without additional assistance from a doctor or exercise therapy instructor.

The closest analogue is a device from the foreign state of the art Gait-altering shoes (Patent US 9,295,302 B1, Int.CI. A43B 7/14 (2006.01). Gait-altering shoes: No. 13/769,632: appl. 02.17.2012: publ. 29.03. 2016 / Reed K. B., Handzic I.; University of South Florida.) This device is a frame equipped with four specially shaped wheels that is attached to the boot of the patient’s healthy leg using belts. The device also includes shock absorbers attached to the wheels. Thanks to this design, while supporting the intact limb, the weight of the leg causes the wheels to rotate backward, thereby the intact limb, after contact with the support, moves back a certain distance. During the transfer of the intact limb, the wheels return to their original position due to shock absorbers. Walking training using this device allows you to restore the symmetry of the step between the paretic and healthy limb.

The disadvantage of this device is that the impact during training is carried out on a healthy limb, and the effect is achieved as a result of the fact that the patient has to voluntarily adjust the step of the paretic limb, forming the correct walking stereotype during training. In addition, the design for a healthy limb increases its height from the floor, creating a functional asymmetry in the length of the left and right limbs and to some extent reduces the support function of the intact limb, which may complicate its use in patients with more severe impairment of motor function.

The purpose of the utility model is to restore walking function in patients with central hemiparesis after suffering an acute cerebrovascular accident.

The technical result from the use of the utility model is to improve walking function by increasing the length of the anterior half-step of a paretic limb, restoring the symmetry of the step, increasing walking speed, and reducing the risk of falling.

The technical result is achieved through the use of rehabilitation shoes with a shifted center of gravity.

The effect is achieved by shifting the center of gravity forward by placing the load in front of the foot. As a result of this, during the transfer period, a traction force is created, which increases the step length of the paretic leg, and during the support period, due to the mass of the load, additional support is created on the paretic limb and stability increases.

Advantages of this model over well-known technical solutions:

1) Simplicity of design and materials used;

2) The ability of the patient to independently use the device without the assistance of specially trained medical personnel and caregivers;

3) The possibility of individual selection of the intensity of exposure by changing the weight of the load depending on the gender, age, height and body weight of the patient;

4) Possibility of changing the side of influence by moving the load to the left or right shoe.

The utility model is a shoe with a shifted center of gravity, made in the form of low shoes.

The appearance and components of the device are shown in the pictures. Fig. 1 - General view of the device from the front, Fig. 2 - general side view, Fig. 3 - front sectional view, FIG. 4 - side sectional view.

The device can be made in the form of a pair of high boots. The components of the shoe (toe (1), vamp (2), ankle boots (3), shaft (4), heel (5) (figure 1,2)) can be made of compacted leather, creating a rigid corset that fixes the ankle joint. This form can be used to prevent ankle hypermobility and weight-induced foot drop in patients with severe dorsiflexion paresis. Shoes can be made with lacing (6) (figure 1,2). In the toe of the boot for a paretic lower limb there is a metal weight (7) (figure 3.4). Lead was used to make the cargo because... has the greatest mass with the smallest size. The shape of the load is made in the form of a semicircle, filling the entire inner area of the toe of the low shoe, which also has a corresponding semicircle shape. The weight and, accordingly, the size of the load for a particular patient is selected individually depending on the weight, height and severity of paresis and varies from 300 to 1000 grams (Table 1).

Table 1. Selection of load weight Height (cm) Weight, kg) Severity of paresis Less than 160 300g Less than 50 300g Rough (1b) 300g 160-169 500g 50-69 500g Expressed (2b) 500g 170-180 800g 70-90 800g Moderate (3b) 800g More than 180 1000g More than 90 1000g Light (4b) 1000g

Each indicator of weight growth and severity of paresis corresponds to a certain weight of the load: 300, 500, 800 or 1000 grams, as shown in table. 1. To calculate the weight of the load required for this particular patient, you need to calculate the arithmetic mean between the three masses and round towards the nearest one.

So, for example, for a patient 159 cm tall, weighing 89 kg with moderate paresis, the weight of the load will be 500 g, and for a patient 182 cm tall, weighing 70 kg with mild paresis, 1000 g, etc.

The weight inside the sock does not have special fastening elements and is not glued together, but is tightly fixed due to the fit of the surrounding elements of the shoe. The load is separated from the insole (8) (figure 3,4) and the patient’s toes using a special insert, which is a continuation of the insole, occupying the height and width of the entire inner part in the area of the vamp of the shoe (9) (figure 3,4). The boot for the intact lower limb has no weight. The insole in the boot for an intact limb is also made with an insert that continues anteriorly. The insoles in shoes for both limbs are tightly fixed by adjacent elements of the shoe.

In the area of the toe of the boot for the intact limb there is an empty space (10) (figure 3,4). This structure allows you to move the load into the boot for the left or right limb, depending on the side of the paresis. To do this, you need to remove the insole and insert the weight into the toe of the boot until it stops, then insert the insole, the load is fixed on one side by the toe of the boot, on the other side by inserting the insole and does not move when walking.

The size of the insole is selected according to the patient’s foot size. The size of the boot is selected individually depending on the size of the load required for a particular patient to provide sufficient training impact to ensure effective movement of the paretic leg forward, and can be 4-10 sizes larger than the patient’s usual shoe size. With a load weight of 300 grams, the shoe size will be 4 sizes larger than the patient’s usual shoe size, with a load weight of 500 grams by 6 sizes, with a load weight of 800 grams by 8 sizes, and with a load weight of 1000 grams by 10 sizes.

Shoes for intact and paretic limbs are the same in design, insole size and size of the boot itself and differ only in the presence or absence of a load. This structure is used to eliminate differences in the height and shape of shoes between the left and right limbs, in order to prevent these differences from influencing the biomechanical parameters of the patient’s gait.

The outer part of the boot can be made of genuine leather. The insole can be made of shoe leather, the insole insert separating it from the load can be made of shoe granite, the sole of the shoe can be made of ethylene vinyl acetate. The parts are connected to each other by stitching and gluing with shoe glue.

Mode of application:

The device can be used for gait training as part of a motor rehabilitation program. Walking training sessions using this device can be carried out in parallel with exercise therapy, robotic mechanotherapy, kinesiotherapy, physiotherapy, and massage. Classes are conducted according to the following scheme: once a day, 5 days a week for at least 10 days, lasting 20-40 minutes, depending on the patient’s tolerance to physical activity. Classes involve walking on a flat surface with or without additional means of support, depending on the degree of impairment of the patient’s walking function. It is also possible to use the device while walking on a treadmill.

To evaluate the effectiveness of restoring walking function using a device for correcting the biomechanics of walking in case of central hemiparesis, clinical testing was carried out on the basis of the Department of Nervous Diseases with a course of medical rehabilitation of the Federal State Budgetary Educational Institution of Higher Education Krasnoyarsk State Medical University named after. prof. V.F. Voino-Yasenetsky Ministry of Health of Russia.

The study involved 12 patients with post-stroke hemiparesis.

Recruitment of patients was carried out on the basis of the neurorehabilitation center of the Federal State Budgetary Institution FSNKTs FMBA of Russia.

Criteria for inclusion in the study:

Early, late recovery periods and the period of residual effects of ischemic and hemorrhagic stroke, confirmed by neuroimaging data (CT/MRI);

Middle and old age (45-75 years);

Central hemiparesis syndrome;

Signed voluntary informed consent.

Exclusion criteria from the study:

Severe neurological deficit, in which the patient is unable to walk independently, including with the use of assistive devices (Rivermead Mobility Index less than 7b);

Severe cognitive impairment

Severe speech disorders (aphasia, dysarthria);

The presence of somatic pathology in the stage of decompensation, which is a contraindication to rehabilitation;

The presence of pathologies of the organs of hearing and vision that interfere with the conduct of classes;

The presence of epileptic seizures or epileptiform activity according to the electroencephalogram;

The presence of clinically significant anxiety and depression, the presence of behavioral disorders.

Walking function was assessed using the impregnation method. To do this, markers with paint are attached to the sole of the patient's regular shoes, and the patient walks a distance of 10 meters at a free pace. The following indicators of gait biomechanics are assessed: the length of the paretic and intact step, the length of the paretic and intact anterior half-step, walking speed and asymmetry between the anterior half-step of the paretic and intact limb, and the risk of falling is assessed using the Dynamic Gait Index functional scale.

A comparison was made of the patient's walking function in regular shoes before and after 10 sessions according to the following scheme: once a day, 5 days a week for 10 days, lasting 20-40 minutes, depending on the patient's tolerance to physical activity.

Statistical analysis of the data was carried out using the Statistica 12.0 program. Nonparametric statistics methods were used. To describe the average quantitative indicators, the median and interquartile range (Me [P25; P75]) were used. The Wilcoxon test was used to assess the statistical significance of differences in walking performance before and after classes. Level of statistical significance p=0.05. (Table 2).

Table 2. Comparison of the patient's walking before and after rehabilitation using a device for restoring gait function for central hemiparesis Walking in regular shoes before class Walking in regular shoes after 10 sessions P(<0.05)
Wilcoxon test Me [P25;P75] Walking speed (m/s) 0.48 [0.4; 0.59] 0.63 [0.48; 0.67] 0.028 Paretic step length (cm) 75.23 [65.18; 96.22] 88.40 [72.66; 101.00] 0.028 Intact stride length (cm) 75.54 [64.50; 96.11] 87.8 [72.92; 101.00] 0.028 Length of the anterior half-step of the paretic leg (cm) 33.35 [28.26; 43.56] 44.00 [30.76; 55.38] 0.028 Front half-step length of intact leg (cm) 48.08 [38.20; 53.56] 49.29 [42.00; 54.62] 0.17 Half-step asymmetry (cm) 14.44 [9.94; 18.08] 6.00 [4.04; 11.24] 0.046 Dynamic Gait Index 8 [5; 14] 11 [9; 17] 0.01

As follows from the table presented, after 10 sessions using the device, patients had a statistically significant increase in walking speed, a decrease in step asymmetry, and as a result, a decrease in the risk of falling while walking.

Thus, gait training using the device can be recommended as a method of motor rehabilitation in patients with impaired extension of the paretic leg as a result of post-stroke hemiparesis.

Clinical example 1.

Patient U. 45 years old. Diagnosis: Ischemic (unspecified) stroke in the basin of the right MCA dated November 21, 2021 with left-sided hemiparesis, pronounced in the arm, moderate in the leg, left-sided hemihypesthesia, extrapyramidal dysarthria of mild severity. Late recovery period.

In neurological status:

VKF: Clear consciousness. She is oriented in the place of time and her own personality, she follows instructions correctly, and the background of her mood is even. Speech extrapyramidal dysarthria of mild severity.

CMN: II pair: visual fields are not impaired. III, IV, VI pairs: palpebral fissures D=S, pupils D=S the reaction of the pupils to light is preserved, the movement of the eyeballs is full. V pair: sensitivity on the face is preserved. VII pair: the face is symmetrical. IX, X, XII pairs: no bulbar disorders, swallowing is not difficult. The palatine and pharyngeal reflex are evoked. Position of the tongue in the midline.

Motor sphere: The range of active movements is limited in the left limbs due to paresis.

Muscle tone: in the left upper limb it is increased according to the pyramidal type to 1b - a slight increase, which can be overcome by the patient himself while maintaining active movements.

There is normotonus in the left lower limb.

Muscle strength: left-sided hemiparesis:

In the upper limb: shoulder flexors 3b, extensors 3b, forearm flexors 3b, extensors 2b, flexors of the hand and fingers 3b, extensors 1b.

In the lower limb: Hip flexors 3b, extensors 3b, shin flexors 2b, extensors 3b, dorsiflexion muscles of the foot 2b, plantar flexion 3b.

Reflex sphere: tendon reflexes from the arms S>D, from the legs S>D. Pathological reflexes: Rossolimo upper, Babinsky left.

Sensitive area:

Superficial sensitivity: left-sided hemihypesthesia - 2b (moderately upset).

Deep joint-muscular feeling is preserved.

Coordinator sphere: in the Romberg position: slight unsteadiness due to paresis. PNP, CAT with a defect on the left due to paresis, performs on the right without a defect.

Pelvic functions: controls.

There are no meningeal signs.

Anthropometry of the patient: Height 167 cm, weight 65 kg.

Upon admission to the patient's rehabilitation center, a study of walking function using the impregnation method was performed. After that, for 10 days, against the background of the main motor rehabilitation program, walking training was carried out using the device for 30 minutes a day. After completing 10 days of classes, walking function was re-assessed using the impregnation method (Table 3).

Table 3. Comparison of patient U.’s walking before and after rehabilitation using the device Walking in regular shoes before class Walking in regular shoes after 10 sessions Me Walking speed (m/s) 0.40 0.48 Paretic step length (cm) 75.23 76.12 Intact stride length (cm) 75.54 76.34 Length of the anterior half-step of the paretic leg (cm) 30.00 45.67 Front half-step length of intact leg (cm) 48.08 49.71 Half-step asymmetry (cm) 18.08 4.04 Dynamic Gait Index 8 10

As can be seen from the table presented, upon admission to the rehabilitation center, the patient had a significant asymmetry of the anterior half-step between the paretic and intact limb, due to a violation of the extension of the paretic leg.

To restore step symmetry, exercises using a device were used as a method of motor rehabilitation. The weight of the load located in front of the paretic foot in this patient was 500 grams. During the training, it was noted that when walking using this device at the end of the period of transfer of the paretic lower limb, due to the mass of the load, an additional traction force is created, increasing the extension of the paretic leg and thereby increasing the length of the front half-step. After 10 sessions, this effect was consolidated when walking in the patient’s usual shoes, as evidenced by the results of a repeated study of the walking function presented in Table 3. As a result, the patient’s walking became more symmetrical, her walking speed increased, and the risk of falling decreased.

Clinical example 2.

Patient M. 55 years old. Diagnosis: Ischemic (atherothrombotic) stroke in the left MCA basin dated November 10, 2022 with mild right-sided hemiparesis, complex motor aphasia of moderate severity. Early recovery period.

In neurological status:

VKF: Clear consciousness. He is oriented in the place of time and his own personality, he follows instructions correctly, the background of his mood is even. Speech complex motor aphasia of moderate severity.

CMN: II pair: visual fields are not impaired. III, IV, VI pairs: palpebral fissures D=S, pupils D=S the reaction of the pupils to light is preserved, the movement of the eyeballs is full. V pair: sensitivity on the face is preserved. VII pair: the face is symmetrical. IX, X, XII pairs: no bulbar disorders, swallowing is not difficult. The palatine and pharyngeal reflex are evoked. Position of the tongue in the midline.

Motor sphere: The range of active movements is full.

Muscle tone: increased pyramidal type in the right limbs to 2b - moderate increase, muscle resistance is not difficult to overcome.

Muscle strength: right hemiparesis:

In the upper limb: shoulder flexors 4b, extensors 4b, forearm flexors 4b, extensors 3b, flexors of the hand and fingers 4b, extensors 3b.

In the lower limb: hip flexors 4b, extensors 4b, shin flexors 3b, extensors 4b, dorsiflexion muscles of the foot 3b, plantar flexion 4b.

Reflex sphere: tendon reflexes from the arms D>S, from the legs D>S. Pathological reflexes: not identified.

Sensitive area:

Superficial sensitivity is not impaired.

Deep joint-muscular feeling is preserved.

Coordinator sphere: in Romberg position: stable. PNP, CAT with a defect on the right due to paresis, performs on the left without a defect.

Pelvic functions: controls.

There are no meningeal signs.

Anthropometry of the patient: Height 182 cm, weight 89 kg.

Just as in the previous clinical case, before the start of classes, a study of walking function using the impregnation method was carried out. After that, for 10 days, against the background of the main motor rehabilitation program, walking training was carried out using the device for 40 minutes a day. The weight of the load located in front of the paretic foot in this patient was 1000 grams. After completing 10 days of training, walking function was re-assessed using the impregnation method (Table 4).

Table 4. Comparison of patient M.’s walking before and after rehabilitation using the device Walking in regular shoes before class Walking in regular shoes after 10 sessions Me Walking speed (m/s) 0.48 0.60 Paretic step length (cm) 96.22 110.31 Intact stride length (cm) 96.11 110.46 Length of the anterior half-step of the paretic leg (cm) 43.56 55.38 Front half-step length of intact leg (cm) 53.56 54.62 Half-step asymmetry (cm) 10.00 0.77 Dynamic Gait Index eleven 13

As can be seen from the table presented, in this clinical case, the patient also increased the forward movement of the paretic leg, the symmetry of the anterior half-step between the paretic and intact limb was restored, due to which the walking speed increased and the risk of falling decreased.

Clinical example 3.

Patient F., 61 years old. Diagnosis: Ischemic (cardioembolic) stroke in the basin of the right MCA dated 05/01/2022 with left-sided hemiparesis, pronounced in the arm, moderate in the leg, left-sided hemihypesthesia, extrapyramidal dysarthria of moderate severity. Late recovery period.

In neurological status:

VKF: Clear consciousness. He is oriented in the place of time and his own personality, he follows instructions correctly, the background of his mood is even. Speech extrapyramidal dysarthria of moderate severity.

CMN: II pair: visual fields are not impaired. III, IV, VI pairs: palpebral fissures D=S, pupils D=S the reaction of the pupils to light is preserved, the movement of the eyeballs is full. V pair: sensitivity on the face is preserved. VII pair: the face is symmetrical. IX, X, XII pairs: no bulbar disorders, swallowing is not difficult. The palatine and pharyngeal reflex are evoked. Position of the tongue in the midline.

Motor sphere: The range of active movements is limited in the left limbs.

Muscle tone: increased pyramidal type in the left limbs, in arm 3b there is a pronounced increase, muscle resistance is difficult to overcome. In leg 1b there is a slight increase, which can be overcome by the patient himself while maintaining active movements.

Muscle strength: left-sided hemiparesis:

In the upper limb: proximally 2b, distally 1b.

In the lower limb: hip flexors 3b, extensors 3b, shin flexors 2b, extensors 4b, dorsiflexion muscles of the foot 2b, plantar flexion 3b.

Reflex sphere: tendon reflexes from the arms S>D, from the legs S>D. Pathological reflexes: Rossolimo upper left, Babinsky left.

Sensitive area:

Superficial sensitivity hemihypesthesia in the left limbs 2b (moderately upset).

Deep joint-muscular feeling: reduced in the left limbs to 2b - recognizes movements not always accurately in small joints.

Coordinator sphere: in the Romberg position: slight unsteadiness due to paresis. PNP does not perform on the left due to paresis, PT with a defect on the left due to paresis.

Pelvic functions: controls.

There are no meningeal signs.

Anthropometry of the patient: Height 171 cm, weight 73 kg.

The mass of the load located in front of the paretic foot in this patient was 800 grams.

10 sessions were conducted using the device for 30 minutes a day (Table 5).

Table 5. Comparison of patient F.’s walking before and after rehabilitation using the device Walking in regular shoes before class Walking in regular shoes after 10 sessions Me Walking speed (m/s) 0.59 0.67 Paretic step length (cm) 84.45 88.45 Intact stride length (cm) 84.70 87.80 Length of the anterior half-step of the paretic leg (cm) 35.27 40.58 Front half-step length of intact leg (cm) 49.80 47.22 Half-step asymmetry (cm) 14.53 6.69 Dynamic Gait Index 7 10

As can be seen from the table presented, this patient also had an increase in the length of the front half-step of the paretic limb, a decrease in walking asymmetry, an increase in walking speed, and a decrease in the risk of falling.

Clinical example 4.

Patient K., 67 years old. Diagnosis: Ischemic (unspecified) stroke in the territory of the left MCA dated December 25, 2022 with severe right-sided hemiparesis, right-sided hemihypesthesia, mild extrapyramidal dysarthria. Early recovery period.

In neurological status:

VKF: Clear consciousness. She is oriented in the place of time and her own personality, she follows instructions correctly, and the background of her mood is even. Speech extrapyramidal dysarthria of mild severity.

CMN: II pair: visual fields are not impaired. III, IV, VI pairs: palpebral fissures D=S, pupils D=S the reaction of the pupils to light is preserved, the movement of the eyeballs is full. V pair: sensitivity on the face is preserved. VII pair: smoothness of the right neuralgia. IX, X, XII pairs: no bulbar disorders, swallowing is not difficult. The palatine and pharyngeal reflex are evoked. Position of the tongue in the midline.

Motor sphere: The range of active movements is limited in the right limbs.

Muscle tone: reduced in the right extremities.

Muscle strength: right hemiparesis:

In the upper limb: proximally 2b, distally 1b.

In the lower limb: hip flexors 3b, extensors 2b, shin flexors 1b, extensors 3b, dorsiflexion muscles of the foot 1b, plantar flexion 2b.

Reflex sphere: tendon reflexes from the arms D<S, from the legs D<S. Pathological reflexes: not identified.

Sensitive area:

Superficial sensitivity - hemihypesthesia in the right extremities 3b (considerably upset, a prick is perceived as a touch).

Deep joint-muscular feeling: reduced in the right extremities to 2b - recognizes movements not always accurately in small joints.

Coordinator sphere: in the Romberg position: unsteadiness due to paresis. PNP does not perform on the left due to paresis, CPP does not perform on the left due to paresis.

Pelvic functions: controls.

There are no meningeal signs.

Anthropometry of the patient: Height 155 cm, weight 49 kg.

Classes were conducted using the device for 10 days, 20 minutes a day. The weight of the load located in front of the paretic foot in this patient was 300 grams (Table 6).

Table 6. Comparison of patient K.’s walking before and after rehabilitation using the device Walking in regular shoes before class Walking in regular shoes after 10 sessions Me Walking speed (m/s) 0.20 0.33 Paretic step length (cm) 46.40 58.70 Intact stride length (cm) 46.53 59.50 Length of the anterior half-step of the paretic leg (cm) 16.56 27.00 Front half-step length of intact leg (cm) 31.00 33.00 Half-step asymmetry (cm) 14.44 6.00 Dynamic Gait Index 6 9

As can be seen from the table presented, as in previous cases, the patient’s extension of the paretic lower limb increased, steps became more symmetrical, walking speed increased, and the risk of falling decreased.

Claims (2)

1. A device for restoring walking function in case of central hemiparesis, made in the form of a low shoe, containing a low shoe toe, vamp, ankle boots, boot, leather heel, insole, which are connected to each other by stitching and gluing with shoe glue; wherein the inner area of the toe of the low shoe is made in the shape of a semicircle and is completely filled with a weight made of metal, the shape of which is made in the form of a semicircle, while the load is separated from the insole fixed by adjacent elements using an insert that is a continuation of the insole and occupies in height and width the entire inner part in the area vamps. 2. The device according to claim 1, characterized in that the weight of the load is from 300 to 1000 grams.