Compensating the Symptomatic Increase in Plantarflexion Torque and Mechanical Work for Dorsiflexion in Patients with Spastic Paresis Using the “Hermes” Ankle–Foot Orthosis

Abstract

Background/Objectives: “Hermes” is an ankle–foot orthosis (AFO) with negative stiffness designed to mechanically compensate the symptomatic increase in plantarflexion (PF) torque (i.e., ankle joint torque resistance to dorsiflexion, DF) in patients with spastic paresis. Methods: The effectiveness of “Hermes” was evaluated in twelve patients with chronic unilateral spastic paresis after stroke. Using a robotic ankle manipulator, stiffness at the ankle joint was assessed across three conditions: ankle without Hermes ((Formula presented.)), ankle with Hermes applying no torque compensation ((Formula presented.)), and ankle with Hermes tuned to compensate 100% of the patients’ ankle joint stiffness ((Formula presented.)). Results: A significant reduction in PF torque was found with Hermes applying compensation ((Formula presented.)) compared to the conditions without Hermes ((Formula presented.)) and with Hermes applying no compensation ((Formula presented.)). Furthermore, a significant reduction in positive dorsiflexion work was found with Hermes applying compensation ((Formula presented.)) compared to the condition with Hermes applying no compensation ((Formula presented.)). Hermes did not significantly contribute to additional PF torque or positive work when applying no compensation ((Formula presented.)). Conclusions: The reductions in PF torque achieved with Hermes are comparable to those seen with repeated ankle stretching programs and ankle robot training. Thus, Hermes is expected to assist voluntary dorsiflexion and improve walking in patients with spastic paresis.