there are many ways of improving the gait for hemiplegic patients , including ankle - foot 
 orthoses ( afos)1 , 2 , functional electric stimulation ( fes)3 , electromyography ( emg ) biofeedback4 , and robotic devices5 . however , few studies of hemiplegic gait have examined the use of 
 assistive devices such as an arm sling . a single - strap hemi - sling was used in several 
 studies which investigated the gait patterns6 , balance7 , and 
 energy consumption8 of stroke patients . 
 nevertheless , wearing a hemi - sling for long periods can cause inappropriate movement 
 patterns in the upper trunk . also , faghri et al.9 suggested that a hemi - sling impedes functional activities and 
 intensifies flexor synergy in the upper trunk . there is a need for a new assistive device for improving the alignment of the upper body 
 while simultaneously improves gait pattern by increasing stability on the affected side . additionally , such a device could be used to help reshape the elbow and wrist on the 
 affected side , and to support the weight of the affected arm itself . thus , we designed a new 
 arm sling with an elastic bandage , which we hearafter refer to as  the elastic arm sling  , 
 and investigated the effects of wearing the elastic arm sling on the gait patterns of 
 chronic stroke patients . this study investigated how the gait patterns of stroke patients were changed by wearing 
 the elastic arm sling . the participants were 13 patients ( 9 males , 4 females ) who had been 
 diagnosed as having had a cerebrovascular accident . the study was explained to the subjects , and their written 
 informed consent was obtained before the study was initiated . the selection criteria were 
 diagnosis of stroke due to intracranial haemorrhage ( ich ) or infarction , more than 6 months 
 post stroke , functional ambulatory category ( fac ) score > 3 , and ability to follow simple 
 instructions . subjects were excluded if they had medical problems other than a neurological 
 lesion that affected their gait patterns , or bilaterally affected limbs . the general 
 characteristics of the subjects are shown in table 
 1table 1.characteristics of the hemiplegic subjectssubjectsgenderage ( years)paretic sidedx.height ( cm)weight ( kg)since onset ( months)1m65lt.infarction167.163.4532m64lt.ich173.560.8243m59rt.ich169.263.3224m52rt.ich175.878.0605m49rt.ich175.078.3606m81rt.infarction170.962.8367m66rt.infarction165.449.1388m48rt.cva155.357.4369m78rt.infarction159.664.74110f74rt.infarction141.552.012011f48rt.sah150.055.92412f55lt.ich158.256.33413f64lt.infarction162.759.740dx , diagnosis ; f , female ; ich , intracranial cerebral hemorrhage ; lt , left ; ethical approval was obtained from the inje university faculty of health 
 science human ethics committee , and all subjects signed an informed consent form prior to 
 their participation . dx , diagnosis ; f , female ; ich , intracranial cerebral hemorrhage ; lt , left ;  m , male ; 
 rt , right ; sah , subarachnoid hemorrhage data was collected using a gaitrite system ( cir systems , easton , pa , usa ) , which can 
 analyze temporal and spatial parameters of gait . the elastic arm sling consisted of four 
 plastic rings made of thin , flexible polyethylene and three pieces of a green elastic 
 bandage produced by thera - band ( akron , ohio , usa ) , which were lapped over each 
 shoulder and the affected arm . patil and rao10 suggested that the green thera - band elastic bandage 
 provides a moderate amount of resistance . the crossover of the figure - of - eight elastic 
 bandage with a ring should be centred over the spine and between the scapulae . the wrist 
 should be at about 30 extension , the elbow should be at 2030 of flexion or less , the 
 elbow strap should be approximately 2  cm distal to the olecranon process , and the shoulder 
 should be in external rotation ( fig . when the participants performed the 
 walking test in bare feet on the gaitrite mat , their walking performance was displayed . the 
 patients were asked to walk at a comfortable speed and were provided with assistance when 
 required . each trial was performed twice by each patient , with a 5-min rest between tests . we analyzed the immediate effects of walking while wearing the elastic arm sling using the 
 paired t - test . we used spss software ( ver . 19.0 for windows , spss , chicago , il , usa ) . the effect of wearing the elastic arm sling on cadence was marginal ( p = 0.05 ) , however , 
 wearing the sling was associated with a significant improvement in velocity ( p = 0.008 ) . furthermore , patients who used the elastic arm sling showed increases in the step lengths of 
 the affected ( p = 0.016 ) and unaffected ( p = 0.027 ) limbs . there were also significant 
 differences in the stride lengths of the affected ( p = 0.005 ) and unaffected ( p = 0.018 ) 
 sides between with and without the use of the elastic arm sling ( table 2table 2.differences of gait parameters with and without the elastic arm sling in stroke 
 patientsgait parameterswithout easwith eascadence ( steps / min)58.4  23.964.4  27.0velocity ( cm / sec)25.2  19.730.1  21.0**affected step length ( cm)25.4  12.127.5  11.6*unaffected step length ( cm)23.5  12.025.7  11.2*affected stride length ( cm)49.3  22.754.0  22.0**unaffected stride length ( cm)49.3  23.053.5  21.8*values are means  sd ; * , p<0.05 ; * * , p<0.01 , eas , elastic arm sling ) . values are means  sd ; * , p<0.05 ; * * , p<0.01 , eas , elastic arm sling we developed the elastic arm sling which consists of three pieces of elastic bandage and 
 four plastic rings . it might provide scapular and shoulder stability and improve alignment 
 of the arm through the tension of the elastic bandage . also , the four plastic rings might 
 contribute to the improvement of the arm position of the affected arm . this might provide 
 shoulder stability without restricting arm motion , and increase body awareness through the 
 establishment of elastic tension in the scapulae , shoulder , elbow , and wrist joints . we 
 hypothesised that the elastic arm sling might help to improve the gait patterns and dynamic 
 stability of stroke patients during walking . this study found no definitive evidence of a change in cadence ( p = 0.05 ) during walking 
 while wearing the elastic arm sling , but mean cadence values with and without the elastic 
 arm sling were quite different . walking velocity significantly increased in patients who 
 were wearing the elastic sling ( p = 0.008 ) . in stroke patients , impaired arm swing could be 
 one of the factors that limit the walking speed11 . some authors have asserted that the unaffected arm could 
 compensate through greater swing when the affected arm moves passively while walking12 . other researchers have reported that 
 walking velocity increases during the transition from passive to active arm swing suggesting 
 that walking speed is related to the recruitment of arm movement13 . thus , we inferred that gait velocity would be related to 
 the improvement of the recruitment of arm movement with the elastic arm sling . we inferred that the elastic arm sling might facilitate some muscles that support the 
 scapulae and upper trunk , which would also simultaneously facilitate the oblique muscles , 
 which are related to lower trunk stability14 . in addition , some authors have indicated that an arm sling assists 
 the affected side , by establishing a proper alignment of the glenohumeral joint of the 
 paretic arm15 . however , these 
 propositions need to be verified by further research . for the present study , we hypothesized 
 that the elastic arm sling might enhance stability through a feedback mechanism , providing 
 support for the paretic side and encouraging better positioning of the paretic arm . the step 
 and stride lengths of the affected and unaffected sides both significantly increased during 
 walking with the elastic arm sling . spasticity in stroke patients leads to adduction of the 
 shoulder , and flexion of the elbow , wrist , and fingers6 , implying that paretic arm swing might not be proper . in hemiplegic 
 patients , paretic arm swing amplitude usually reduces and arm swing of the unaffected side 
 gets larger16 , which means increased 
 asymmetry of arm swing . in other words , the elastic arm sling might decrease asymmetric arm 
 swing , resulting in decreased lateral leaning , leading to improved gait stability and step 
 and stride lengths increases . maki17 
 reported that changes in gait , such as in walking velocity and stride length , were related 
 to individuals fear of falling . thus , stride - to - stride variability may predict falling and 
 may be a useful measurement of an individual s fall risk17 . we suggest that the elastic arm sling should be adopted in gait 
 training instead of a hemi - sling because it increases step and stride lengths on both sides , 
 which may decrease the fear of falling of stroke patients . the elastic arm sling was only worn by patients 
 during walking for a short period . the assumption that some muscles in the upper extremity 
 were facilitated by the arm sling needs verifying because we did nt measure muscle 
 activities while walking with the elastic arm sling . we focused on the gait patterns of 
 stroke patients wearing the elastic arm sling because we wanted to establish its effect on 
 gait patterns in order to recommend its clinical use . in future studies , the gait patterns 
 and emg activities of the elastic arm sling should be researched and compared with those of 
 several kinds of arm slings used by patients with stroke .
[ purpose ] we developed a new arm sling with an elastic bandage which we hearafter refer 
 to as  the elastic arm sling  . 
 this study investigated the immediate effects of the 
 elastic arm sling on the gait patterns of stroke patients . 
 [ subjects and methods ] thirteen 
 stroke patients were enrolled in this study after providing their informed consent . 
 they 
 walked on a gaitrite mat twice , with a 5-min rest between the trials . 
 [ results ] 
 significant improvements were seen in cadence and walking velocity during walking while 
 wearing the elastic arm sling . 
 furthermore , patients who used the elastic arm sling showed 
 significant increases in step lengths of the affected and unaffected limbs . 
 the stride 
 lengths of the affected and unaffected sides while wearing the elastic arm sling and those 
 without the elastic arm sling also significantly differed . 
 [ conclusion ] these results 
 demonstrate that the elastic arm sling is a useful tool for the gait training of stroke 
 patients , especially cadence , walking velocity , and the step and stride lengths of both 
 limbs . 
 therefore , therapists should use the elastic arm sling as a gait - training assistive 
 device for stroke patients .