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Vistamehr A, Neptune RR, Conroy CL, Freeborn PA, Brunetti GM, Fox EJ. Articulated ankle-foot-orthosis improves inter-limb propulsion symmetry during walking adaptability task post-stroke. Clin Biomech (Bristol, Avon) 2024; 116:106268. [PMID: 38795609 DOI: 10.1016/j.clinbiomech.2024.106268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Community ambulation involves complex walking adaptability tasks such as stepping over obstacles or taking long steps, which require adequate propulsion generation by the trailing leg. Individuals post-stroke often have an increased reliance on their trailing nonparetic leg and favor leading with their paretic leg, which can limit mobility. Ankle-foot-orthoses are prescribed to address common deficits post-stroke such as foot drop and ankle instability. However, it is not clear if walking with an ankle-foot-orthosis improves inter-limb propulsion symmetry during adaptability tasks. This study sought to examine this hypothesis. METHODS Individuals post-stroke (n = 9) that were previously prescribed a custom fabricated plantarflexion-stop articulated ankle-foot-orthosis participated. Participants performed steady-state walking and adaptability tasks overground with and without their orthosis. The adaptability tasks included obstacle crossing and long-step tasks, leading with both their paretic and nonparetic leg. Inter-limb propulsion symmetry was calculated using trailing limb ground-reaction-forces. FINDINGS During the obstacle crossing task, ankle-foot-orthosis use resulted in a significant improvement in inter-limb propulsion symmetry. The orthosis also improved ankle dorsiflexion during stance, reduced knee hyperextension, increased gastrocnemius muscle activity, and increased peak paretic leg ankle plantarflexor moment. In contrast, there were no differences in propulsion symmetry during steady-state walking and taking a long-step when using the orthosis. INTERPRETATION Plantarflexion-stop articulated ankle-foot-orthoses can improve propulsion symmetry during obstacle crossing tasks in individuals post-stroke, promoting paretic leg use and reduced reliance on the nonparetic leg.
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Affiliation(s)
- Arian Vistamehr
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA.
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Christy L Conroy
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Paul A Freeborn
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Gina M Brunetti
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Emily J Fox
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA; Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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Ohtsuka K, Mukaino M, Yamada J, Fumihiro M, Tanikawa H, Tsuchiyama K, Teranishi T, Saitoh E, Otaka Y. Effects of ankle-foot orthosis on gait pattern and spatiotemporal indices during treadmill walking in hemiparetic stroke. Int J Rehabil Res 2023; 46:316-324. [PMID: 37755385 PMCID: PMC10619636 DOI: 10.1097/mrr.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023]
Abstract
Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in post-stroke gait, a three-dimensional motion analysis of gait pattern was conducted. Forty patients with hemiparesis were enrolled. A three-dimensional motion analysis system was used to analyze patients' treadmill walking with/without an AFO. Outcome measures were 12 abnormal gait indices (forefoot contact, knee extensor thrust, retropulsion of the hip, flexed-knee gait, medial whip in the stance phase, circumduction gait, hip hiking, insufficient knee flexion during the swing phase, excessive lateral shifting of the trunk, contralateral vaulting, excessive hip external rotation, and posterior pelvic tilt), calculated using kinematic data and spatiotemporal indices, and the symmetry index of double-stance and single-stance time and step length. Forefoot contact (without AFO vs. with AFO: 71.0 vs. 65.8, P < 0.001), circumduction gait (65.0 vs. 57.9, P < 0.001), and contralateral vaulting (78.2 vs. 72.2, P = 0.003) were significantly reduced, whereas excessive hip external rotation (53.7 vs. 62.8, P = 0.003) significantly increased during walking with an AFO. Hip hiking (77.1 vs. 71.7) showed marginal reduction with the use of AFO ( P = 0.096). The absolute symmetry index of double-stance time (21.9 vs. 16.1, P = 0.014) significantly decreased during walking with an AFO. AFO effectively mitigates abnormal gait patterns typical of hemiparetic gait. A 3D motion analysis system with clinically oriented indices can help assess intervention efficacy for gait abnormalities.
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Affiliation(s)
- Kei Ohtsuka
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Hokkaido
| | - Junya Yamada
- Department of Rehabilitation, Fujita Health University Hospital
| | - Matsuda Fumihiro
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | - Hiroki Tanikawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | - Kazuhiro Tsuchiyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | - Toshio Teranishi
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | | | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Thitithunwarat N, Krityakiarana W, Kheowsri S, Jongkamonwiwat N, Richards J. The effect of a modified elastic band orthosis on gait and balance in stroke survivors. Prosthet Orthot Int 2023; 47:466-472. [PMID: 36752760 DOI: 10.1097/pxr.0000000000000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/21/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Gait is crucial for independent living for stroke survivors and assistive devices have been developed to support gait performance. Ankle foot orthosis (AFOs) are commonly provided to stroke survivors to prevent foot drop during walking. However, previous studies have reported limitations of AFOs including them being too heavy, creating skin irritation, and being a stigma of disability. OBJECTIVE The purpose was to compare the gait and balance improvement between elastic band orthosis (EBOs) and AFOs. STUDY DESIGN Experimental study design. METHODS The AFOs and EBOs were provided to 17 stroke survivors, and changes in gait and balance were assessed compared to barefoot (control). Gait spatiotemporal parameters were measured using the zebris-FDM-Rehawalk® system, and balance ability was evaluated using the time up and go test (TUG). Satisfaction with the EBOs was determined using the Quebec user evaluation of satisfaction with assistive technology (QUEST2.0) questionnaire. RESULTS The EBO showed significant differences in; gait speed, cadence, stride length, stride time, step length unaffected side, stance phase and swing phase on the affected side, and pre-swing on the unaffected side, and balance performance (TUG) (p<0.05) when compared to the AFO and control conditions. The participants were quite satisfied with the EBOs with QUEST2.0 scores greater than 4 out of 5. CONCLUSIONS EBOs could be provided to stroke survivors given their acceptability and properties to improve gait and balance. The EBO used in this study offered clinically important improvements in gait and balance when compare to AFO and control conditions, and could mitigate against some of the limitations reported in the use of AFOs in stroke survivors.
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Affiliation(s)
- Nutkritta Thitithunwarat
- Assistive Technology for Persons with Disabilities, Ratchasuda College, Mahidol University, Nakhon Pathom, Thailand
| | - Warin Krityakiarana
- Assistive Technology for Persons with Disabilities, Ratchasuda College, Mahidol University, Nakhon Pathom, Thailand
- Biomechanics and Sports (BaS) Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Suchittra Kheowsri
- Assistive Technology for Persons with Disabilities, Ratchasuda College, Mahidol University, Nakhon Pathom, Thailand
| | - Nopporn Jongkamonwiwat
- Center for Neuroscience Research, Faculty of Science, Mahidol University, Nakhon Pathom, Thailand
- Department of Anatomy, Faculty of Science, Mahidol University, Nakhon Pathom, Thailand
| | - Jim Richards
- Allied Health Research Unit, Faculty of Allied Health and Well-being, University of Central Lancashire, Preston, UK
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Elattar O, Smith T, Ferguson A, Farber D, Wapner K. Republication of "Uses of Braces and Orthotics for Conservative Management of Foot and Ankle Disorders". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231193419. [PMID: 37566687 PMCID: PMC10408344 DOI: 10.1177/24730114231193419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will summarize the orthoses used for treatment of the most commonly encountered foot and ankle pathologies, with the exclusion of treatment for the diabetic foot because of the unique requirements of that disease process.
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Affiliation(s)
- Osama Elattar
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Tyler Smith
- Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Adam Ferguson
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Daniel Farber
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Keith Wapner
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
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Balkman GS, Hafner BJ, Rosen RE, Morgan SJ. Mobility experiences of adult lower limb orthosis users: a focus group study. Disabil Rehabil 2022; 44:7904-7915. [PMID: 34807780 PMCID: PMC10111250 DOI: 10.1080/09638288.2021.2002437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE People with lower limb impairments are often prescribed orthoses to preserve or enhance their mobility. Exploration of mobility experiences common among orthosis users may provide insights into how orthoses, and other mobility aids, are utilized and regarded. The objective of this study was to broadly explore how lower limb orthosis users describe their mobility. MATERIALS AND METHODS Four focus groups were held online with participants who lived in the U.S. or Canada. Participants had at least six months of experience using an ankle-foot- and/or a knee-ankle-foot-orthosis for one or both legs. All discussions were transcribed and coded. Thematic analysis was used to identify cross-cutting themes. RESULTS Participants included 29 orthosis users with a variety of health conditions. Inter-related themes, including personal factors, situational contexts, and assistance were identified as elements that influenced participants' mobility. Participants described a process of modifying their mobility through the use and non-use of one or more mobility aids. CONCLUSIONS The current study findings may assist clinicians in developing strategies to optimize orthosis users' mobility in different situations. Experiences described by participants in this study may also help researchers identify aspects of mobility most pertinent to orthosis users and inform the development of new outcome measures.Implications for RehabilitationPeople who use lower-limb orthoses share common mobility experiences, despite differences in health diagnoses.Orthosis users often have opportunities to modify their mobility by choosing to use or not use their brace(s) and/or handheld mobility aids.When providing mobility aid interventions, clinicians should consider how each patient's individual characteristics, including physical characteristics (e.g., the health condition and how it presents, pain, fatigue) and psychosocial characteristics (e.g., fear and confidence, self-motivation, emotional responses), can affect mobility.Clinicians may be able to help patients optimize their mobility by asking about environmental obstacles they regularly encounter and recommending strategies for utilization of mobility aids, including simultaneous use of multiple aids, use of one aid, or choosing not to use any aids, depending on the activity and situation.Clinicians should inquire about all mobility aids available to a patient at home and in the community, including fixed objects, and consider how new mobility aid interventions might affect the patient's mobility when used alone and in combination with other forms of assistance.
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Affiliation(s)
- Geoffrey S. Balkman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brian J. Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Rachael E. Rosen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sara J. Morgan
- Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
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Daryabor A, Kobayashi T, Yamamoto S, Lyons SM, Orendurff M, Akbarzadeh Baghban A. Effect of ankle-foot orthoses on functional outcome measurements in individuals with stroke: a systematic review and meta-analysis. Disabil Rehabil 2022; 44:6566-6581. [PMID: 34482791 DOI: 10.1080/09638288.2021.1970248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Sumiko Yamamoto
- Department of Assistive Technological Science, Graduate School, International University of Health and Welfare, Tokyo, Japan
| | - Samuel M Lyons
- Motion Analysis and Sports Performance Lab, Department of Orthopedic Sports Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA
| | | | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Golding-Day MR, Walker MF, Whitehead PJ. Orthotic intervention following stroke: a survey of physiotherapist, occupational therapist and orthotist practice and views in the UK. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Orthoses are often used to promote mobility and rehabilitation for patients in the UK after a stroke. The perspective of stroke therapists in the UK is an important factor determining current practice and orthotic provision. The purpose of this study was to investigate the views of orthotists, physiotherapists and occupational therapists on the delivery mechanisms and relationships that influence orthoses intervention and provision for patients with stroke in the UK. Methods A UK-based online survey was conducted. Participants were stroke therapy clinicians within acute and community settings, recruited through their membership of the British Association of Prosthetists and Orthotists, the Association of Chartered Physiotherapists Interested in Neurology, and the Royal Collage of Occupational Therapists—Specialist Section for Neurological Practice. Data were analysed using descriptive statistics and content analysis. Results A total of 305 questionnaires were completed (64 orthotists, 131 physiotherapists, 110 occupational therapists). Some 67% (n=190) of respondents identified the optimal timing for initial orthotic assessment as within the first days following a stroke or before discharge from hospital. Waiting times and operational barriers to orthoses provision were perceived to have a negative impact on patients’ rehabilitation. A closer working relationship between orthotists and the stroke rehabilitation team is desirable. Conclusions The survey found that the use of orthoses and orthotic specialist input are perceived to play an important role within the stroke rehabilitation pathway. Further evaluative research is warranted to explore the optimal timing and benefits, and the orthotist's role within the stroke rehabilitation team.
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Affiliation(s)
- Miriam R Golding-Day
- Centre of Rehabilitation and Ageing Research, The University of Nottingham, Nottingham, UK
| | - Marion F Walker
- Centre of Rehabilitation and Ageing Research, The University of Nottingham, Nottingham, UK
| | - Phillip J Whitehead
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
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Chen CPC, Suputtitada A, Chatkungwanson W, Seehaboot K. Anterior or Posterior Ankle Foot Orthoses for Ankle Spasticity: Which One Is Better? Brain Sci 2022; 12:brainsci12040454. [PMID: 35447984 PMCID: PMC9027033 DOI: 10.3390/brainsci12040454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives: Ankle foot orthoses (AFOs) are commonly used by stroke patients to walk safely and efficiently. Both posterior AFOs (PAFOs) and anterior AFOs (AAFOs) are available. The objective of this study was to compare the efficacy of AAFOs and PAFOs in the treatment of ankle spasticity. Materials and Methods: A crossover design with randomization for the interventions and blinded assessors was used. Twenty patients with chronic stroke, a Modified Ashworth Scale (MAS) score of the ankle joint of 2, and a Tardieu angle ≥20 degrees were recruited. The patients were assigned to wear either an AAFO or PAFO at random and subsequently crossover to the other AFO. Results: Twenty stroke patients with ankle spasticity were recruited. The mean age was 46.60 (38−60) years. The mean time since stroke onset was 9.35 (6−15) months. It was discovered that the AAFO improved walking speed as well as the stretch reflex dynamic electromyography (dEMG) and walking dEMG amplitudes of the medial gastrocnemius muscles more significantly than the PAFO (p < 0.05). Conclusions: The AAFO had greater efficacy in reducing both static and dynamic ankle spasticity, and allowed for faster walking than the PAFO. The stretch reflex and walking dEMG amplitudes could be used for quantitative spasticity assessment.
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Affiliation(s)
- Carl P. C. Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan;
| | - Areerat Suputtitada
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
- Division of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
- Excellent Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Correspondence: or
| | - Watchara Chatkungwanson
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Kittikorn Seehaboot
- Division of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
- Excellent Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
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Sato K, Inoue T, Maeda K, Shimizu A, Murotani K, Ueshima J, Ishida Y, Ogawa T, Suenaga M. Early Wearing of Knee-Ankle-Foot Orthosis Improves Functional Prognosis in Patients after Stroke. J Stroke Cerebrovasc Dis 2022; 31:106261. [PMID: 35032757 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Knee-ankle-foot orthosis (KAFO) is sometimes used for gait training in stroke patients. The impact of the time of wearing KAFO on activities of daily living (ADL) recovery has not been clarified. This study aimed to examine the relationship between the days from onset to KAFO wearing and functional prognosis in patients after stroke. MATERIALS AND METHODS This retrospective, observational study was conducted with stroke patients who were prescribed a KAFO. Patients were divided into early and delayed groups according to the median days from onset to KAFO wearing. Baseline characteristics were evaluated at the initiation of KAFO wearing. The primary outcome was the Functional Independence Measure (FIM) gain, which was scored by the nurse at baseline and discharge. RESULTS 112 participants (mean age 67.9 ± 14.0 years, 51.8% male) were included. The time period measure from day of onset to KAFO wearing for the early group was significantly shorter than the delayed group (35.8 ± 6.6 days vs. 73.5 ± 28.9 days). The early group had a higher FIM at discharge (84.9 ± 28.0% vs. 65.1 ± 29.0%, P < 0.001) and higher FIM gain (36.9 ± 19.8% vs. 26.8 ± 22.3, P = 0.013) than did the delayed group. Multiple regression analysis showed that the early group was associated with FIM gain (coefficient = 8.607, P = 0.032). CONCLUSIONS Early wearing of KAFO, irrespective of the difference in ADL at the time of KAFO wearing, may have a positive impact on the improvement of ADL in patients after stroke.
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Affiliation(s)
- Keisuke Sato
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy Niigata University of Health and Welfare, Niigata, Japan
| | - Keisuke Maeda
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan.; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan..
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | | | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, Nagakute, Japan
| | - Takahiro Ogawa
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan; Department of Rehabilitation Medicine, Chuzan Hospital, Okinawa, Japan
| | - Masaki Suenaga
- Department of Rehabilitation Medicine, Chuzan Hospital, Okinawa, Japan
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Zarezadeh R, Arazpour M, Aminian G. The effect of anterior ankle-foot orthosis and posterior ankle-foot orthosis on functional ambulation in stroke patients. J Rehabil Assist Technol Eng 2022; 9:20556683221082451. [PMID: 36394001 PMCID: PMC9644154 DOI: 10.1177/20556683221082451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background The goal of rehabilitation after stroke is to restore safe and sufficient
function to hemiplegic patients, and prescription of an ankle-foot orthosis
(AFO) to improve speed and functional ambulation is a part of this
program. Objective This crossover randomized interventional study aimed to evaluate the effect
of an anterior ankle-foot orthosis (AAFO) and posterior leaf-spring
ankle-foot orthosis (PLS AFO) on speed and functional ambulation in
hemiplegic stroke patients. Method Clinical assessments were performed on 11 hemiplegic stroke patients by the
AAFO, PLS AFO, and wearing shoes. Functional ambulation was measured by the
6-min walking test, Timed Up and Go Test, Time Up and Down Stair Test, and
Functional Ambulation Category. Walking speed was measured by the 10-m
test. Results Both PLS AFO and AAFO significantly improved the performance of TUDS and TUG
tests in hemiplegic patients. However, by using PLS AFO, walking distance
was significantly greater than walking with shoes. There was no significant
effect on the walking speed improvement using PLS AFO or AAFO compared to
wearing shoes. Conclusions The positive effects of the AAFO and PLS AFO on functional ambulation were
significant. By using PLS AFO, hemiplegic patients could walk a longer
distance than wearing shoes.
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Affiliation(s)
- Reihaneh Zarezadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Gholamreza Aminian
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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11
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Wada Y, Otaka Y, Mukaino M, Tsujimoto Y, Shiroshita A, Kawate N, Taito S. The effect of ankle-foot orthosis on ankle kinematics in individuals after stroke: A systematic review and meta-analysis. PM R 2021; 14:828-836. [PMID: 34369101 DOI: 10.1002/pmrj.12687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate whether ankle-foot orthosis (AFO) has a beneficial effect on dorsiflexion angle increase during the swing phase among individuals with stroke and patient-important outcomes in individuals with stroke. LITERATURE SURVEY Randomized controlled trials (RCTs), randomized crossover trials, and cluster RCTs until May 2020 were researched through CENTRAL, MEDLINE, EMBASE, PEDro, CINAHL, and REHABDATA databases. Studies reporting on AFO use to improve walking, functional mobility, quality of life, and activity limitations and reports of adverse events in individuals with stroke were included. METHODOLOGY Two independent reviewers extracted the data and assessed the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. SYNTHESIS Fourteen trials that enrolled 282 individuals with stroke and compared AFO with no AFO were included. Compared with no AFO, AFO could increase the dorsiflexion angle of ankle joints during walking (mean difference [MD, 3.7°]; 95% confidence interval [CI], 2.0-5.3; low certainty of evidence). Furthermore, AFO could improve walking ability (walking speed) (MD, 0.09 [m/s]; 95% CI, 0.06-0.12; low certainty of evidence). No study had reported the effects of AFO on quality of life, adverse events, fall frequency, and activities of daily life. CONCLUSIONS Our findings suggest that AFO improved ankle kinematics and walking ability in the short term; nonetheless, the evidence was characterized by a low degree of certainty.
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Affiliation(s)
- Yoshitaka Wada
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Himeji, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Akihiro Shiroshita
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Respiratory Medicine, Ichinomiyanishi Hospital, Ichinomiya, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Shunsuke Taito
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
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12
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Choo YJ, Chang MC. Effectiveness of an ankle-foot orthosis on walking in patients with stroke: a systematic review and meta-analysis. Sci Rep 2021; 11:15879. [PMID: 34354172 PMCID: PMC8342539 DOI: 10.1038/s41598-021-95449-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/20/2021] [Indexed: 12/04/2022] Open
Abstract
We conducted a meta-analysis to investigate the effectiveness of ankle–foot orthosis (AFO) use in improving gait biomechanical parameters such as walking speed, mobility, and kinematics in patients with stroke with gait disturbance. We searched the MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, and Scopus databases and retrieved studies published until June 2021. Experimental and prospective studies were included that evaluated biomechanics or kinematic parameters with or without AFO in patients with stroke. We analyzed gait biomechanical parameters, including walking speed, mobility, balance, and kinematic variables, in studies involving patients with and without AFO use. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies, and the level of evidence was evaluated using the Research Pyramid model. Funnel plot analysis and Egger’s test were performed to confirm publication bias. A total of 19 studies including 434 participants that reported on the immediate or short-term effectiveness of AFO use were included in the analysis. Significant improvements in walking speed (standardized mean difference [SMD], 0.50; 95% CI 0.34–0.66; P < 0.00001; I2, 0%), cadence (SMD, 0.42; 95% CI 0.22–0.62; P < 0.0001; I2, 0%), step length (SMD, 0.41; 95% CI 0.18–0.63; P = 0.0003; I2, 2%), stride length (SMD, 0.43; 95% CI 0.15–0.71; P = 0.003; I2, 7%), Timed up-and-go test (SMD, − 0.30; 95% CI − 0.54 to − 0.07; P = 0.01; I2, 0%), functional ambulation category (FAC) score (SMD, 1.61; 95% CI 1.19–2.02; P < 0.00001; I2, 0%), ankle sagittal plane angle at initial contact (SMD, 0.66; 95% CI 0.34–0.98; P < 0.0001; I2, 0%), and knee sagittal plane angle at toe-off (SMD, 0.39; 95% CI 0.04–0.73; P = 0.03; I2, 46%) were observed when the patients wore AFOs. Stride time, body sway, and hip sagittal plane angle at toe-off were not significantly improved (p = 0.74, p = 0.07, p = 0.07, respectively). Among these results, the FAC score showed the most significant improvement, and stride time showed the lowest improvement. AFO improves walking speed, cadence, step length, and stride length, particularly in patients with stroke. AFO is considered beneficial in enhancing gait stability and ambulatory ability.
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Affiliation(s)
- Yoo Jin Choo
- Production R&D Division Advanced Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea. .,Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea.
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13
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Lin CC, Yeh CH, Tsai YC, Kuo LC, Hsu HY, Chuang PH, Chang K, Su FC. Evidence-based Customized Ankle-Foot Orthosis with Energy Storage. J Med Biol Eng 2021. [DOI: 10.1007/s40846-020-00593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Johnston TE, Keller S, Denzer-Weiler C, Brown L. A Clinical Practice Guideline for the Use of Ankle-Foot Orthoses and Functional Electrical Stimulation Post-Stroke. J Neurol Phys Ther 2021; 45:112-196. [PMID: 33675603 DOI: 10.1097/npt.0000000000000347] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Level of ambulation following stroke is a long-term predictor of participation and disability. Decreased lower extremity motor control can impact ambulation and overall mobility. The purpose of this clinical practice guideline (CPG) is to provide evidence to guide clinical decision-making for the use of either ankle-foot orthosis (AFO) or functional electrical stimulation (FES) as an intervention to improve body function and structure, activity, and participation as defined by the International Classification of Functioning, Disability and Health (ICF) for individuals with poststroke hemiplegia with decreased lower extremity motor control. METHODS A review of literature published through November 2019 was performed across 7 databases for all studies involving stroke and AFO or FES. Data extracted included time post-stroke, participant characteristics, device types, outcomes assessed, and intervention parameters. Outcomes were examined upon initial application and after training. Recommendations were determined on the basis of the strength of the evidence and the potential benefits, harm, risks, or costs of providing AFO or FES. RESULTS/DISCUSSION One-hundred twenty-two meta-analyses, systematic reviews, randomized controlled trials, and cohort studies were included. Strong evidence exists that AFO and FES can each increase gait speed, mobility, and dynamic balance. Moderate evidence exists that AFO and FES increase quality of life, walking endurance, and muscle activation, and weak evidence exists for improving gait kinematics. AFO or FES should not be used to decrease plantarflexor spasticity. Studies that directly compare AFO and FES do not indicate overall superiority of one over the other. But evidence suggests that AFO may lead to more compensatory effects while FES may lead to more therapeutic effects. Due to the potential for gains at any phase post-stroke, the most appropriate device for an individual may change, and reassessments should be completed to ensure the device is meeting the individual's needs. LIMITATIONS This CPG cannot address the effects of one type of AFO over another for the majority of outcomes, as studies used a variety of AFO types and rarely differentiated effects. The recommendations also do not address the severity of hemiparesis, and most studies included participants with varied baseline ambulation ability. SUMMARY This CPG suggests that AFO and FES both lead to improvements post-stroke. Future studies should examine timing of provision, device types, intervention duration and delivery, longer term follow-up, responders versus nonresponders, and individuals with greater impairments. DISCLAIMER These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for people with poststroke hemiplegia who have decreased lower extremity motor control that impacts ambulation and overall mobility.A Video Abstract is available as supplemental digital content from the authors (available at: http://links.lww.com/JNPT/A335).
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Affiliation(s)
- Therese E Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania and Ossur, Foothill Ranch, California (T.E.J.); Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, Illinois (S.K.); Kessler Institute for Rehabilitation, Chester, New Jersey (C.D.-W.); and Boston University College of Health and Rehabilitation Sciences: Sargent, Boston, Massachusetts (L.B.)
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15
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Ramstrand N, Stevens PM. Clinical outcome measures to evaluate the effects of orthotic management post-stroke: a systematic review. Disabil Rehabil 2021; 44:3019-3038. [PMID: 33438496 DOI: 10.1080/09638288.2020.1859630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify, and classify, according to International Classification of Functioning, Disability and Health (ICF), clinically applicable outcome measures that have been used to evaluate lower limb orthotic management post-stroke and to investigate which outcome measures recorded the largest effect sizes. MATERIALS AND METHODS Electronic searches were performed in Pubmed, Cochrane, Web of Science, Cinahl, Scopus and Embase databases from inception to May 2020. Articles were included if they investigated clinical outcomes in people post-stroke who had received a lower-limb orthotic intervention. RESULTS 88 articles underwent full-text review and 54 were included in the review, which was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. 48 different outcome measures were identified; effect sizes were able to be calculated from 39 studies. The most frequently applied outcome measures were the 10-metre Walk Test and the timed-up-and-go test. Outcome measures that recorded large effect sizes in two or more studies were the 10-metre Walk Test, Functional Reach Test, and Physiological Cost Index. When coded according to the ICF, the most frequently represented codes were d450 (Walking) and d455 (moving around). CONCLUSIONS Results suggest that outcome measures related to mobility (ICF chapter d4) are most often applied to evaluate orthotic management post-stroke. Effect sizes appear to be greatest in outcome measures related to velocity, balance, and energy expenditure.IMPLICATIONS FOR REHABILITATIONThe 10-meter Walk Test appears to have the greatest effect size when evaluating orthotic management post-stroke.While outcome measures related to mobility are commonly applied when evaluating orthotic management post-stroke, rehabilitation professionals should consider complementing these with measures representing the participation domain of the ICF.
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Affiliation(s)
- Nerrolyn Ramstrand
- CHILD Research Group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Phillip M Stevens
- Department of Clinical and Scientific Affairs, Hanger Clinic, Salt Lake City, UT, USA.,Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
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16
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Drake R, Parker K, Clifton KL, Allen S, Adderson J, Mountain A, Eskes GA. Ankle-foot orthoses improve walking but do not reduce dual-task costs after stroke. Top Stroke Rehabil 2020; 28:463-473. [PMID: 33063635 DOI: 10.1080/10749357.2020.1834271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cognitive-motor interference, as measured by dual-task walking (performing a mental task while walking), affects many clinical populations. Ankle-foot orthoses (AFOs) are lower-leg splints prescribed to provide stability to the foot and ankle, as well as prevent foot drop, a gait deficit common after stroke. AFO use has been shown to improve gait parameters such as speed and step time, which are often negatively impacted by dual-task walking. OBJECTIVES Our objective was to establish whether AFOs could protect against cognitive-motor interference, as measured by dual-task walking, following post-stroke hemiplegia. METHODS A total of 21 individuals with post-stroke hemiplegia that use an AFO completed a dual-task walking paradigm in the form of a 2 (walking with vs. without a concurrent cognitive task) by 2 (walking with vs. without an AFO) repeated-measures design. Changes to both motor and cognitive performance were analyzed. RESULTS The results suggest that the use of an AFO improves gait overall in both single- and dual-task walking, particularly with respect to stride regularity, but there were no interactions to suggest that AFOs reduce the cognitive-motor dual-task costs themselves. A lack of differences in cognitive performance during dual-task walking with and without the AFO suggests that the AFO's benefit to motor performance cannot be attributed to task prioritization. CONCLUSIONS These data support the use of AFOs to improve certain gait parameters for post-stroke hemiplegia, but AFOs do not appear to protect against cognitive-motor interference during dual-task walking. Future research should pursue alternate therapeutics for ameliorating task-specific declines under cognitively demanding circumstances.
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Affiliation(s)
- Richard Drake
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - Kim Parker
- Assistive Technology, Nova Scotia Health Authority, Halifax, Canada.,Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada
| | | | - Stefan Allen
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada
| | - James Adderson
- Assistive Technology, Nova Scotia Health Authority, Halifax, Canada
| | - Anita Mountain
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada
| | - Gail A Eskes
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Canada
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17
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Fatone S, Jerousek S, Slater BCS, Deutsch A, LaVela SL, Peterson M, Soltys NT, McPherson V, Heinemann AW. Identifying Instruments to Assess Care Quality for Individuals With Custom Ankle Foot Orthoses: A Scoping Review. Arch Phys Med Rehabil 2020; 102:709-734. [PMID: 32791070 DOI: 10.1016/j.apmr.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We conducted 2 complementary scoping reviews to identify instruments that assess the experience and outcomes of custom ankle-foot orthosis (AFO) care in individuals with neurologic and traumatic conditions and to determine to what extent they might be psychometrically sound for AFO users. A stakeholder advisory committee considered to what extent the identified and psychometrically sound instruments might be feasible for use in developing quality measures for custom AFO users. DATA SOURCES Both scoping reviews were conducted using PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, and Cochrane Systematic Reviews. The following were used for the first scoping review only: Cochrane Central Register of Controlled Trials and the Physiotherapy Evidence Database. STUDY SELECTION The initial scoping review yielded 79 articles with 82 instruments, 16 of which were used in 4 or more studies. The second scoping review yielded 57 articles reporting psychometric properties. DATA EXTRACTION Psychometric properties for populations who use AFOs were summarized for 15 of the 16 instruments. The advisory committee eliminated 2 insrtruments, noted overlap between 4 instruments in terms of the constructs measured, and suggested 6 potential contemporary substitutes. DATA SYNTHESIS Most instruments assessed activity (specifically mobility) and pertained to the National Quality Forum domain of "Health-Related Quality of Life." The 10-meter walk test, 6-minute walk test, Berg Balance Scale, Timed Up and Go, and Rivermead Mobility Index were reported to have adequate reliability and validity, and were considered feasible for administration in a clinical setting. CONCLUSIONS Complementary scoping reviews demonstrated that some instruments with reasonable psychometric properties are available that are feasible to use in developing quality measures for custom AFO care. However, experience of care instruments suitable for this population were not identified but are needed for a comprehensive evaluation of care quality for AFO users.
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Affiliation(s)
- Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Sara Jerousek
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | | | - Anne Deutsch
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; The Shirley Ryan Ability Lab, Chicago, IL; RTI International, Chicago, IL
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL
| | | | | | | | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; The Shirley Ryan Ability Lab, Chicago, IL
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18
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Peng Z, Luo R, Huang R, Yu T, Hu J, Shi K, Cheng H. Data-Driven Optimal Assistance Control of a Lower Limb Exoskeleton for Hemiplegic Patients. Front Neurorobot 2020; 14:37. [PMID: 32719595 PMCID: PMC7347968 DOI: 10.3389/fnbot.2020.00037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
More recently, lower limb exoskeletons (LLE) have gained considerable interests in strength augmentation, rehabilitation, and walking assistance scenarios. For walking assistance, the LLE is expected to control the affected leg to track the unaffected leg's motion naturally. A critical issue in this scenario is that the exoskeleton system needs to deal with unpredictable disturbance from the patient, and the controller has the ability to adapt to different wearers. To this end, a novel data-driven optimal control (DDOC) strategy is proposed to adapt different hemiplegic patients with unpredictable disturbances. The interaction relation between two lower limbs of LLE and the leg of patient's unaffected side are modeled in the context of leader-follower framework. Then, the walking assistance control problem is transformed into an optimal control problem. A policy iteration (PI) algorithm is utilized to obtain the optimal controller. To improve the online adaptation to different patients, an actor-critic neural network (AC/NN) structure of the reinforcement learning (RL) is employed to learn the optimal controller on the basis of PI algorithm. Finally, experiments both on a simulation environment and a real LLE system are conducted to verify the effectiveness of the proposed walking assistance control method.
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Affiliation(s)
- Zhinan Peng
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Luo
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Huang
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Tengbo Yu
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiangping Hu
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Kecheng Shi
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong Cheng
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
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19
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Eddison N, Healy A, Needham R, Chockalingam N. The effect of tuning ankle foot orthoses-footwear combinations on gait kinematics of children with cerebral palsy: A case series. Foot (Edinb) 2020; 43:101660. [PMID: 32179372 DOI: 10.1016/j.foot.2019.101660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Case series. BACKGROUND AFOs are a commonly prescribed medical device given to children with cerebral palsy (CP) in an attempt to improve their gait. The current literature is equivocal on the effects AFOs have on the gait of children with CP. The vast majority of AFOs issued are not subject to AFO-FC tuning. There are emerging studies investigating the effects tuning AFO-FCs has on the gait of children with CP. However, the research is limited, and there is a lack of quantitative data. OBJECTIVE To compare the kinematics of tuned versus non-tuned gait in children with CP. METHODS Gait analysis assessment of five children aged between 7-11 years with a diagnosis of CP (one hemiplegic and four diplegic participants, two female, three male, with a Gross Motor Functional Classification System (GMFCS) of 2) at a Gait Analysis Laboratory. RESULTS In comparison to barefoot and non-tuned gait, walking with a tuned AFO-FC produced improvements in several key gait parameters. Including hip flexion and extension, posterior pelvic tilt and knee extension. Results also indicated that the type of gait pattern demonstrated by the participant affected the outcomes of tuning. CONCLUSIONS Tuning the AFO-FC of children with CP has the potential to improve hip function, pelvic function, knee extension in stance phase and knee flexion during swing phase and that a non-tuned AFO-FC can potentially decrease hip function, posterior pelvic tilt and increase knee extension. CLINICAL RELEVANCE Whilst AFO-FC tuning has been recommended for routine clinical practice, there still remains a paucity of research on the kinematic effects of using a tuned AFO-FC compared to a non-tuned. This paper provides a comparison of kinematics on children with CP, during barefoot, non-tuned and tuned AFO-FC walking with a view to inform clinical practice.
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Affiliation(s)
- N Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom; Royal Wolverhampton NHS Trust, Wolverhampton.
| | - A Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
| | - R Needham
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
| | - N Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
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20
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Kato M, Kamono A, Ogihara N. Effect of ankle-foot orthosis on level walking in healthy subjects. Proc Inst Mech Eng H 2019; 233:1262-1268. [PMID: 31623517 DOI: 10.1177/0954411919880359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An ankle-foot orthosis is often prescribed in the rehabilitation of patients with neurological motor disorders such as hemiparesis. However, walking with a unilateral ankle-foot orthosis may not be effectively achieved just by trying to reproduce normal intact walking with a symmetrical gait pattern. Understanding skills to facilitate walking gait with a unilateral ankle-foot orthosis has implications for better rehabilitative interventions to help restore walking ability in patients with stroke. We, therefore, analyzed the kinematics and ground reaction forces of walking with and without an ankle-foot orthosis in healthy subjects to infer the possible skills to facilitate walking gait with a unilateral ankle-foot orthosis. Adult male participants were asked to walk with and without an ankle-foot orthosis across two force platforms set in a wooden walkway, and body kinematics and ground reaction force profiles in the sagittal plane were simultaneously recorded. We found that the forward tilting angle of the trunk at the time of toe-off of the leg with the ankle-foot orthosis was significantly larger than that of the leg without the ankle-foot orthosis, to adaptively compensate for the loss of ankle joint mobility due to the unilateral ankle-foot orthosis. Furthermore, the peak vertical ground reaction force at heel-contact was significantly larger in the leg without the ankle-foot orthosis than in the leg with the ankle-foot orthosis owing to the fact that the stance phase duration of the leg with the ankle-foot orthosis was relatively shorter. Such information may potentially be applied to facilitate walking training in stroke patients wearing a unilateral ankle-foot orthosis.
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Affiliation(s)
- Mizuki Kato
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan
| | - Arinori Kamono
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan.,School of Nursing and Rehabilitation Science, Showa University, Yokohama, Japan
| | - Naomichi Ogihara
- Department of Mechanical Engineering, Faculty of Science and Technology, Keio University, Yokohama, Japan.,Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
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21
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Hong JC, Hayashi Y, Suzuki S, Fukushima Y, Yasuda K, Ohashi H, Iwata H. Identification of Spring Coefficient for Heel Rocker Function Support Based on Estimated Dorsiflexion Torque. IEEE Int Conf Rehabil Robot 2019; 2019:355-359. [PMID: 31374655 DOI: 10.1109/icorr.2019.8779393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In previous research, we have developed a high-dorsiflexion assistive robotic technology aiming for gait rehabilitation targeting on ankle dorsiflexion movement. A McKibben-type artificial muscle is applied to provide large dorsiflexion force while adding little weight to the device. This ensures the foot clearance before initial stance phase in gait. Meanwhile, a tension spring is deployed in series with the artificial muscle to support heel rocker function in loading response phase. Suitable spring coefficient for each individual differs according to ankle's dorsiflexion torque in loading response. An unsuitable spring would lead to knee deviation in this phase. In this study, we derived an identification equation to determine a suitable spring coefficient for individuals based on estimation of dorsiflexion torque required to support. An evaluation test on healthy objects was conducted, which shows no negative effects on participants' knee angles with the identified spring coefficient.
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22
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Park JS, Lee SH, Yoo WG, Chang MY. Immediate effect of a wearable foot drop stimulator to prevent foot drop on the gait ability of patients with hemiplegia after stroke. Assist Technol 2019; 33:313-317. [PMID: 31311426 DOI: 10.1080/10400435.2019.1634658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The purpose of this study was to compare the effects of a foot drop stimulator (FDS) and ankle-foot orthosis (AFO) on the gait ability of patients with hemiplegia after stroke. This study recruited 10 patients with hemiplegia after stroke. All patients performed gait under two conditions (AFO and FDS gait). Gait parameters were measured with the GAITRite® system to analyze the spatial and temporal parameters of the patients' gaits. No significant differences in cadence, velocity, swing time, stance time, or step length of the affected or less-affected limbs were found between the two conditions (all, p > .05). These findings demonstrate that AFO and FDS have a similar effect on the gait ability of patients with hemiplegia after stroke.
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Affiliation(s)
- Ji-Su Park
- a Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, Dongseo University , Busan , Republic of Korea
| | - Sang-Hoon Lee
- b Department of Rehabilitation Science, Graduate School, Inje University , Gimhae , Republic of Korea
| | - Won-Gyu Yoo
- c Department of Physical Therapy, Inje University , Gimhae , Republic of Korea
| | - Moon-Young Chang
- d Department of Occupational Therapy, Inje University , Gimhae , Republic of Korea
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23
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Pourhosseingholi E, Farahmand B, Bagheri A, Kamali M, Saeb M. Efficacy of different techniques of AFO construction for hemiplegia patients: A systematic review. Med J Islam Repub Iran 2019; 33:50. [PMID: 31456974 PMCID: PMC6708092 DOI: 10.34171/mjiri.33.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Ankle foot orthoses (AFOs) are frequently prescribed to improve gait deviation and normalize walking pattern in patients with drop foot hemiplegia disorder. This study was to review the efficacy of different techniques of AFO construction and biomechanics parameters of AFOs. Furthermore, this study aimed to provide a guideline for researchers in detail and help them choose a sufficient measurement instrument.
Methods: Information sources included MEDLINE, CINAHL, Scopus, PubMed, and the Full Cochrane Library up to December 25, 2015. The inclusion criteria include: (1) type and method of controlled clinical trial studies; (2) age of hemiplegia groups (3); AFOs as an intervention; and (4) kinetic and kinematic parameters, and energy expenditure as an intervention of gait performance.
Results: Considering eligibility criteria such as study design, setting, time frame and Language 9 papers with Pedro scores of 5 to 8 for methodological quality were included in the review.
Conclusion: The findings of this review can help to develop guidelines for the best AFO reporting as an intervention and to prevent vagueness of results in the different types of AFOs.
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Affiliation(s)
- Ensieh Pourhosseingholi
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran Universi-ty of Medial Sciences, Tehran, Iran
| | - Behshid Farahmand
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran Universi-ty of Medial Sciences, Tehran, Iran
| | - Azam Bagheri
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran Universi-ty of Medial Sciences, Tehran, Iran
| | - Mohammad Kamali
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran Universi-ty of Medial Sciences, Tehran, Iran
| | - Morteza Saeb
- Kermanshah University of Medial Sciences, Kermanshah, Iran
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24
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Heinemann AW, Fatone S, LaVela SL, Slater BCS, Deutsch A, Peterson M, Soltys NT, McPherson V. Orthotists' and physical therapists' perspectives on quality of care indicators for persons with custom ankle-foot orthoses. Assist Technol 2019; 33:206-216. [PMID: 31091177 DOI: 10.1080/10400435.2019.1610814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Purpose: To describe the priorities of orthotists and physical therapists about quality measurement themes, and the feasibility and utility of collecting data from persons using custom AFOs that could inform quality measure development.Materials and Methods: Online survey assessed respondents' perspectives and experiences. An Advisory Committee representing professional, organizational, and accreditor groups distributed survey invitations.Results: 461 orthotists and 153 physical therapists completed part or all of the survey; 60% rated 9 quality themes and 20 quality of care topics as extremely important, and 12 standard instruments as feasible and good to use for quality measurement. Patients were the preferred source of information for ease of scheduling, device weight, ease of donning and doffing, adherence to device use, beneficial effects, activity level and independence, and quality of life. Clinicians were the preferred source for material quality, device modifiability, and joint range of motion. Facility records were the preferred source for timeliness of device delivery and clinician follow-up. Respondents reported that gait speed and walking endurance were best obtained by patient performance.Conclusions: Results provide insight on the topics orthotists and physical therapists regard as priorities for defining healthcare quality for persons using custom ankle-foot orthoses and instruments for data collection.
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Affiliation(s)
- Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.,Center for Rehabilitation Outcomes Research, The Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.,Prosthetics-Orthotics Center, Northwestern University, Chicago, Illinois, USA
| | - Sherri L LaVela
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.,Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Hines, Illinois, USA
| | - Billie C S Slater
- Minneapolis Adaptive Design and Engineering (MADE), Minneapolis VAHealth Care System, Minneapolis, Minnesota, USA
| | - Anne Deutsch
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.,Center for Rehabilitation Outcomes Research, The Shirley Ryan Ability Lab, Chicago, Illinois, USA.,RTI International, Chicago, Illinois, USA
| | - Michelle Peterson
- Physical Medicine and Rehabilitation Department, Polytrauma Rehabilitation Center, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Nicole T Soltys
- Center for Rehabilitation Outcomes Research, The Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - Vari McPherson
- Center for Rehabilitation Outcomes Research, The Shirley Ryan Ability Lab, Chicago, Illinois, USA
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25
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Kirker S, Tyler A. Bespoke versus off the shelf ankle-foot orthosis for people with stroke: randomized controlled trial. Clin Rehabil 2018; 32:1418-1425. [PMID: 29978714 DOI: 10.1177/0269215518781195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Choi EH, Kim SG, Shin YJ, Lee DH, Kim MK. Study on the design development of a multi joint ankle foot orthosis. J Phys Ther Sci 2018; 30:1161-1163. [PMID: 30214117 PMCID: PMC6127493 DOI: 10.1589/jpts.30.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/22/2018] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of a newly designed
multi joint ankle-foot orthosis on the gait and dynamic balance of stroke patients having
foot drop. [Participants and Methods] This study was investigated 10 participants who were
diagnosed with stroke. Patients were evaluated based on a 10-meter walk test, timed up and
go test and Berg balance scale after each participant wore a plastic ankle-foot orthosis
and a multi joint ankle-foot orthosis (AFO) that consisted of orthosis joints (having
poster-stop joint and Klenzak joint functions). [Results] The 10-meter walk test, timed up
and go test and Berg balance scale showed significant differences in the orthosis with the
Klenzak joint function. [Conclusion] The appropriate use of Klenzak AFO of the newly
designed multi joint AFO is expected to have a positive effect on improving the gait and
balancing ability of stroke patients having foot drop.
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Affiliation(s)
- Eun-Hong Choi
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea
| | - Seong-Gil Kim
- Department of Physical Therapy, Uiduk University, Republic of Korea
| | - Young-Jun Shin
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea
| | - Dae-Hwan Lee
- G.O. Meditech, Rehabilitation Medicine Device Research Institute, Republic of Korea
| | - Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University: Jillyang, Gyeongsan, Gyeongbuk 712-714, Republic of Korea
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Elattar O, Smith T, Ferguson A, Farber D, Wapner K. Uses of Braces and Orthotics for Conservative Management of Foot and Ankle Disorders. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418780700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will summarize the orthoses used for treatment of the most commonly encountered foot and ankle pathologies, with the exclusion of treatment for the diabetic foot because of the unique requirements of that disease process.
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Affiliation(s)
- Osama Elattar
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Tyler Smith
- Department of Orthopedics, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Adam Ferguson
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Daniel Farber
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
| | - Keith Wapner
- Department of Orthopedics, University of Pennsylvania Medicine, Philadelphia, PA, USA
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28
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Park D, Lee JH, Kang TW, Cynn HS. Immediate effects of talus-stabilizing taping on balance and gait parameters in patients with chronic stroke: a cross-sectional study. Top Stroke Rehabil 2018; 25:417-423. [PMID: 29717946 DOI: 10.1080/10749357.2018.1466972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Talus-stabilizing taping (TST) may improve ankle range of motion and gait performance by providing a posterior-inferior talar glide in a closed-chain dorsiflexion position. OBJECTIVES This study aimed to investigate the immediate effects of TST on balance and gait parameters in patients with chronic stroke. METHODS Twenty post-stroke patients participated in this study. Each participant performed tests under three conditions (TST, barefoot, and conventional ankle-foot orthosis [AFO]), in random order. Before testing, the patients walked for 10 min under the three conditions, followed by a 5 min rest period. The outcome measures were static balance ability (SBA), timed up-and-go (TUG) test results, and gait parameters evaluated using a 6-m-long gait mat. One-way repeated measures analysis of variance was used to determine the difference in balance and gait parameters under the three conditions. RESULTS SBA more significantly improved in the TST condition than in the barefoot condition. SBA more significantly improved in the conventional AFO condition than in the barefoot condition. The TUG test results more significantly improved in the TST condition than in the conventional AFO and barefoot conditions. Walking speed, cadence, and affected side and unaffected side step and stride lengths more significantly improved in the TST condition than in the conventional AFO and barefoot conditions. CONCLUSIONS This study used a cross-sectional method and demonstrated that TST improves SBA, TUG, gait speed, cadence, step length, and stride length in patients with chronic stroke.
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Affiliation(s)
- Donghwan Park
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of South Korea
| | - Ji-Hyun Lee
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of South Korea
| | - Tae-Woo Kang
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of South Korea
| | - Heon-Seock Cynn
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of South Korea
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29
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Kerzoncuf M, Jaouen M, Mancini J, Delarque A, Bensoussan L, Viton JM. Satisfaction and long-term use of orthopedic shoes in people with chronic stroke. Ann Phys Rehabil Med 2018; 61:180-182. [PMID: 29476932 DOI: 10.1016/j.rehab.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/07/2018] [Accepted: 02/09/2018] [Indexed: 11/25/2022]
Affiliation(s)
- M Kerzoncuf
- Aix Marseille Univ, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, 13005 Marseille, France.
| | - M Jaouen
- Aix Marseille Univ, APHM, CHU Timone, Physical and Rehabilitation Medicine Department, 13005 Marseille, France
| | - J Mancini
- Aix Marseille Université, Inserm, IRD, 13005 Marseille, France
| | - A Delarque
- Aix Marseille Univ, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, 13005 Marseille, France
| | - L Bensoussan
- Aix Marseille Univ, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, 13005 Marseille, France
| | - J-M Viton
- Aix Marseille Univ, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, 13005 Marseille, France
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30
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Tyson SF, Vail A, Thomas N, Woodward-Nutt K, Plant S, Tyrrell PJ. Bespoke versus off-the-shelf ankle-foot orthosis for people with stroke: randomized controlled trial. Clin Rehabil 2017; 32:367-376. [PMID: 28856945 DOI: 10.1177/0269215517728764] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the study was to compare the effect of two designs of ankle-foot orthosis on people with stroke. DESIGN The study design was an assessor-blind, multicentre randomized controlled trial. SETTING The setting was community stroke services. PARTICIPANTS A total of 139 community-dwelling stroke survivors with limited mobility were recruited. INTERVENTIONS The two most commonly used types of ankle-foot orthosis (bespoke and off-the-shelf) were chosen. MAIN MEASURES The main measures of the study were as follows: short- (6 weeks) and long-term (12 weeks) effects on stroke survivors' satisfaction; adverse events; mobility (Walking Handicap Scale); fear of falling (Falls Efficacy Scale-International (FES-I)) and walking impairments (gait speed and step length using the 5-m walk test). RESULTS Long-term satisfaction was non-significantly higher in the off-the-shelf group: 72% versus 64%; OR (95% CI) = 0.64 (0.31 to 1.3); P = 0.21. No statistically significant differences were found between the orthoses except that the off-the-shelf group had less fear of falling at short-term follow-up than the bespoke group: mean difference (95% CI) = -4.6 (-7.6 to -1.6) points on the FES-I; P = 0.003. CONCLUSION No differences between off-the-shelf and bespoke ankle-foot orthoses were found except that participants in the off-the-shelf orthosis group had less fear of falling at short-term follow-up.
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Affiliation(s)
- Sarah F Tyson
- 1 Stroke Research Centre, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,2 Division of Nursing, Midwifery and Social Work, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Andy Vail
- 1 Stroke Research Centre, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,3 Division of Population Health, Health Services Research and Primary Care, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Nessa Thomas
- 1 Stroke Research Centre, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,2 Division of Nursing, Midwifery and Social Work, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Kate Woodward-Nutt
- 1 Stroke Research Centre, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,2 Division of Nursing, Midwifery and Social Work, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Plant
- 1 Stroke Research Centre, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,2 Division of Nursing, Midwifery and Social Work, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Pippa J Tyrrell
- 1 Stroke Research Centre, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,4 Division of Cardiovascular Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
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31
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In T, Jin Y, Jung K, Cho HY. Treadmill training with Thera-Band improves motor function, gait and balance in stroke patients. NeuroRehabilitation 2017; 40:109-114. [DOI: 10.3233/nre-161395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Taesung In
- Department of Physical Therapy, Gimcheon University, Gimcheon, Republic of Korea
| | - Youngmi Jin
- Department of Physical Therapy, Kaiser Rehabilitation Hospital, Gyeonggi-do, Republic of Korea
| | - Kyoungsim Jung
- Institute for Life Sciences, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
| | - Hwi-young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
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32
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Lee SM, Cynn HS, Yi CH, Yoon TL, Lee JH. Wearable tubing assistive walking device immediately enhances gait parameters in subjects with stroke: A randomized controlled study. NeuroRehabilitation 2016; 40:99-107. [PMID: 27935557 DOI: 10.3233/nre-161394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Stroke patients develop compensatory movements due to limitations of ankle dorsiflexion and knee flexion. To solve the limitations, there are many adjustable walking assistive devices such as robotic devices, ankle-foot orthoses, and functional electric stimulation in rehabilitation session. However, these assistive devices have some disadvantages, including expense and discomforts. Therefore, the development of a new assistive device for stroke patients is needed to assist ankle dorsiflexion and knee flexion. OBJECTIVE This study investigated the effects of a wearable tubing assistive walking device (WTAWD) on gait parameters (gait speed, cadence, and step length and stride length on affected and less affected sides) in patients with stroke. METHODS Gait parameters were measured using the GAITRite system. One-way repeated measures analysis of variance was used to determine gait differences under three conditions (WTAWD, barefoot, and conventional elastic band orthosis). RESULTS Gait speed, cadence, and step length and stride length on both affected and less affected sides were significantly greater with WTAWD, compared to barefoot and conventional elastic band orthosis conditions. CONCLUSION WTAWD could be effective for patients with stroke.
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Affiliation(s)
- Seung-Mi Lee
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of South Korea
| | - Heon-Seock Cynn
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of South Korea
| | - Chung-Hwi Yi
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of South Korea
| | - Tae-Lim Yoon
- Department of Physical Therapy, College of Health Science, Cheongju University, Cheongju, Republic of South Korea
| | - Ji-Hyun Lee
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of South Korea
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33
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Farmani F, Mohseni Bandpei MA, Bahramizadeh M, Aminian G, Nikoo MR, Sadeghi-Goghari M. The effect of different shoes on functional mobility and energy expenditure in post-stroke hemiplegic patients using ankle-foot orthosis. Prosthet Orthot Int 2016; 40:591-7. [PMID: 26184035 DOI: 10.1177/0309364615592704] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle-foot orthoses could be utilized both with and without shoes. While several studies have shown that ankle-foot orthoses improve gait abilities in hemiplegic patients, it remains unclear whether they should be used with shoes or without. OBJECTIVES The study purpose was to compare the effect of standard shoes and rocker shoes on functional mobility in post-stroke hemiplegic patients utilizing ankle-foot orthosis. STUDY DESIGN Randomized clinical study. METHODS Thirty post-stroke hemiplegic patients participated in this study randomly assigned to two groups. Group I received standard shoes + ankle-foot orthosis and group II were provided with rocker shoes + ankle-foot orthosis. Their functional mobility and energy expenditure parameters including timed up and go, timed up stairs, timed down stairs, preferred walking speed, and oxygen (O2) cost (mL/kg/m) were measured. RESULTS In group I, no significant changes were seen in outcome measures after wearing standard shoes. While in group II, O2 cost and timed up and go time significantly decreased, and preferred walking speed increased when patients wore rocker shoes. Also, there was a significant difference between rocker shoes and standard shoes in improvement of timed up and go, preferred walking speed, and O2 cost. CONCLUSION When patients using ankle-foot orthosis wore rocker shoes, their functional mobility improved and oxygen cost diminished. Also, rocker shoes was significantly more effective than standard shoes in improving functional mobility parameters. CLINICAL RELEVANCE This study suggests that in post-stroke hemiplegic patients using ankle-foot orthosis, wearing rocker shoes can lead to much more improved functional mobility and decreased energy expenditure compared to ankle-foot orthosis only. Thus, in stroke patients, the combination of ankle-foot orthosis-rocker shoes is recommended for both rehabilitation programs and ankle-foot orthosis efficacy investigations.
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Affiliation(s)
- Farzad Farmani
- Department of Occupational Therapy, School of Rehabilitation Sciences, Hamedan University of Medical Sciences, Hamedan, Islamic Republic of Iran Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Ali Mohseni Bandpei
- Iranian Research Center on Aging, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Faculty of Allied Health, University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Mahmood Bahramizadeh
- Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Gholamreza Aminian
- Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Reza Nikoo
- Department of Occupational Therapy, School of Rehabilitation Sciences, Hamedan University of Medical Sciences, Hamedan, Islamic Republic of Iran
| | - Mohammad Sadeghi-Goghari
- Department of Physiotherapy, School of Paramedical Sciences, Kerman University of Medical Sciences, Kerman, Islamic Republic of Iran
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de Wit DCM, Buurke JH, Nijlant JMM, Ijzerman MJ, Hermens HJ. The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial. Clin Rehabil 2016; 18:550-7. [PMID: 15293489 DOI: 10.1191/0269215504cr770oa] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFO) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. Design: Cross-over design with randomization for the interventions. Methods: Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test. Results: The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85–8.7), in the TUG test 3.6 s (95% CI 2.4 4.8) and in the stairs test 8.6 s (95% CI 3.1 –14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO. Conclusions: The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO.
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Affiliation(s)
- D C M de Wit
- Roessingh Research and Development, Roessinghbleekweg 33B, 7522 AH Enschede, The Netherlands.
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35
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Nikamp CDM, Buurke JH, van der Palen J, Hermens HJ, Rietman JS. Early or delayed provision of an ankle-foot orthosis in patients with acute and subacute stroke: a randomized controlled trial. Clin Rehabil 2016; 31:798-808. [DOI: 10.1177/0269215516658337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Corien DM Nikamp
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Job van der Palen
- Medisch Spectrum Twente, Medical School Twente, Enschede, The Netherlands
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Hermie J Hermens
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Amputation and Orthopaedics, Roessingh Centre for Rehabilitation, Enschede, The Netherlands
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36
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Pohl M, Mehrholz J. Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients. Clin Rehabil 2016; 20:324-30. [PMID: 16719030 DOI: 10.1191/0269215506cr951oa] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the immediate effects of individually designed functional in-shoe ankle-foot orthoses (AFO) made of soft and hard cast on balance, standing, and gait parameters in hemiparetic patients. Design: Crossover design with randomized 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, standing and gait parameters based on ground reaction forces in two conditions: Patients were randomly 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 postural sway in stance (12.5 mm9 ± 5.2 with AFO versus 15.7 mm9 ± 6.7 without AFO, P < ± 0.05), double stance duration (21.19 ± 14.4% of gait cycle with AFO versus 25.99 ± 21.6% of gait cycle without AFO, P < ± 0.05), and symmetry ratios of gait parameters such as stance duration (2.09 ± 1.5 s with AFO versus 3.39 ± 3.6 s without AFO, P < ± 0.05) and deceleration forces (1.69 ± 0.5 with AFO versus 1.99 ± 0.6 without AFO, P < ± 0.05) during gait. No significant differences were observed in all other symmetry ratios of gait parameters. Conclusion: An individually designed functional in-shoe AFO can improve stance and gait parameters, even in a single use, in patients with hemiparesis.
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Affiliation(s)
- Marcus Pohl
- Department of Early Neurological Rehabilitation, Klinik Bavaria, Kreischa, Germany.
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37
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Bouchalová V, Houben E, Tancsik D, Schaekers L, Meuws L, Feys P. The influence of an ankle-foot orthosis on the spatiotemporal gait parameters and functional balance in chronic stroke patients. J Phys Ther Sci 2016; 28:1621-8. [PMID: 27313385 PMCID: PMC4905924 DOI: 10.1589/jpts.28.1621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/06/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Observational study investigating the influence of various ankle-foot orthoses on the spatiotemporal gait parameters and functional balance in chronic stroke patients. [Subjects and Methods] Fifteen chronic stroke patients participated in this study after providing informed consent. Two groups of patients were differentiated based on the Timed Up and Go Test. Patients were tested in three different conditions: with standard prefabricated ankle-foot orthosis (Maramed), with individualized ankle-foot orthosis (Y-tech), and without any ankle-foot orthrosis. Spatiotemporal gait parameters were obtained by walking on an instrumented walkway (GAITRite(®)) at usual and fastest speed. Balance was assessed with Timed Up and Go Test, Step Test, and Four Square Step Test. [Results] Maramed and Y-tech significantly improved the spatiotemporal parameters while walking at usual and maximal speed (single support time affected side; double support time affected side and step length unaffected side). The Y-tech in addition improved velocity and cadence. Among the balance tests, only the Timed Up and Go test showed improvements in favor of Maramed and Y-tech. [Conclusion] Patients benefited from wearing orthosis at both usual and maximal speed, irrespective of whether they wore Maramed or Y-tech. Only severe stroke patients benefited from wearing an orthoses compared to mild impaired group.
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Affiliation(s)
- Vendula Bouchalová
- Department of Public Health and Preventive Medicine, Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Els Houben
- Rehabilitation Department of Ziekenhuis Oost-Limburg, Belgium
| | - Dorine Tancsik
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Lotte Schaekers
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Leni Meuws
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Peter Feys
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
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Bettoni E, Ferriero G, Bakhsh H, Bravini E, Massazza G, Franchignoni F. A systematic review of questionnaires to assess patient satisfaction with limb orthoses. Prosthet Orthot Int 2016; 40:158-69. [PMID: 25428901 DOI: 10.1177/0309364614556836] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Assessment of patient satisfaction with orthosis is a key point for clinical practice and research, requiring questionnaires with robust psychometric properties. OBJECTIVES To identify which validated questionnaires are used to investigate patient satisfaction with orthosis in limb orthotics and to analyse (1) their main fields of clinical application, (2) the orthosis-related features analysed by the questionnaires and (3) the strength of their psychometric properties. STUDY DESIGN Systematic review. METHODS A literature search using MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases for original articles published within the last 20 years was performed. RESULTS A total of 106 papers pertaining to various clinical fields were selected. The main features of patient satisfaction with orthosis analysed were as follows: aesthetic, ease in donning and doffing the device, time of orthotic use and comfort. CONCLUSION Of the questionnaires used to investigate patient satisfaction with orthosis, only four are adequately validated for this purpose: two for generic orthotic use (Quebec User Evaluation of Satisfaction with assistive Technology 2.0 and Client Satisfaction with Device of Orthotics and Prosthetic Users' Survey) and two for specific application with orthopaedic shoes (Questionnaire for the Usability Evaluation of orthopaedic shoes and Monitor Orthopaedic Shoes). Further development, refinement and validation of outcome measures in this field are warranted. CLINICAL RELEVANCE Given the importance of analysing patient satisfaction with orthosis (PSwO), appropriate instruments to assess outcome are needed. This article reviews the currently available instruments and reflects on how future studies could be focused on the development, refinement and validation of outcome measures in this field.
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Affiliation(s)
| | - Giorgio Ferriero
- Scientific Institute of Veruno, Fondazione Salvatore Maugeri, Veruno, Italy
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Zissimopoulos A, Fatone S, Gard S. Effects of ankle-foot orthoses on mediolateral foot-placement ability during post-stroke gait. Prosthet Orthot Int 2015; 39:372-9. [PMID: 24878846 DOI: 10.1177/0309364614534294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/10/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Accurate and precise mediolateral foot placement is important for balance during gait, but is impaired post stroke. Mediolateral foot placement may be improved with ankle-foot orthosis use. OBJECTIVE The purpose of this study was to determine whether an ankle-foot orthosis improves mediolateral foot-placement ability during post-stroke ambulation. STUDY DESIGN Crossover trial with randomized order of conditions tested. METHODS The accuracy and precision of mediolateral foot placement was quantified while subjects targeted four different randomized step widths. Subjects were tested with and without their regular non-rigid ankle-foot orthosis in two separate visits (order randomized). RESULTS While ankle-foot orthosis use corrected foot and ankle alignment (i.e. significantly decreased mid-swing plantar flexion, p = 0.000), effects of ankle-foot orthosis use on hip hiking (p = 0.545), circumduction (p = 0.179), coronal plane hip range of motion (p = 0.06), and mediolateral foot-placement ability (p = 0.537) were not significant. CONCLUSION While ankle-foot orthosis-mediated equinovarus correction of the affected foot and ankle was not associated with improved biomechanics of walking (i.e. proximal ipsilateral hip kinematics or mediolateral foot-placement ability), it may affect other aspects of balance that were not tested in this study (e.g. proprioception, cerebellar, vestibular, and cognitive mechanisms). CLINICAL RELEVANCE Studies that investigate the effect of ankle-foot orthosis on gait can help advance stroke rehabilitation by documenting the specific gait benefits of ankle-foot orthosis use. In this study, we investigated the effect of ankle-foot orthosis use on mediolateral foot-placement ability, an aspect of gait important for maintaining balance.
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Affiliation(s)
- Angelika Zissimopoulos
- Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA Department of Biomedical Engineering, Northwestern University, Evanston, USA
| | - Stefania Fatone
- Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, USA
| | - Steven Gard
- Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, USA
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Kim HG, Oh YS. Effects of Removable Ankle-Foot Orthosis in Chronic Patients With Effects of Removable Ankle-Foot Orthosis in Chronic Patients With. ACTA ACUST UNITED AC 2015. [DOI: 10.12674/ptk.2015.22.3.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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McMonagle C, Rasmussen S, Elliott MA, Dixon D. Use of the ICF to investigate impairment, activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities. Disabil Rehabil 2015; 38:605-12. [DOI: 10.3109/09638288.2015.1055374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee HY, Lee JH, Kim K. Changes in angular kinematics of the paretic lower limb at different orthotic angles of plantar flexion limitation of an ankle-foot-orthosis for stroke patients. J Phys Ther Sci 2015; 27:825-8. [PMID: 25931739 PMCID: PMC4395723 DOI: 10.1589/jpts.27.825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/24/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] An ankle-foot-orthosis (AFO) is an assistive brace that allows stroke patients
to achieve an independent gait. Therefore, we examined whether or not the orthotic angle
for plantar flexion limitation affects the kinematic parameters of the hip and knee joints
on the affected side of patients with stroke. [Subjects and Methods] Fifteen patients with
chronic hemiplegia were recruited for this study. Kinematic three-dimensional data was
acquired, while patients walked along a walkway wearing AFOs under five different
conditions of 0°, 5°, 10°, 15°, and 20° of plantar stop limitation angle in the orthotic
joint. Peak angles of the hip and knee joints on the affected side were analyzed.
[Results] At the peak angle of the knee joint, statistically significant differences were
found only at mid-stance in the sagittal plane and the horizontal plane. However, no
significant differences were observed among any of the orthotic limitation angles in the
frontal plane. [Conclusion] According to the results, an orthotic limitation angle of more
than 10° elicits changes in the knee joint angle at mid-stance in the sagittal and
horizontal planes. This study provided basic data on postural changes of patients with
stroke.
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Affiliation(s)
- Hye Young Lee
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Jeon Hyeong Lee
- Department of Physical Therapy, Daegu Health College, Republic of Korea
| | - Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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Romkes J, Schweizer K. Immediate effects of unilateral restricted ankle motion on gait kinematics in healthy subjects. Gait Posture 2015; 41:835-40. [PMID: 25800648 DOI: 10.1016/j.gaitpost.2015.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 02/22/2015] [Accepted: 02/28/2015] [Indexed: 02/02/2023]
Abstract
Correcting a pathological toe walking gait pattern can be achieved by restricting excessive plantarflexion during the swing phase of gait. A common conservative treatment measure is providing the patient with an ankle-foot-orthosis on the affected lower leg. This study examined the lower body gait kinematics and temporal-spatial parameters of fifteen healthy adults when walking freely and with unilateral restricted ankle motion. The latter was achieved by fitting an ankle-foot-orthosis. Specific hip and knee kinematic parameters and temporal-spatial parameters were investigated. Differences between the two conditions were calculated by paired Student's t-tests and 95% confidence intervals. Unilateral restricted ankle motion influenced kinematics mainly in the swing phase. Hip and knee peak flexion in the swing phase were increased on the restricted side (hip: 49.2° (SD 4.2°), knee: 75.9° (SD 6.1°)) compared to walking freely (hip: 43.3° (SD 4.5°), knee: 66.7° (SD 5.3°)). Peak hip flexion occurred earlier in the swing phase in the restricted condition (85% (SD 2%)) compared to the free-walking condition (96% (SD 5%)). For these parameters, the confidence intervals were different, indicating clinical relevance. Walking with unilateral restricted ankle motion had a negative effect on walking velocity, cadence, step time, and step length. The confidence intervals, however, overlapped. These results might be a reaction to unusual sensory feedback from the feet with the ankle-foot-orthosis or due to increased hip flexor activity compensating for the reduced function of the plantarflexors. The evaluation of the immediate changes in unilateral restricted ankle motion in individuals with healthy gaits can contribute to a more complete understanding on this topic.
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Affiliation(s)
- Jacqueline Romkes
- Laboratory for Movement Analysis, University Children's Hospital Basel, Spitalstrasse 33, CH-4031 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Katrin Schweizer
- Laboratory for Movement Analysis, University Children's Hospital Basel, Spitalstrasse 33, CH-4031 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Hwang YI, An DH. Immediate effects of an elastic arm sling on walking patterns of chronic stroke patients. J Phys Ther Sci 2015; 27:35-7. [PMID: 25642032 PMCID: PMC4305591 DOI: 10.1589/jpts.27.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/04/2014] [Indexed: 11/24/2022] Open
Abstract
[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.
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Affiliation(s)
| | - Duk-Hyun An
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Tilson JK, Settle SM, Sullivan KJ. Application of Evidence-Based Practice Strategies: Current Trends in Walking Recovery Interventions Poststroke. Top Stroke Rehabil 2015; 15:227-46. [DOI: 10.1310/tsr1503-227] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Effects of Custom-Molded and Prefabricated Hinged Ankle-Foot Orthoses on Gait Parameters and Functional Mobility in Adults with Hemiplegia. ACTA ACUST UNITED AC 2015. [DOI: 10.1097/jpo.0000000000000053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Singer ML, Kobayashi T, Lincoln LS, Orendurff MS, Foreman KB. The effect of ankle-foot orthosis plantarflexion stiffness on ankle and knee joint kinematics and kinetics during first and second rockers of gait in individuals with stroke. Clin Biomech (Bristol, Avon) 2014; 29:1077-80. [PMID: 25241248 PMCID: PMC4254304 DOI: 10.1016/j.clinbiomech.2014.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stiffness of an ankle-foot orthosis plays an important role in improving gait in patients with a history of stroke. To address this, the aim of this case series study was to determine the effect of increasing plantarflexion stiffness of an ankle-foot orthosis on the sagittal ankle and knee joint angle and moment during the first and second rockers of gait. METHODS Gait data were collected in 5 subjects with stroke at a self-selected walking speed under two plantarflexion stiffness conditions (0.4Nm/° and 1.3Nm/°) using a stiffness-adjustable experimental ankle-foot orthosis on a Bertec split-belt fully instrumented treadmill in a 3-dimensional motion analysis laboratory. FINDINGS By increasing the plantarflexion stiffness of the ankle-foot orthosis, peak plantarflexion angle of the ankle was reduced and peak dorsiflexion moment was generally increased in the first rocker as hypothesized. Two subjects demonstrated increases in both peak knee flexion angle and peak knee extension moment in the second rocker as hypothesized. The two subjects exhibited minimum contractility during active plantarflexion, while the other three subjects could actively plantarflex their ankle joint. INTERPRETATION It was suggested that those with the decreased ability to actively plantarflex their ankle could not overcome excessive plantarflexion stiffness at initial contact of gait, and as a result exhibited compensation strategies at the knee joint. Providing excessively stiff ankle-foot orthoses might put added stress on the extensor muscles of the knee joint, potentially creating fatigue and future pathologies in some patients with stroke.
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Affiliation(s)
- Madeline L. Singer
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - Toshiki Kobayashi
- Orthocare Innovations, Mountlake Terrace, WA, USA,Corresponding Author: Toshiki Kobayashi PhD, Orthocare Innovations, 6405 218th St. SW, Suite 301 Mountlake Terrace, WA 98043-2180, USA; Tel: +1 800.672.1710; Fax: +1 206.219.1144; ;
| | | | | | - K. Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
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Chen CL, Teng YL, Lou SZ, Lin CH, Chen FF, Yeung KT. User satisfaction with orthotic devices and service in taiwan. PLoS One 2014; 9:e110661. [PMID: 25338026 PMCID: PMC4206442 DOI: 10.1371/journal.pone.0110661] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022] Open
Abstract
User satisfaction is afforded considerable importance as an outcome measurement in evidence-based healthcare and the client-centered approach. Several studies have investigated user satisfaction with orthoses. Few studies have investigated user satisfaction with orthoses in Taiwan. Therefore, the purpose of this study was to investigate the user satisfaction with orthotic devices and service using the Taiwanese version of Quebec User Evaluation of Satisfaction with Assistive Technology. We conducted a cross-sectional study of 280 subjects who had used orthoses and received services. The results showed that the mean satisfaction score was 3.74 for the devices and 3.56 for service. Concerning the participants, 69.1% and 59.6% were quite satisfied or very satisfied with their devices and service, respectively. The satisfaction score of orthotic service was lower than that of the devices. Regarding demographic characteristics, participants living in different areas differed only in service score (p = 0.002). The participants living in eastern area and offshore islands were the least satisfied with the orthotic service. For clinical characteristics, there was a significant difference in satisfaction scores among severity of disability (all p = 0.015), types of orthoses (all p = 0.001), and duration of usage (all p = 0.001). The participants with mild disability, wearing the pressure garment and using the orthosis for less than one year, were the most satisfied with their orthotic devices and service. There is a need for improved orthotic devices and services, especially with respect to the comfort of the devices and the provision of subsidy funding.
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Affiliation(s)
- Chiung-Ling Chen
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ya-Ling Teng
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shu-Zon Lou
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Hui Lin
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Fen-Fen Chen
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kwok-Tak Yeung
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
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Prenton S, Kenney LP, Cooper G, Major MJ. A sock for foot-drop: a preliminary study on two chronic stroke patients. Prosthet Orthot Int 2014; 38:425-30. [PMID: 24107635 DOI: 10.1177/0309364613505107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Foot-drop is a common motor impairment of chronic stroke patients, which may be addressed with an ankle foot orthosis. Although there is reasonable evidence of effectiveness for ankle foot orthoses, user compliance is sometimes poor. This study investigated a new alternative to the ankle foot orthosis, the dorsiflex sock. CASE DESCRIPTION AND METHODS The dorsiflex sock was evaluated using an A-B single case experimental design. Two community-dwelling, chronic stroke patients with foot-drop participated in this study. Measures were selected to span the International Classification of Function, Disability and Health domains and user views on the dorsiflex sock were also collected. FINDINGS AND OUTCOMES The dorsiflex sock was not effective in improving participants' walking symmetry, speed or energy expenditure. Participant 1 showed improvement in the distance he could walk in 6 min when using the dorsiflex sock, but this was in keeping with a general improvement trend over the course of this study. However, both participants viewed the dorsiflex sock positively and reported a positive effect on their walking. CONCLUSION Despite positive user perceptions, the study found no clear evidence that dorsiflex sock is effective in improving foot-drop. CLINICAL RELEVANCE Although the dorsiflex sock offers an attractive alternative to an ankle foot orthosis, the case studies found no clear evidence of its efficacy. Clinicians should view this device with caution until further research becomes available.
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Affiliation(s)
- Sarah Prenton
- School of Health Sciences, University of Salford, Salford, UK
| | | | - Glen Cooper
- School of Engineering, The Manchester Metropolitan University, Manchester, UK
| | - Matthew J Major
- Northwestern University Prosthetics and Orthotics Center, Northwestern University, Chicago, IL, USA
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The effects of two different ankle-foot orthoses on gait of patients with acute hemiparetic cerebrovascular accident. Rehabil Res Pract 2014; 2014:301469. [PMID: 25276433 PMCID: PMC4174983 DOI: 10.1155/2014/301469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/27/2014] [Indexed: 11/26/2022] Open
Abstract
Objective. To compare the effects of two types of ankle-foot orthoses on gait of patients with cerebrovascular accident (CVA) and to evaluate their preference in using each AFO type. Design. Thirty individuals with acute hemiparetic CVA were tested without an AFO, with an off-the-shelf carbon AFO (C-AFO), and with a custom plastic AFO (P-AFO) in random order at the time of initial orthotic fitting. Gait velocity, cadence, stride length, and step length were collected using an electronic walkway and the subjects were surveyed about their perceptions of each device. Results. Subjects walked significantly faster, with a higher cadence, longer stride, and step lengths, when using either the P-AFO or the C-AFO as compared to no AFO (P < 0.05). No significant difference was observed between gait parameters of the two AFOs. However, the subjects demonstrated a statistically significant preference of using P-AFO in relation to their balance, confidence, and sense of safety during ambulation (P < 0.05). Moreover, if they had a choice, 50.87 ± 14.7% of the participants preferred the P-AFO and 23.56 ± 9.70% preferred the C-AFO. Conclusions. AFO use significantly improved gait in patients with acute CVA. The majority of users preferred the P-AFO over the Cf-AFO especially when asked about balance and sense of safety.
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