Effects of an Ankle-Foot Orthosis on Walking and Mobility After Stroke: a Clinical Trial
DOI:
https://doi.org/10.25759/spmfr.240Keywords:
Ankle, Foot Orthoses, Motor Skills, Orthotic Devices, Recovery of Function, Stroke/complications, Stroke Rehabilitation, WalkingAbstract
Introduction: The aim of the present study was to analyze the effect of an ankle-foot orthosis on walking and mobility of stroke patients with equinus and/or varus foot.
Material and Methods: Nineteen subacute/chronic stroke patients with equinus and/or varus foot which were able to walk without assistance were assessed with and without an ankle-foot orthosis. Physical performance was tested with Fugl-Meyer, mobility was assessed using the timed up & go test and gait measurements were performed with a portable GAITRite system®.
Results: There was a tendency of improvement on mobility and temporo-spatial parameters when using ankle-foot orthosis expressed by a timed up & go test decrease (43.00 to 39.77 s, p = 0.064), a speed improvement (32.10 to 42.00 cm/s, p = ns), a cadence increase (64.40 to 70.00 steps/ minute, p = ns), a cycle time decrease (1.86 to 1.71 s, p = ns) and a base of support decrease (14.67 to 14.55 cm, p = ns), although without significant difference. The positive difference in cadence with orthosis use had moderate correlation with a low Fugl-Meyer assessment lower extremity score (CC = -0.616). The positive difference in velocity with ankle-foot orthosis use had moderate correlation with its use before testing (CC = 0.600).
Conclusion: According to the present study, there is a tendency that supports the use of an ankle-foot orthosis to improve mobility, temporo-spatial parameters and gait symmetry. However, the impact of this orthosis was inconclusive, as these differences were not statically significant. It is known that small improvements in walking cadence may represent important functional benefits. Our research shows the use of an ankle-foot orthosis, namely the more impaired patients with lowest Fugl-Meyer lower extremity score, are those that benefit more. The correlation between the previous using of ankle-foot orthosis with a speed improvement seems to demonstrate the importance of training. There is a need for further well-designed randomized, controlled clinical trials, with larger samples, to establish better scientific evidence for walking effects related to ankle-foot orthosis wearing on stroke patients with equinus and/or varus foot.
Downloads
References
Stein J, Brandstater ME. Stroke Rehabilitation. In: Frontera WR, DeLisa JA,
editors. Physical medicine and rehabilitation: principles and practice. 5th
ed. Philadelphia: Lippincott Williams & Wilkins Health; 2010. xxii, 2200, 39p.
Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic
review. Lancet Neurol. 2009;8:741-54. doi: 10.1016/S1474-4422(09)70150-
Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after
stroke: a systematic review of the literature. Arch Phys Med Rehabil.
;83:1629-37.
Ferreira LA, Neto HP, Grecco LA, Christovao TC, Duarte NA, Lazzari RD,
et al. Effect of ankle-foot orthosis on gait velocity and cadence of stroke
patients: a systematic review. J Phys Ther Sci. 2013;25:1503-8. doi:
1589/jpts.25.1503.
Belda-Lois JM, Mena-del Horno S, Bermejo-Bosch I, Moreno JC, Pons JL,
Farina D, et al. Rehabilitation of gait after stroke: a review towards a topdown
approach. J Neuroeng Rehabil. 2011;8:66. doi: 10.1186/1743-0003-
-66.
Tyson SF, Kent RM. Effects of an ankle-foot orthosis on balance and
walking after stroke: a systematic review and pooled meta-analysis. Arch
Phys Med Rehabil. 2013;94:1377-85. doi: 10.1016/j.apmr.2012.12.025.
Tyson SF, Sadeghi-Demneh E, Nester CJ. A systematic review and metaanalysis
of the effect of an ankle-foot orthosis on gait biomechanics after
stroke. Clin Rehabil. 2013;27:879-91. doi: 10.1177/0269215513486497.
Guerra Padilla M, Molina Rueda F, Alguacil Diego IM. Effect of ankle-foot
orthosis on postural control after stroke: a systematic review. Neurologia.
;29:423-32. doi: 10.1016/j.nrl.2011.10.003.
Brincks J. 3D gait analysis of lower extremity muscle group power in
healthy subjects and subacute stroke patients, and task- specific gait
interventions in early stroke rehabilitation. [Dissertation - Faculty of Health
Sciences, Aarhus University]. Aarhus: FHS, AU; 2010.
Hennessey WJ. Lower Limb Orthotic Devices. In: Braddom RL, Chan L,
Harrast MA, editors. Physical medicine and rehabilitation. 4th ed.
Philadelphia: Saunders/Elsevier; 2011. p. xxiv, 1506 p.
Esquenazi A, Talaty M. Gait Analysis: Technology and Clinical Applications.
In: Braddom RL, Chan L, Harrast MA, editors. Physical medicine and
rehabilitation. 4th ed. Philadelphia: Saunders/Elsevier; 2011. p. xxiv, 1506
p.
Pease WS, Bowyer BL. Human Walking. In: Frontera WR, DeLisa JA,
editors. Physical medicine and rehabilitation: principles and practice. 5th
ed. Philadelphia: Lippincott Williams & Wilkins Health; 2010. xxii, 2200, 39
p.
Esquenazi A, Ofluoglu D, Hirai B, Kim S. The effect of an ankle-foot orthosis
on temporal spatial parameters and asymmetry of gait in hemiparetic
patients. PM R. 2009;1:1014-8. doi: 10.1016/j.pmrj.2009.09.012.
Ng SS, Hui-Chan CW. The timed up & go test: its reliability and association
with lower-limb impairments and locomotor capacities in people with
chronic stroke. Arch Phys Med Rehabil. 2005;86:1641-7. doi: 10.1016/
j.apmr.2005.01.011
Clinical Practice Guideline for the Assessment and Prevention of Falls in
Older People. National Institute for Health and Clinical Excellence:
Guidance. London: NICE; 2004.
Havertown P. GAITRite Operating Manual. MAP/CIR INC; 2007.
Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Longterm
risk of recurrent stroke after a first-ever stroke. The Oxfordshire
Community Stroke Project. Stroke. 1994;25:333-7.
Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke
hemiplegic patient. 1. a method for evaluation of physical performance.
Scand J Rehabil Med. 1975;7:13-31.
Banks JL, Marotta CA. Outcomes validity and reliability of the modified
Rankin scale: implications for stroke clinical trials: a literature review and
synthesis. Stroke. 2007;38:1091-6. doi: 10.1161/01.STR.0000258355.
c6
de Wit DC, Buurke JH, Nijlant JM, Ijzerman MJ, Hermens HJ. The effect of
an ankle-foot orthosis on walking ability in chronic stroke patients: a
randomized controlled trial. Clin Rehabil. 2004;18:550-7. doi: 10.1191/
cr770oa
Downloads
Published
How to Cite
Issue
Section
License
Copyright statement
Authors must also submit a copyright statement (as seen below) on article submission.
To the Editor-in-chief of the SPMFR Journal:
The below signed author(s) hereby state that the article
________________________________________ (ref. MFR_________) is
an original unpublished work and all facts stated are a product of the author(s) investigation. This article does not violate any copyright laws or privacy statements. The author(s) also hereby confirm that there is no conflict of interest's issues in this article.
By submitting this article the author(s) agree that after publication all copyrights belong to the SPMFR Journal.
Signed by all authors
Date:
Names (capital letters):
Signatures:
The SPMFR Journal’s contents are follow a Creative Commons licence. After publication the authors can hand out the articles as long as the SPMFR Journal is credited.
