Objective: To investigate the short- and long-term effects of dynamic ankle foot orthoses on functional ambulation activities in chronic hemiparetic patients.
Design: Randomized controlled trial.
Setting: University’s neurological rehabilitation outpatient clinic and orthotics department.
Subjects: Twenty-eight chronic hemiparetic patients of level 3–5 according to Functional Ambulation Classification and with a maximum spasticity level of 3 according to Modified Ashworth Scale, were randomly assigned to the study and control groups.
Interventions: The control group (n = 14) was assessed with tennis shoes whereas the study group (n = 14) was assessed initially with tennis shoes and after three months with dynamic ankle foot orthosis.
Measures: Functional Reach, Timed Up and Go, Timed Up Stairs, Timed Down Stairs, gait velocity and Physiological Cost Index.
Results: In the initial assessment no difference was found between the groups for any of the measured parameters (P > 0.05). After three months, intergroup comparisons while the patients in the study group were wearing dynamic ankle-foot orthosis showed a significant difference in favour of the study group for Timed Up Stairs 12.00 (10.21) seconds study versus 15.00 (7.29) seconds control group; for gait velocity 0.99 (0.45) m/s study versus 0.72 (0.20) m/s control group and for Physiological Cost Index 0.12 (0.06) beats/min study versus 0.28 (0.13) beats/min control group (P < 0.05). No difference was found between the groups for Functional Reach, Timed Up and Go, Timed Down Stairs (P > 0.05).
Conclusion: Chronic hemiparetic patients may benefit from using dynamic ankle-foot orthosis.
Danielsson A,Sunnerhagen KS.Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis.J Rehabil Med. 2004;36:165-168
2.
Lehmann JF,Condon SM,Price R,deLateur BJ.Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses.Arch Phys Med Rehabil. 1987;68:763-771
3.
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;18:550-557
4.
Chen G,Patten C,Kothari DH,Zajac FE.Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds.Gait Posture. 2005;22:51-56
5.
Ford MP,Wagenaar RC,Newell KM.Phase manipulation and walking in stroke.J Neurol Phys Ther. 2007;31:85-91
6.
Franceschini M,Massucci M,Ferrari L,Agosti M,Paroli C.Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait.Clin Rehabil. 2003;17:368-372
7.
Thijssen DH,Paulus R,van Uden CJ,Kooloos JG,Hopman MT.Decreased energy cost and improved gait pattern using a new orthosis in persons with long-term stroke.Arch Phys Med Rehabil. 2007;88:181-186
8.
Leung J.Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia, systematic literature review.Physiotherapy. 2002;89:39-55
9.
Geiger RA,Allen JB,O’Keefe J,Hicks RR.Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training.Phys Ther. 2001;81:995-1005
10.
Hylton NM.Postural and functional impact of dynamic AFO’s and FO’s in a pediatric population.J Prosthet Orthot. 1989;2:40-53
11.
Mueller K,McPoil T.Effect of a tone-inhibiting dynamic ankle-foot orthosis on the foot-loading pattern of a hemiplegic adult: a preliminary study.J Prosthet Orthot. 1992;4:86-92
12.
Naslund A,Tamm M,Ericsson AK.Dynamic ankle foot orthoses as a part of treatment in children with spastic diplegia parents’ perceptions.Physiother Res Int. 2003;8:59-68
13.
Bjornson KF,Schmale GA,Adamczyk-Foster A,McLaughlin J.The effect of dynamic ankle foot orthoses on function in children with cerebral palsy.J Pediatr Orthop. 2006;26:773-776
14.
Romkes J,Brunner R.Comparison of a dynamic and a hinged ankle-foot orthosis by gait analysis in patients with hemiplegic cerebral palsy.Gait Posture. 2002;15:18-24
15.
Lam WK,Leong JC,Li YH,Hu Y,Lu WW.Biomechanical and electromyographic evaluation of ankle foot orthosis and dynamic ankle foot orthosis in spastic cerebral palsy.Gait Posture. 2005;22:189-197
16.
Radtka SA,Skinner SR,Dixon DM,Johanson ME.A comparison of gait with solid, dynamic, and no ankle-foot orthoses in children with spastic cerebral palsy.Phys Ther. 1997;77:395-409
17.
Ibuki A,Bach T,Rogers D,Bernhardt J.The effect of tone-reducing orthotic devices on soleus muscle reflex excitability while standing in patients with spasticity following stroke.Prosthet Orthot Int. 2010;34:46-57
18.
Ibuki A,Bach T,Rogers D,Bernhardt J.An investigation of the neurophysiologic effect of tone-reducing AFOs on reflex excitability in subjects with spasticity following stroke while standing.Prosthet Orthot Int. 2010;34:154-165
19.
Dieli J.Effect of dynamic AFOs on three hemiplegic adults.J Prosthet Orthot. 1997;2:82-89
20.
Diamond MF,Ottenbacher KJ.Effect of a tone-inhibiting dynamic ankle-foot orthosis on stride characteristics of an adult with hemiparesis.Phys Ther. 1990;70:423-430
21.
Holden MK,Gill KM.Gait assessment for neurologically impaired patients Standards for outcome assessment.Phys Ther. 1986;66:1530-1539
22.
Holden MK,Gill KM,Magliozzi MR,Nathan J,Piehl-Baker L.Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness.Phys Ther. 1984;64:35-40
23.
Blackburn M,van Vliet P,Mockett SP.Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke.Phys Ther. 2002;82:25-34
24.
Smith PS,Hembree JA,Thompson ME.Berg Balance Scale and Functional Reach: determining the best clinical tool for individuals post acute stroke.Clin Rehabil. 2004;18:811-818
25.
Duncan PW,Weiner DK,Chandler J,Studenski S.Functional reach: a new clinical measure of balance.J Gerontol. 1990;45:M192-M197
26.
Deathe AB,Miller WC.The L test of functional mobility: measurement properties of a modified version of the timed ‘up & go’ test designed for people with lower-limb amputations.Phys Ther. 2005;85:626-635
27.
Danielsson A,Willen C,Sunnerhagen KS.Measurement of energy cost by the physiological cost index in walking after stroke.Arch Phys Med Rehabil. 2007;88:1298-1303
28.
.
29.
Kotrlik JW,Williams HA.The incorporation of effect size in information technology, learning and performance research.Information Technol Learning Performance J. 2003;21:1-7
30.
Cohen J.Statistical power analysis.Curr Dir Psychol Sci. 1992;1:98-101
31.
Salbach NM,Mayo NE,Higgins J,Ahmed S,Finch LE,Richards CL.Responsiveness and predictability of gait speed and other disability measures in acute stroke.Arch Phys Med Rehabil. 2001;82:1204-1212
32.
Ford MP,Wagenaar RC,Newell KM.Phase manipulation and walking in stroke.J Neurol Phys Ther. 2007;31:85-91
33.
Mojica JA,Nakamura R,Kobayashi T,Handa T,Morohashi I,Watanabe S.Effect of ankle-foot orthosis (AFO) on body sway and walking capacity of hemiparetic stroke patients.Tohoku J Exp Med. 1988;156:395-401
34.
Tyson SF,Thornton HA.The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users’ opinions.Clin Rehabil. 2001;15:53-58
35.
Corcoran PJ,Jebsen RH,Brengelmann GL,Simons BC.Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation.Arch Phys Med Rehabil. 1970;51:69-77
36.
Beckerman H,Becher J,Lankhorst GJ,Verbeek AL.Walking ability of stroke patients: efficacy of tibial nerve blocking and a polypropylene ankle-foot orthosis.Arch Phys Med Rehabil. 1996;77:1144-1151
37.
Beckerman H,Becher J,Lankhorst GJ,Verbeek AL.The efficacy of thermocoagulation of the tibial nerve and a polypropylene ankle-foot orthosis on spasticity of the leg in stroke patients: results of a randomized clinical trial.Clin Rehabil. 1996;10:112-120
38.
Graham RC,Smith NM,White CM.The reliability and validity of the physiological cost index in healthy subjects while walking on 2 different tracks.Arch Phys Med Rehabil. 2005;86:2041-2046
39.
Flansbjer UB,Holmback AM,Downham D,Patten C,Lexell J.Reliability of gait performance tests in men and women with hemiparesis after stroke.J Rehabil Med. 2005;37:75-82
40.
Zaino CA,Marchese VG,Westcott SL.Timed up and down stairs test: preliminary reliability and validity of a new measure of functional mobility.Pediatr Phys Ther. 2004;16:90-98
41.
Tyson SF,DeSouza LH.Reliability and validity of functional balance tests post stroke.Clin Rehabil. 2004;18:916-923
