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.
Get full access to this article
View all access options for this article.
References
1.
1 Kirker SG, Simpson DS, Jenner JR, Wing AM. Stepping before standing: hip muscle function in stepping and standing balance after stroke. J Neurol Neurosurg Psychiatry2000; 68: 458–464.
2.
2 Carr J, Shepherd R. Stroke rehabilitation: guidelines for exercise and training to optimise motor skills. Butterworth-Heinemann, 2003.
3.
3 Tyson SF, Thornton HA. The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users' opinions. Clin Rehabil2001; 15:53–58.
4.
4 Churchill A, Halligan P, Wade D. Relative contribution of footwear to the efficacy of ankle-foot orthoses. Clin Rehabil2003; 17: 553–557.
5.
5 Hesse S, Werner C, Matthias K, Stephen K, Berteanu M. Non-velocity-related effects of a rigid double-stopped ankle-foot orthosis on gait and lower limb muscle activity of hemiparetic subjects with an equinovarus deformity. Stroke1999; 30: 1855–1861.
6.
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 Rehabil2003; 17: 368–372.
7.
7 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 Rehabil1970; 51:69–77.
8.
8 Burdett RG, Borello-France D, Blatchly C, Potter C. Gait comparison of subjects with hemiplegia walking unbraced, with ankle-foot orthosis, and with Air-Stirrup brace. Phys Ther1988; 68: 1197–1203.
9.
9 Chen CL, Yeung KT, Wang CH, Chu HT, Yeh CY. Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients. Arch Phys Med Rehabil1999; 80: 1587–1592.
10.
10 Iwata M, Kondo I, Sato Y et al. An ankle-foot orthosis with inhibitor bar: effect on hemiplegic gait. Arch Phys Med Rehabil2003; 84: 924–927.
11.
11 Sienko Thomas S, Buckon CE, Jakobson-Huston S, Sussman MD, Aiona MD. Stair locomotion in children with spastic hemiplegia: the impact of three different ankle foot orthosis (AFOs) configurations. Gait Posture2002; 16: 180–187.
12.
12 Romkes J, Brunner R. Comparison of a dynamic and a hinged ankle-foot orthosis by gait analysis in patients with hemiplegic cerebral palsy. Gait Posture2002; 15:18–24.
13.
13 Geboers JF, Drost MR, Spaans F, Kuipers H, Seelen HA. Immediate and long-term effects of ankle-foot orthosis on muscle activity during walking: a randomized study of patients with unilateral foot drop. Arch Phys Med Rehabil2002; 83: 240–245.
14.
14 Gok H, Kucukdeveci A, Altinkaynak H, Yavuzer G, Ergin S. Effects of ankle-foot orthoses on hemiparetic gait. Clin Rehabil2003; 17: 137–139.
15.
15 Diamond MF, Ottenbacher KJ. Effect of a tone-inhibiting dynamic ankle-foot orthosis on stride characteristics of an adult with hemiparesis. Phys Ther1990; 70: 423–430.
16.
16 Hesse S, Schewe H, Strohmeyer K. Verordnung von Sprunggelenksorthesen für Patienten mit Hemiparese. Z Physiother1993; 45: 827–834.
17.
17 Mehrholz J, Rockstroh G, Mrass G, Pohl M. Einfluß funktioneller Gehschienen auf Gehen und Stehen von Patienten mit Hemiparese. Z Physiother2001; 53: 1334–1339.
18.
18 Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther1984; 64:35–40.
19.
19 Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther1987; 67: 206–207.
20.
20 Schuren J. 3. Teil: Verbände der unteren Extremität. In Schuren J ed. Arbeiten mit Softcast. Ein handbuch fü r die semi-rigide Immobilisation. Minnesota Mining & Manufacturing, 1994: 104–109.
21.
21 Laufer Y. The effect of walking aids on balance and weight-bearing patterns of patients with hemiparesis in various stance positions. Phys Ther2003; 83: 112–122.
22.
22 Le Clair K, Riach C. Postural stability measures: what to measure and for how long. Clin Biomech (Bristol, Avon)1996; 11: 176–178.
23.
23 Stüssi E, Debrunner, HU. Parameter-Analyse des menschlichen Ganges. Biomed Tech1980; 25: 222–223.
24.
24 Pohl M, Rockstroh G, Ruckriem S, Mrass G, Mehrholz J. Immediate effects of speed-dependent treadmill training on gait parameters in early Parkinson's disease. Arch Phys Med Rehabil2003; 84: 1760–1766.
25.
25 Hesse SA, Jahnke MT, Bertelt CM et al. Gait outcome in ambulatory hemiparetic patients after a 4-week comprehensive rehabilitation program and prognostic factors. Stroke1994; 25: 1999–2004.
26.
26 Sachs L. Angewandte Statistik. Springer, 2004.
27.
27 Glantz S. Biostatistik. McGraw-Hill, 1998.
28.
28 Burtner PA, Woollacott MH, Qualls C. Stance balance control with orthoses in a group of children with spastic cerebral palsy. Dev Med Child Neurol1999; 41: 748–757.
29.
29 Hesse S, Luecke D, Jahnke MT, Mauritz KH. Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis. Int J Rehabil Res1996; 19: 133–141.
30.
30 Davies P. Im Mittelpunkt. Springer, 1990.
31.
31 Bobath B. Die Hemiplegie Erwachsener. Thieme, 1990.
32.
32 Edwards S. Neurological physiotherapy: a problem-solving approach. Churchill Livingstone, 2001.
33.
33 Lehmann JF, Condon SM, Price R, deLateur BJ. Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses. Arch Phys Med Rehabil1987; 68: 763–771.
34.
34 Leung J, Moseley A. Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia: systematic literature review. Physiotherapy2003; 89:39–55.
35.
35 Perry J. Gait analysis, normal and pathological function. Slack Inc, 1992.
36.
36 Hesse S, Werner C. Poststroke motor dysfunction and spasticity: novel pharmacological and physical treatment strategies. CNS Drugs2003; 17: 1093–1107.
37.
37 Cross J, Tyson S. The effect of a slider shoe on hemiparetic gait. Clin Rehabil2003; 17: 817–824.
