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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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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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Intersegmental coordination of gait after hemorrhagic stroke. Exp Brain Res 2014; 233:125-35. [DOI: 10.1007/s00221-014-4099-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/04/2014] [Indexed: 11/25/2022]
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Effect of ankle-foot orthosis on postural control after stroke: A systematic review. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2011.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Shrivastava S, Prabhu RKR, Kirubakaran R, Thomasraj J, Sundaram B. Ankle foot orthosis for walking in stroke rehabilitation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sonali Shrivastava
- Advanced Physiotherapy Centre; House Number 188, Jawahar Nagar Durg Chhattisgarh India 491001
| | - Rama KR Prabhu
- Gulf Medical University; College of Allied Health Sciences; Ajman United Arab Emirates
| | - Richard Kirubakaran
- Christian Medical College; South Asian Cochrane Network & Center, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
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Chisholm AE, Perry SD, McIlroy WE. Correlations between ankle-foot impairments and dropped foot gait deviations among stroke survivors. Clin Biomech (Bristol, Avon) 2014; 28:1049-54. [PMID: 24094611 DOI: 10.1016/j.clinbiomech.2013.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 07/04/2013] [Accepted: 09/13/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this paper is to 1) evaluate the relationship between ankle kinematics during gait and standardized measures of ankle impairments among sub-acute stroke survivors, and 2) compare the degree of stroke-related ankle impairment between individuals with and without dropped foot gait deviations. METHODS Fifty-five independently ambulating stroke survivors participated in this study. Dropped foot was defined as decreased peak dorsiflexion during the swing phase and reduced ankle joint motion in stance. Standardized outcome measures included the Chedoke-McMaster Stroke Assessment (motor impairment), Modified Ashworth Scale (spasticity), Medical Research Council (muscle strength), passive and active range of motion, and isometric muscle force. FINDINGS Foot impairment was not related to peak dorsiflexion during swing (r=-0.17, P=0.247) and joint motion during stance (r=0.05, P=0.735). Active (r=0.45, P<0.001) and passive (r=0.48, P<0.001) range of motion was associated with stance phase joint motion. Peak dorsiflexion during swing was related to isometric dorsiflexor muscle force (r=-0.32, P=0.039). Individuals with dropped foot demonstrated greater motor impairment, plantarflexor spasticity and ankle muscle weakness compared to those without dropped foot. INTERPRETATION Our investigation suggests that ankle-foot impairments are related to ankle deviations during gait, as indicated by greater impairment among individuals with dropped foot. These findings contribute to a better understanding of gait-specific ankle deviations, and may lead to the development of a more effective clinical assessment of dropped foot impairment.
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Affiliation(s)
- Amanda E Chisholm
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada.
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Bulley C, Mercer TH, Hooper JE, Cowan P, Scott S, van der Linden ML. Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis. Disabil Rehabil Assist Technol 2014; 10:458-467. [PMID: 24796365 DOI: 10.3109/17483107.2014.913713] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE A constructivist phenomenological study explored impacts of ankle foot orthoses (AFOs) or functional electrical stimulation (FES) on people with foot-drop from multiple sclerosis (MS). METHOD Focus groups following topic guides were analysed using interpretative phenomenological analysis, with researcher reflexivity, participant verification and peer checking of analysis. Participants with sustained use of the devices (under 2 y) were invited from two quantitative studies that (a) investigated immediate FES effects (n = 12) and (b) compared habitual use of AFO (n = 7) or FES (n = 6). Two focus groups addressed AFO (n = 4) and FES (n = 6) experiences. RESULTS Similar numbers of positive and negative aspects were described for AFO and FES. Both reduced fatigue, improved gait, reduced trips and falls, increased participation, and increased confidence; greater balance/stability was reported for AFOs, and increased walking distance, fitness and physical activity for FES. Barriers to both included avoiding reliance on devices and implications for shoes and clothing; a non-normal gait pattern was reported for AFO, and difficulties of application and limitations in the design of FES. However, participants felt the positives outweighed the negatives. CONCLUSIONS Participants felt benefits outweighed the drawbacks for AFO and FES; greater understanding of user preferences and satisfaction may increase likelihood of usage and efficacy. Implications for Rehabilitation Interventions to reduce the impacts of foot-drop in people with multiple sclerosis (MS) are important to optimise physical activity participation and participation in life; they include ankle foot orthoses (AFOs) and functional electrical stimulation (FES). Research is lacking regarding user satisfaction and perceived outcomes, therefore, two separate focus groups were conducted from a constructivist phenomenological perspective to explore the impacts of AFOs (n = 4) and FES (n = 6) on people with foot-drop from MS. Some similar positive aspects of AFO and FES use were described, including reduced fatigue, improved gait and fewer trips and falls, while common barriers included finding the device cumbersome, uncomfortable, and inconvenient, with some psychological barriers to their use. On balance, the impacts of the devices on improving activities and participation were more important for participants than practical barriers, highlighting the importance of combining understanding of individual experiences and preferences with clinical decision-making when prescribing a device to manage foot-drop.
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Affiliation(s)
- Catherine Bulley
- a School of Health Sciences, Queen Margaret University , Edinburgh , UK
| | - Thomas H Mercer
- a School of Health Sciences, Queen Margaret University , Edinburgh , UK
| | | | - Paula Cowan
- c Kenilworth Medical Centre , Cumbernauld , UK
| | - Sasha Scott
- a School of Health Sciences, Queen Margaret University , Edinburgh , UK
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Chow JW, Yablon SA, Stokic DS. Effect of Intrathecal Baclofen Bolus Injection on Ankle Muscle Activation During Gait in Patients With Acquired Brain Injury. Neurorehabil Neural Repair 2014; 29:163-73. [DOI: 10.1177/1545968314533615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Intrathecal baclofen (ITB) bolus injection effectively decreases spinal excitability but the impact on lower limb muscle activation during gait has not been thoroughly investigated. Objective. Examine activation of medial gastrocnemius (MG) and tibialis anterior (TA) muscles during gait before and after ITB bolus injection in patients with resting hypertonia after acquired brain injury. Methods. Lower extremity Ashworth score, temporospatial gait parameters, characteristics of the linear relationship between electromyogram (EMG) and lengthening velocity (LV) in MG during stance, and the duration and magnitude of TA-MG coactivation were assessed before and at 2, 4, and 6 hours after a 50-µg ITB injection via lumbar puncture in 8 hemorrhagic stroke and 11 traumatic brain injury subjects. Results. Temporospatial gait parameters did not significantly differ across the evaluation points ( P ≥ .170). However, Ashworth score ( P < .001), frequency and gain of significant positive EMG-LV slope ( P ≤ .020), and duration of TA-MG coactivation ( P ≤ .013) significantly decreased in the more-affected leg after ITB bolus. EMG changes were not significantly different between patients who did (n = 10) and did not (n = 9) increase gait speed after the injection. The timing of the largest decrease in Ashworth score and the largest decrease in EMG parameters coincided in 36% of cases, on average. Conclusions. ITB bolus injection alters the activation of MG and TA during gait. However, the changes in muscle activation are not closely related to the changes in gait speed or resting muscle hypertonia. The analysis of ankle muscle activation during gait better characterizes the response to ITB bolus injection than gait kinematics.
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Affiliation(s)
- John W. Chow
- Methodist Rehabilitation Center, Jackson, MS, USA
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Zissimopoulos A, Fatone S, Gard S. The effect of ankle-foot orthoses on self-reported balance confidence in persons with chronic poststroke hemiplegia. Prosthet Orthot Int 2014; 38:148-54. [PMID: 23798045 DOI: 10.1177/0309364613490445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND One intervention often used to address physical impairments post stroke is an ankle-foot orthosis. Ankle-foot orthoses may improve walking speed, stride length, and gait pattern. However, effects on balance, crucial for safe ambulation, are thus far inconclusive. One aspect of balance shown to contribute to functional ability is self-efficacy. Self-efficacy, defined as the belief in one's ability to succeed in particular situations, has been shown to be more strongly associated with activity and participation (as defined by the International Classification of Functioning, Disability, and Health) than physical performance measures of gait or balance. OBJECTIVES We investigated whether self-efficacy, or balance confidence when referred to in the context of balance capabilities, is improved with ankle-foot orthosis use. STUDY DESIGN Repeated measures study design. METHODS Balance confidence was measured using the Activities-specific Balance Confidence Scale in 15 persons with chronic poststroke hemiplegia, with and without their regular ankle-foot orthosis. RESULTS Activities-specific Balance Confidence Scale scores were significantly higher (p ≤ 0.01) for the ankle-foot orthosis condition compared to no ankle-foot orthosis. CONCLUSIONS One mechanism by which ankle-foot orthosis use may influence balance is improved balance confidence. Future work should explore the specific mechanisms underlying this improvement in self-efficacy. Clinical relevance Self-efficacy may be an important factor to consider when evaluating functioning post stroke. Rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations, particularly in the fall-prone poststroke population. Study results provide evidence for improvements in balance confidence with ankle-foot orthosis use.
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Affiliation(s)
- Angelika Zissimopoulos
- 1Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA
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60
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Ferreira LAB, Neto HP, Grecco LAC, Christovão TCL, Duarte NA, Lazzari RD, Galli M, Oliveira CS. Effect of Ankle-foot Orthosis on Gait Velocity and Cadence of Stroke Patients: A Systematic Review. J Phys Ther Sci 2013; 25:1503-8. [PMID: 24396220 PMCID: PMC3881487 DOI: 10.1589/jpts.25.1503] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/20/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the present study was to analyze the effect of an ankle-foot orthosis on gait variables (velocity and cadence) of stroke patients. To do this, a systematic review was conducted of four databases. [Subjects and Methods] The papers identified were evaluated based on the following inclusion criteria: 1) design: controlled, clinical trial; 2) population: stroke patients; 3) intervention: analysis of spatiotemporal variables of gait with an ankle-foot orthosis; 4) control group with different intervention or no intervention; and 5) outcome: improvement in gait velocity or cadence. [Results] Thirteen controlled trials addressing the effect of an ankle-foot orthosis on gait variables of stroke patients were found. They exhibited methodological quality of 3 or more points on the PEDro scale. [Conclusion] While the findings suggest the benefits of an AFO regarding gait velocity, the impact of this type of orthosis on cadence remains inconclusive. Thus, there is a need for further well-designed randomized, controlled, clinical trials to establish better scientific evidence for the effects of AFO usage on gait variables of stroke patients.
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Affiliation(s)
- Luiz Alfredo Braun Ferreira
- Physical Therapy Department, Guairacá College, Brazil,
Student in Doctoral Program in Rehabilitation Sciences, Nove de Julho University,
Brazil
| | - Hugo Pasini Neto
- Doctoral Program in Rehabilitation Sciences, Nove de Julho
University, Brazil
| | | | | | | | | | - Manuela Galli
- Applied Mechanics (Biomechanics) Politecnico di Milano.
Responsible of the Scientific, Technical, Administrative Activities of Posture and
Movement Analysis Laboratory “Luigi Divieti”, Italy
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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. [PMID: 23416220 DOI: 10.1016/j.apmr.2012.12.025] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/13/2012] [Indexed: 11/23/2022]
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Tyson SF, Sadeghi-Demneh E, Nester CJ. A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke. Clin Rehabil 2013; 27:879-91. [PMID: 23798747 DOI: 10.1177/0269215513486497] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review the evidence on the effects of an ankle-foot orthosis on gait biomechanics after stroke. DATA SOURCES The following databases were searched; AMED, CINHAL, Cochrane Library (Stroke section), Medline, PubMed, Science Direct and Scopus. Previous reviews, reference lists and citation tracking of the selected articles were screened and the authors of selected trials contacted for any further unpublished data. REVIEW METHODS Controlled trials of an ankle-foot orthosis on gait biomechanics in stroke survivors were identified. A modified PEDro score evaluated trial quality; those scoring 4/8 or more were selected. Information on the trial design, population, intervention, outcomes, and mean and standard deviation values for the treatment and control groups were extracted. Continuous outcomes were pooled according to their mean difference and 95% confidence intervals in a fixed-effect model. RESULTS Twenty trials involving 314 participants were selected. An ankle-foot orthosis had a positive effect on ankle kinematics (P < 0.00001-0.0002); knee kinematics in stance phase (P < 0.0001-0.01); kinetics (P = 0.0001) and energy cost (P = 0.004), but not on knee kinematics in swing phase (P = 0.84), hip kinematics (P < 0.18-0.89) or energy expenditure (P = 0.43). There were insufficient data for pooled analysis of individual joint moments, muscle activity or spasticity. All trials, except one, evaluated immediate effects only. CONCLUSIONS An ankle-foot orthosis can improve the ankle and knee kinematics, kinetics and energy cost of walking in stroke survivors.
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Affiliation(s)
- S F Tyson
- Stroke and Vascular Research Centre and School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Arvin M, Kamyab M, Moradi V, Hajiaghaei B, Maroufi N. Influence of modified solid ankle-foot orthosis to be used with and without shoe on dynamic balance and gait characteristic in asymptomatic people. Prosthet Orthot Int 2013; 37:145-51. [PMID: 22907949 DOI: 10.1177/0309364612454159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle-foot orthoses are usually used in combination with footwear. Shoe design can have a significant effect on kinematics of the lower limb joints and line of action of the ground reaction force during walking. But, ankle-foot orthosis-footwear combination is not appropriate for indoor barefoot walking in some Asian cultures. In this study, we have modified a solid ankle-foot orthosis in order to set it in the same position as a solid ankle-foot orthosis-footwear combination. OBJECTIVE To investigate the effect of a modified solid ankle-foot orthosis; a solid ankle-foot orthosis which can be locked in different positions on gait and balance performance in comparison with a conventional solid ankle-foot orthosis, a common solid ankle-foot orthosis-shoe combination in asymptomatic adults. STUDY DESIGN Cross sectional. METHODS Two standard solid ankle-foot orthoses were manufactured with the ankle joint in neutral position. Then, one of these solid ankle-foot orthoses was modified in order to allow locking in a different alignment. Walk across, limit of stability, and sit-to-stand tests of the balance master system were performed while participants wore the modified solid ankle-foot orthosis aligned in 5°-7° anterior inclination without a shoe and a conventional solid ankle-foot orthosis-shoe combination. RESULTS There was no significant change in walking speed, step length, and step width with the conventional and modified solid ankle-foot orthoses. In addition, movement velocity and maximum excursion of the center of gravity during the limit of stability test were not different, although the maximal forward excursion of the center of gravity was longer when wearing the modified solid ankle-foot orthosis compared to the conventional solid ankle-foot orthosis-shoe combination (P = 0.000). Sway velocity of the center of gravity did not change during the sit-to-stand test. CONCLUSION The results demonstrated that the modified solid ankle-foot orthosis had the same effects as the conventional solid ankle-foot orthosis-shoe combination on the gait and balance performance of asymptomatic adults. Clinical relevance The findings of the present study can be used as the basis for further investigations on the efficacy of the modified solid ankle-foot orthoses in different neuromuscular populations in order to help people who do not wear shoes at home, as is the custom in some Asian cultures.
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Affiliation(s)
- Mina Arvin
- Tehran University of Medical Sciences, Faculty of Rehabilitation Sciences, Tehran, Iran.
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Kobayashi T, Leung AKL, Akazawa Y, Hutchins SW. The effect of varying the plantarflexion resistance of an ankle-foot orthosis on knee joint kinematics in patients with stroke. Gait Posture 2013; 37:457-9. [PMID: 22921491 DOI: 10.1016/j.gaitpost.2012.07.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 07/25/2012] [Accepted: 07/30/2012] [Indexed: 02/02/2023]
Abstract
Ankle-foot orthoses (AFOs) can improve gait in patients with hemiplegia. However, it is anecdotally known that excessive plantarflexion resistance of an AFO could induce undesired knee flexion at early stance. The aim of this study was to systematically investigate the effect of varying the degrees of plantarflexion resistance of an AFO on knee flexion angles at early stance in five subjects with chronic stroke who demonstrated two clear knee flexion peaks at early stance and swing. Each subject wore an experimental AFO constructed with an oil-damper type ankle joint and was instructed to walk at their self-selected walking speed under five plantarflexion resistance conditions. The sagittal plane ankle and knee joint kinematics and gait speed were analyzed using a 3-D Motion Analysis System. A number of significant differences (P<0.005) in maximum knee flexion angles at early stance amongst different plantarflexion resistance conditions were revealed. The knee flexion angle was 23.80 (3.25) degrees under the free hinge joint condition (condition 1), while that was 26.09 (3.79) degrees under the largest resistance condition (condition 5). It was therefore demonstrated that increasing the plantarflexion resistance of an AFO would induce more knee flexion at early stance phase in patients with stroke.
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Affiliation(s)
- Toshiki Kobayashi
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.
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Gatti MA, Freixes O, Fernández SA, Rivas ME, Crespo M, Waldman SV, Olmos LE. Effects of ankle foot orthosis in stiff knee gait in adults with hemiplegia. J Biomech 2012; 45:2658-61. [PMID: 22980576 DOI: 10.1016/j.jbiomech.2012.08.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 08/08/2012] [Accepted: 08/09/2012] [Indexed: 11/28/2022]
Abstract
Stroke survivors present a less efficient gait compared to healthy subjects due to abnormal knee flexion during the swing phase of gait, associated with spasticity of the rectus femoris muscle and overactivity of the ankle plantarflexors. It is relevant to understand the effect of the ankle foot orthosis (AFO) on gait in individuals with plantarflexor spasticity. The aim of this study was to compare the knee kinematics with an AFO/footwear combination and barefoot in post-stroke subjects with plantarflexor spasticity. Ten subjects with chronic hemiplegia were measured. Two kinematic variables were assessed during the swing phase of the paretic limb: knee flexion angle at toeoff and peak knee flexion angle. We also analyzed gait speed and step length of the non-paretic limb. All variables were obtained with and without the orthosis. Kinematic data were acquired using a motion capture system (ELITE). Subjects wearing an AFO showed significant improvements in gait speed (0.62 m/s (0.08 SD) vs. 0.47 m/s (0.13 SD) (p=0.007)), step length of the non-paretic limb (42 cm (5.9 SD) vs. 33.5 cm (6.6 SD) (p=0.005)) and peak knee flexion angle during the swing phase: 30.7° (14.1° SD) vs. 26.3° (11.7° SD) p=0.005. No significant differences were obtained in the knee flexion angle at toeoff between no AFO and AFO conditions. We described benefits with AFO/footwear use in the kinematics of the knee, the step length of the non-paretic limb, and the gait velocity in hemiplegic subjects after mild to moderate stroke. We conclude that the use of an AFO can improve the gait pattern and increase velocity in these subjects.
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Affiliation(s)
- Marcelo Andrés Gatti
- Physical Therapy Unit, FLENI Rehabilitation Institute, Ruta 9 Km 52.5 Colectora Este, Escobar Buenos Aires, Argentina.
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Ambulatory Function and Perception of Confidence in Persons with Stroke with a Custom-Made Hinged versus a Standard Ankle Foot Orthosis. Rehabil Res Pract 2012; 2012:206495. [PMID: 22685664 PMCID: PMC3362993 DOI: 10.1155/2012/206495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/07/2012] [Accepted: 03/16/2012] [Indexed: 11/20/2022] Open
Abstract
Objective. The aim was to compare walking with an individually designed dynamic hinged ankle foot orthosis (DAFO) and a standard carbon composite ankle foot orthosis (C-AFO). Methods. Twelve participants, mean age 56 years (range 26–72), with hemiparesis due to stroke were included in the study. During the six-minute walk test (6MW), walking velocity, the Physiological Cost Index (PCI), and the degree of experienced exertion were measured with a DAFO and C-AFO, respectively, followed by a Stairs Test velocity and perceived confidence was rated. Results. The mean differences in favor for the DAFO were in 6MW 24.3 m (95% confidence interval [CI] 4.90, 43.76), PCI −0.09 beats/m (95% CI −0.27, 0.95), velocity 0.04 m/s (95% CI −0.01, 0.097), and in the Stairs Test −11.8 s (95% CI −19.05, −4.48). All participants except one perceived the degree of experienced exertion lower and felt more confident when walking with the DAFO. Conclusions. Wearing a DAFO resulted in longer walking distance and faster stair climbing compared to walking with a C-AFO. Eleven of twelve participants felt more confident with the DAFO, which may be more important than speed and distance and the most important reason for prescribing an AFO.
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Chisholm AE, Perry SD. Ankle-foot orthotic management in neuromuscular disorders: recommendations for future research. Disabil Rehabil Assist Technol 2012; 7:437-49. [PMID: 22533384 DOI: 10.3109/17483107.2012.680940] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Guerra Padilla M, Molina Rueda F, Alguacil Diego IM. Effect of ankle-foot orthosis on postural control after stroke: a systematic review. Neurologia 2011; 29:423-32. [PMID: 22178049 DOI: 10.1016/j.nrl.2011.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/05/2011] [Accepted: 10/10/2011] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Stroke is currently the main cause of permanent disability in adults. The impairments are a combination of sensory, motor, cognitive and emotional changes that result in restrictions on the ability to perform basic activities of daily living (BADL). Postural control is affected and causes problems with static and dynamic balance, thus increasing the risk of falls and secondary injuries. The purpose of this review was to compile the literature to date, and assess the impact of ankle-foot orthosis (AFO) on postural control and gait in individuals who have suffered a stroke. DEVELOPMENT The review included randomised and controlled trials that examined the effects of AFO in stroke patients between 18 and 80 years old, with acute or chronic evolution. No search limits on the date of the studies were included, and the search lasted until April 2011. The following databases were used: Pubmed, Trip Database, Cochrane library, Embase, ISI Web Knowledge, CINHAL and PEDro. Intervention succeeded in improving some gait parameters, such as speed and cadence. However it is not clear if there was improvement in the symmetry, postural sway or balance. CONCLUSIONS Because of the limitations of this systematic review, due to the clinical diversity of the studies and the methodological limitations, 0these results should be considered with caution.
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Affiliation(s)
- M Guerra Padilla
- Fisioterapia, Patología Neurológica, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España.
| | - F Molina Rueda
- Fisioterapia, Patología Neurológica, Departamento de Fisioterapia, Terapia Ocupacional, Medicina Física y Rehabilitación, Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos, Madrid, España
| | - I M Alguacil Diego
- Medicina Física y Rehabilitación, Departamento de Fisioterapia, Terapia Ocupacional, Medicina Física y Rehabilitación, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España
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Eckhardt MM, Mulder MCB, Horemans HL, van der Woude LH, Ribbers GM. The effects of high custom made shoes on gait characteristics and patient satisfaction in hemiplegic gait. Gait Posture 2011; 34:543-7. [PMID: 21872473 DOI: 10.1016/j.gaitpost.2011.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 07/22/2011] [Accepted: 07/24/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effects of a temporary high custom made orthopaedic shoe on functional mobility, walking speed, and gait characteristics in hemiplegic stroke patients. In addition, interference of attentional demands and patient satisfaction were studied. DESIGN Clinical experimental study. SETTING University Medical Centre. PARTICIPANTS Nineteen stroke patients (12 males; mean age 55 years (standard deviation (SD) 10 years); mean time post onset 3.6 months (SD 1.4 months)) with a spastic paresis of the lower extremity. MAIN OUTCOME MEASURES Functional mobility was assessed with the timed up and go test, walking speed and gait characteristics were measured with clinical gait analysis and performed with and without a verbal dual task. Patient satisfaction was determined with a questionnaire. RESULTS Walking with the high orthopaedic shoe resulted in improved functional mobility (22%; p<.001), walking speed (37%; p<.001) and gait characteristics compared to walking with normal shoes. The dual task interfered with functional mobility during walking. The interference was equally big for normal shoes as for the orthopaedic shoe. Patients evaluated walking with the high orthopaedic shoe as an improvement (p<.001). An average of 84% reported improvements in foot lifting, swing progression, taking weight, confidence while walking, safety, walking distance and walking speed. CONCLUSION In the early recovery phase after stroke, when regaining walking ability, a temporary high orthopaedic shoe can improve hemiplegic gait, even with dual task interference.
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Affiliation(s)
- Martine M Eckhardt
- Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Centre and Department of Rehabilitation Medicine Erasmus MC, Rotterdam, The Netherlands
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User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke. Physiotherapy 2011; 97:226-33. [DOI: 10.1016/j.physio.2010.11.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 11/01/2010] [Indexed: 11/23/2022]
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de Sèze MP, Bonhomme C, Daviet JC, Burguete E, Machat H, Rousseaux M, Mazaux JM. Effect of early compensation of distal motor deficiency by the Chignon ankle-foot orthosis on gait in hemiplegic patients: a randomized pilot study. Clin Rehabil 2011; 25:989-98. [DOI: 10.1177/0269215511410730] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To compare the effect of the Chignon ankle-foot orthosis on gait versus a standard ankle-foot orthosis. Method: A multicentre randomized study was conducted in seven rehabilitation centres. Hemiplegic patients were recruited after unilateral stroke lasting less than six months. Exclusion criteria were: impossibility to stand for 10 seconds; ankle passive dorsiflexion <5 degrees with knee flexed to 90 degrees; triceps spasticity ≥3/4 on the Ashworth modified scale; diseases that might impair active participation in the study. Thirteen patients were randomized to the Chignon group and 15 to the control group. Included patients were given a standard ankle-foot orthosis or Chignon ankle-foot orthosis. The Chignon ankle-foot orthosis is an articulated double-stopped custom-made orthosis with elements to assist dorsiflexion and plantar flexion. Gait speed improvement (ten-metre test), kinematic assessment, and functional scales were assessed. Results: Gain ratio of walking speed with the orthosis increased significantly more in the Chignon group than in the control group at day 0 (27.2 ± 36% versus −0.8 ± 17%; P = 0.006), day 30 (39.9 ± 19% versus 7.5 ± 17%; P = 0.0004) and day 90 (44.6 ± 27% versus 17.1 ± 0.3%; P = 0.04). There was also a significant improvement in kinematic parameters and spasticity in the Chignon group. Conclusion: Early compensation of distal motor deficiency by the Chignon ankle-foot orthosis improves the immediate gait of hemiplegics more than the standard ankle-foot orthosis and seems to modify motor recovery processes in the legs after stroke.
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Affiliation(s)
- Mathieu-Panchoa de Sèze
- Université Victor Segalen Bordeaux 2, Handicap et Système Nerveux, Bordeaux, France
- Service de Médecine Physique et de Réadaptation, Pôle Neurosciences Cliniques, CHU Bordeaux Pellegrin, Bordeaux, France
| | - Clément Bonhomme
- Université Victor Segalen Bordeaux 2, Handicap et Système Nerveux, Bordeaux, France
- Service de Médecine Physique et de Réadaptation, Pôle Neurosciences Cliniques, CHU Bordeaux Pellegrin, Bordeaux, France
| | - Jean-Christophe Daviet
- CHU de Limoges, Service de Médecine Physique et de Réadaptation, Pôle des Médecines Aiguës Spécialisées, Limoges, France
| | - Emmanuel Burguete
- Université Victor Segalen Bordeaux 2, Handicap et Système Nerveux, Bordeaux, France
- Service de Médecine Physique et de Réadaptation, Pôle Neurosciences Cliniques, CHU Bordeaux Pellegrin, Bordeaux, France
| | - Hugues Machat
- Université Victor Segalen Bordeaux 2, Handicap et Système Nerveux, Bordeaux, France
- Service de Médecine Physique et de Réadaptation, Pôle Neurosciences Cliniques, CHU Bordeaux Pellegrin, Bordeaux, France
| | - Marc Rousseaux
- Service de Reeducation et Convalescence Neurologiques, Hôpital Swynghedauw, CHRU de Lille, Lille, France
| | - Jean Michel Mazaux
- Université Victor Segalen Bordeaux 2, Handicap et Système Nerveux, Bordeaux, France
- Service de Médecine Physique et de Réadaptation, Pôle Neurosciences Cliniques, CHU Bordeaux Pellegrin, Bordeaux, France
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Suat E, Fatma U, NilgÜn B. The effects of dynamic ankle-foot orthoses on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait. Disabil Rehabil 2011; 33:2605-11. [DOI: 10.3109/09638288.2011.582926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nolan KJ, Yarossi M. Weight transfer analysis in adults with hemiplegia using ankle foot orthosis. Prosthet Orthot Int 2011; 35:45-53. [PMID: 21515889 DOI: 10.1177/0309364610393061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Identifying and understanding the changes in transfer of momentum that are directly affected by orthotic intervention are significant factors related to the improvement of mobility in individuals with hemiplegia. OBJECTIVES The purpose of this investigation was to use a novel analysis technique to objectively measure weight transfer during double support (DS) in healthy individuals and individuals with hemiplegia secondary to stroke with and without an ankle foot orthosis. STUDY DESIGN Prospective, Repeated measures, case-controlled trial. METHODS Participants included 25 adults with stroke-related hemiplegia >6 months using a prescribed ankle foot orthosis and 12 age-matched healthy controls. Main outcome measures included the weight transfer point timing (WTP, %DS), maximum total force timing (MTF, %DS), timing difference between WTP and MTF (MTF-WTP, %DS) and the linearity of loading (LOL, R(2)) during the DS phase of the gait cycle. RESULTS The WTP and LOL were significantly different between conditions with and without the ankle foot orthosis for the affected and unaffected limb in post-stroke individuals, p ≤ 0.01. The MTF and difference in timing between MTF-WTP were significantly different during affected limb loading with and without the ankle foot orthosis in the stroke group, p ≤ 0.0001 and p = 0.03, respectively. MTF, MTF-WTP and LOL were significantly different between individuals with stroke (during affected limb loading) and healthy controls (during right limb loading). CONCLUSIONS This research established a systematic method for analysing weight transfer during walking to evaluate the effect of an ankle foot orthosis on loading during double support in hemiplegic gait. This novel method can be used to elucidate biomechanical mechanisms behind orthosis-mediated changes in gait patterns and quantify functional mobility outcomes in rehabilitation. CLINICAL RELEVANCE This novel approach to orthotic assessment will provide the clinician with needed objective evidence to select the most effective orthotic intervention to maximize functional recovery for individuals with hemiplegia secondary to stroke.
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Affiliation(s)
- Karen J Nolan
- Kessler Foundation Research Center, Human Performance and Movement Analysis Laboratory & Traumatic Brain Injury Laboratory, West Orange, New Jersey 07052, USA.
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Harlaar J, Brehm M, Becher JG, Bregman DJJ, Buurke J, Holtkamp F, De Groot V, Nollet F. Studies examining the efficacy of ankle foot orthoses should report activity level and mechanical evidence. Prosthet Orthot Int 2010; 34:327-35. [PMID: 20738235 DOI: 10.3109/03093646.2010.504977] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.
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Affiliation(s)
- Jaap Harlaar
- Department of Rehabilitation Medicine, Research Unit MOVE, VU University Medical Center, Amsterdam, The Netherlands.
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Ankle-foot orthoses in stroke: effects on functional balance, weight-bearing asymmetry and the contribution of each lower limb to balance control. Clin Biomech (Bristol, Avon) 2009; 24:769-75. [PMID: 19665825 DOI: 10.1016/j.clinbiomech.2009.07.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 07/01/2009] [Accepted: 07/01/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle-foot orthoses are often provided to improve walking in stroke patients, although the evidence of effects on walking and balance control is still inconsistent. This could be caused by a lack of insight into the influence of orthoses on the underlying impairments. These impairments can be assessed with dual plate posturography to determine the relative contribution of each lower limb to balance control and weight-bearing. This study examined the effects of ankle-foot orthoses on functional balance, static and dynamic weight-bearing asymmetry and dynamic balance control of the paretic and non-paretic lower limbs. METHODS Twenty stroke subjects (time since stroke 5-127 months) completed the study. Subjects were assessed with and without ankle-foot orthosis. Functional balance was assessed using the Berg Balance Scale, Timed Up & Go test, Timed Balance Test, 10-m walking test and Functional Ambulation Categories. Weight-bearing asymmetry and dynamic balance control were assessed with force plates on a movable platform. FINDINGS No significant effects of ankle-foot orthoses were found for weight-bearing asymmetry and dynamic balance control, but significant differences in favour of ankle-foot orthosis use were found for most functional tests. INTERPRETATION Although ankle-foot orthoses had no effect on weight-bearing asymmetry or dynamic balance contribution of the paretic lower limb, functional tests were performed significantly better with orthoses. Apparently, improvements at functional level cannot be readily attributed to a greater contribution of the paretic lower limb to weight-bearing or balance control. This finding suggests that ankle-foot orthoses influence compensatory mechanisms.
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Nolan KJ, Savalia KK, Lequerica AH, Elovic EP. Objective assessment of functional ambulation in adults with hemiplegia using ankle foot orthotics after stroke. PM R 2009; 1:524-9. [PMID: 19627941 DOI: 10.1016/j.pmrj.2009.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/22/2009] [Accepted: 04/28/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To objectively evaluate the effect of ankle foot orthotics (AFOs) on functional ambulation in individuals with hemiplegia secondary to stroke using quantifiable outcome measures. DESIGN With-without repeated measures design. SETTING Rehabilitation research center. PARTICIPANTS Eighteen adults with stroke-related hemiplegia 6 months using a prescribed AFO. INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS The distance (m) and velocity (m/s) during the 6-Minute Walk Test (6MWT) and total time (s) and velocity (m/s) during the 25-ft walk (25ftW). Secondary analysis evaluated the 6MWT and 25ftW grouped by the time component of the Ambulatory Index (AI). RESULTS Distance walked during the 6MWT was significantly greater with AFO (228.54 +/- 103.93) than without AFO (197.49 +/- 104.13), P = .002. Time to complete the 25ftW was significantly greater without AFO (21.22 +/- 20.57) than with AFO (15.49 +/- 14.65), P = .010. There was a significant difference in average velocity between the 25ftW and 6MWT during the with AFO condition, P = .010. Secondary analysis grouped by the AI time showed that as level of function decreases, brace effect on functional ambulation increases (Group 3: 25ftW with AFO, P = .040). CONCLUSIONS AFO usage in hemiplegic stroke patients improves functional ambulation, particularly in individuals with a slower gait velocity. The 25ftW, with and without AFO, may be useful to the patient and clinician when determining the importance of brace utilization. Speed modulation was improved when the AFO was added to the paretic limb, and AI grouping indicated that the AFO was more beneficial in people with a slower gait velocity (>20 seconds for the 25ftW). A more definitive study is needed to more completely address this issue. As an exploratory study, the feasibility of different walking assessments was determined so that future studies can validate which objective measures can be used and easily implemented in clinical settings.
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Affiliation(s)
- Karen J Nolan
- Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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Cruz TH, Dhaher YY. Impact of ankle-foot-orthosis on frontal plane behaviors post-stroke. Gait Posture 2009; 30:312-6. [PMID: 19570678 PMCID: PMC3641757 DOI: 10.1016/j.gaitpost.2009.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 05/19/2009] [Accepted: 05/25/2009] [Indexed: 02/02/2023]
Abstract
Abnormal within and across-joint synergistic behaviors have been reported in the lower limb post stroke. It is unknown, however, whether these impairments limit adaptive movement strategies in response to imposed kinematic constraints. In this context, the goal of this pilot study was to examine changes to three-dimensional swing phase kinematics of the paretic hip, knee, and ankle joints and pelvis induced by AFO use in subjects with chronic stroke. Overground gait analysis was performed on 9 ambulating hemiplegic subjects with and without their AFOs. Both the toeoff and peak ankle dorsiflexion angles were significantly decreased in the no AFO condition. Likewise, the peak and toeoff swing phase pelvic obliquity angles significantly increased when the AFO was removed (6.47 degrees (2.0 SD) vs. 8.16 degrees (2.8 SD), paired t-tests, p=0.03 and 0.8 degrees (3.1 SD) vs. 2.9 degrees (1.1 SD), paired t-test, p=0.02, respectively). These behaviors were consistent across subjects (7 of 9 subjects). The hip frontal plane, and hip and knee sagittal plane kinematics were unaffected by removal of the AFO. Finally, the minimum toe clearance was not affected by the removal of the AFO (1.39 cm+/-0.62 SD vs. 1.27 cm+/-0.47 SD, p>0.05). Taken together, these findings suggest that pelvic obliquity is the primary compensatory degree of freedom utilized to achieve toe clearance in response to impaired dorsiflexion in the stroke population. We propose that this degree of freedom is exploited as it is not constrained by synergistic torque coupling of the lower limb.
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Affiliation(s)
- Theresa Hayes Cruz
- Northwestern University Department of Biomedical Engineering, 345 East Superior Street, Chicago, IL 60611, United States,Rehabilitation Institute of Chicago, Sensory Motor Performance Program 345 East Superior Street, Chicago, IL 60611, United States,Corresponding author at: Rehabilitation Institute of Chicago, Sensory Motor Performance Program, Room 1406, 345 East Superior Street, Chicago, IL 60611, United States. Tel.: +1 312 238 685; fax: +1 312 238 2208. (T.H. Cruz)
| | - Yasin Y. Dhaher
- Northwestern University Department of Biomedical Engineering, 345 East Superior Street, Chicago, IL 60611, United States,Rehabilitation Institute of Chicago, Sensory Motor Performance Program 345 East Superior Street, Chicago, IL 60611, United States
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Rao N, Chaudhuri G, Hasso D, D'Souza K, Wening J, Carlson C, Aruin AS. Gait assessment during the initial fitting of an ankle foot orthosis in individuals with stroke. Disabil Rehabil Assist Technol 2009; 3:201-7. [DOI: 10.1080/17483100801973023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking. OBJECTIVES To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions. SEARCH STRATEGY In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field. SELECTION CRITERIA We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. MAIN RESULTS We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials. AUTHORS' CONCLUSIONS A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.
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Affiliation(s)
- Sarah F Tyson
- University of SalfordCentre for Rehabilitation & Human Performance ResearchFrederick Road CampusSalfordUKM6 6PU
| | - Ruth M Kent
- University of LeedsAcademic Department of Rehabilitation Medicine, Faculty of Medicine and HealthLevel D, Martin Wing, Great George StreetLeeds General InfirmaryLeedsUKLS1 3EX
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Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia. Arch Phys Med Rehabil 2009; 90:810-8. [PMID: 19406301 DOI: 10.1016/j.apmr.2008.11.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 10/31/2008] [Accepted: 11/20/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia. DESIGN Repeated measures, quasi-experimental study. SETTING Motion analysis laboratory. PARTICIPANTS Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age. INTERVENTIONS Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90 degrees plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with 3/4 length foot-plate-3/4 AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference. MAIN OUTCOME MEASURES Sagittal plane ankle and knee kinematics and kinetics. RESULTS In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects. CONCLUSIONS These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.
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Affiliation(s)
- Stefania Fatone
- Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
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Abstract
BACKGROUND Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking. OBJECTIVES To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions. SEARCH STRATEGY In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field. SELECTION CRITERIA We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. MAIN RESULTS We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials. AUTHORS' CONCLUSIONS A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.
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Affiliation(s)
- Sarah F Tyson
- Centre for Rehabilitation & Human Performance Research, University of Salford, Frederick Road Campus, Salford, UK, M6 6PU.
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Therapeutic effect of an implantable peroneal nerve stimulator in subjects with chronic stroke and footdrop: a randomized controlled trial. Phys Ther 2008; 88:437-48. [PMID: 18218825 DOI: 10.2522/ptj.20070035] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Footdrop, characterized by a person's inability to raise the foot at the ankle, is a common problem in patients with stroke. A randomized controlled trial was performed to determine the therapeutic effect of using a new implantable, 2-channel peroneal nerve stimulator for 6 months versus an ankle-foot orthosis (AFO). SUBJECTS Twenty-nine patients with chronic stroke and footdrop participated in the study. The mean time from stroke was 7.3 years (SD=7.3), and all subjects were community ambulators. METHODS The study used a randomized controlled trial design. The functional electrical stimulation (FES) group received the implantable stimulation system for correction of their footdrop. The control group continued using their conventional walking device (ie, AFO, orthopedic shoes, or no walking device). All subjects were measured at baseline and at weeks 4, 8, 12, and 26 in the gait laboratory. The therapeutic effect of FES on the maximum value of the root mean square (RMSmax) of the tibialis anterior (TA) muscle with both flexed and extended knees and walking speed were selected as the primary outcome measures. The RMSmax of the peroneus longus (PL), gastrocnemius (GS), and soleus (SL) muscles with both flexed and extended knees and muscle activity of the TA muscle of the affected leg during the swing phase of gait were selected as secondary outcome measures. RESULTS A significantly higher RMSmax of the TA muscle with extended knee was found after using FES. No change in walking speed was found when the stimulator was not switched on. A significantly increased RMSmax of the GS muscle with both flexed and extended knees was found after using FES. DISCUSSION AND CONCLUSION Functionally, no therapeutic effect of implantable peroneal nerve stimulation was found. However, the significantly increased voluntary muscle output of the TA and GS muscles after the use of FES suggests that there was a certain extent of plasticity in the subjects in this study.
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Bleyenheuft C, Caty G, Lejeune T, Detrembleur C. [Assessment of the Chignon dynamic ankle-foot orthosis using instrumented gait analysis in hemiparetic adults]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2008; 51:147-53. [PMID: 18242754 DOI: 10.1016/j.annrmp.2007.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 12/22/2007] [Indexed: 11/18/2022]
Affiliation(s)
- C Bleyenheuft
- Département de médecine physique et réadaptation, cliniques universitaires Saint-Luc, université catholique de Louvain, 1200 Bruxelles, Belgique
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86
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Assessment of the Chignon® dynamic ankle–foot orthosis using instrumented gait analysis in hemiparetic adults. ACTA ACUST UNITED AC 2008; 51:154-60. [DOI: 10.1016/j.annrmp.2007.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 12/22/2007] [Indexed: 11/20/2022]
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87
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Wang RY, Lin PY, Lee CC, Yang YR. Gait and balance performance improvements attributable to ankle-foot orthosis in subjects with hemiparesis. Am J Phys Med Rehabil 2007; 86:556-62. [PMID: 17581290 DOI: 10.1097/phm.0b013e31806dd0d3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the change in the balance performance and the improvement in the gait performance of subjects with hemiparesis, as a result of their wearing an ankle-foot orthosis. DESIGN This was a cross-sectional control trial. Fifty-eight subjects with hemiparesis of a duration of less than 6 mos participated in this study. Each subject was evaluated for the balance and gait performance with and without an ankle-foot orthosis on the affected side. The balance activities were evaluated by the Balance Master System, and the gait performance was measured using GAITRite. RESULTS The increase in movement velocity and the change in maximal excursion toward the affected side during the balance testing were found to be correlated significantly with the change in walking speed as a result of wearing an ankle-foot orthosis (r=0.274, P=0.039; r=0.325, P=0.020; respectively). Only the change in maximal excursion toward the affected side was found to be significantly correlated with the change in nonaffected step length (r=0.381, P=0.010). CONCLUSION The maximal excursion toward the affected side improved as a result of wearing an ankle-foot orthosis. This correlated with an increase in step length on the nonaffected side and, hence, an improvement in the walking speed of the subjects with hemiparesis.
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Affiliation(s)
- Ray-Yau Wang
- Institute and Faculty of Physical Therapy, National Yang-Ming University, and Department of Education and Research and Section of Physical Therapy, Taipei City Hospital, Taipei, Taiwan
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Van Peppen RPS, Kwakkel G, Wood-Dauphinee S, Hendriks HJM, Van der Wees PJ, Dekker J. The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clin Rehabil 2005; 18:833-62. [PMID: 15609840 DOI: 10.1191/0269215504cr843oa] [Citation(s) in RCA: 487] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke. METHODS MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnline were searched for controlled studies. Physical therapy was divided into 10 intervention categories, which were analysed separately. If statistical pooling (weighted summary effect sizes) was not possible due to lack of comparability between interventions, patient characteristics and measures of outcome, a best-research synthesis was performed. This best-research synthesis was based on methodological quality (PEDro score). RESULTS In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs). Methodological quality of all RCTs had a median of 5 points on the 10-point PEDro scale (range 2-8 points). Based on high-quality RCTs strong evidence was found in favour of task-oriented exercise training to restore balance and gait, and for strengthening the lower paretic limb. Summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% Cl 0.03-0.23) for effects of high intensity of exercise training to 0.92 (95% Cl 0.54-1.29) for improving symmetry when moving from sitting to standing. Strong evidence was also found for therapies that were focused on functional training of the upper limb such as constraint-induced movement therapy (SES 0.46; 95% Cl 0.07-0.91), treadmill training with or without body weight support, respectively 0.70 (95% Cl 0.29-1.10) and 1.09 (95% Cl 0.56-1.61), aerobics (SES 0.39; 95% Cl 0.05-0.74), external auditory rhythms during gait (SES 0.91; 95% Cl 0.40-1.42) and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% Cl 0.76-2.06). No or insufficient evidence in terms of functional outcome was found for: traditional neurological treatment approaches; exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics and assistive devices; and physical therapy interventions for reducing hemiplegic shoulder pain and hand oedema. CONCLUSIONS This review showed small to large effect sizes for task-oriented exercise training, in particular when applied intensively and early after stroke onset. In almost all high-quality RCTs, effects were mainly restricted to tasks directly trained in the exercise programme.
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Affiliation(s)
- R P S Van Peppen
- Department of Physical Therapy, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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