Ambulatory Function and Perception of Confidence in Persons with Stroke with a Custom-Made Hinged versus a Standard Ankle Foot Orthosis

The effect of a powered ankle foot orthosis on walking in a stroke subject: a case study

[Purpose] Standing and walking are impaired in stroke patients. Therefore, assisted devices are required to restore their walking abilities. The ankle foot orthosis with an external powered source is a new type of orthosis. The aim of this study was to evaluate the performance of a powered ankle foot orthosis compared with unpowered orthoses in a stroke patient. [Subjects and Methods] A single stroke subject participated in this study. The subject was fitted with three types of ankle foot orthosis (powered, posterior leg spring, and carbon ankle foot orthoses). He was asked to walk with and without the three types of orthoses, and kinetic and kinematic parameters were measured. [Results] The results of the study showed that the moments applied on the ankle, knee, and hip joints increased while walking with the powered ankle foot orthosis. [Conclusion] As the powered ankle foot orthosis influences the moments of the ankle, knee, and hip joints, it can increase the standing and walking abilities of stroke patients more than other available orthoses. Therefore, it is recommended to be used in rehabilitation programs for stroke patients.

A Randomized Controlled Evaluation of the Efficacy of an Ankle-Foot Cast on Walking Recovery Early After Stroke: SWIFT Cast Trial

Background. Timely provision of an ankle-foot orthosis (AFO) orthotist customized for individuals early after stroke can be problematic. Objective. To evaluate the efficacy of a therapist-made AFO (SWIFT Cast) for walking recovery. Methods. This was a randomized controlled, observer-blind trial. Participants (n = 105) were recruited 3 to 42 days poststroke. All received conventional physical therapy (CPT) that included use of “off-the-shelf” and orthotist-made AFOs. People allocated to the experimental group also received a SWIFT Cast for up to 6 weeks. Measures were undertaken before randomization, 6 weeks thereafter (outcome), and at 6 months after stroke (follow-up). The primary measure was walking speed. Clinical efficacy evaluation used analysis of covariance. Results. Use of a SWIFT Cast during CPT sessions was significantly higher (P < .001) for the SWIFT Cast (55%) than the CPT group (3%). The CPT group used an AFO in 26% of CPT sessions, compared with 11% for the SWIFT Cast group (P = .005). At outcome, walking speed was 0.42 (standard deviation [SD] = 0.37) m/s for the CPT group and 0.32 (SD = 0.34) m/s for the SWIFT Cast group. Follow-up walking speed was 0.53 (SD = 0.38) m/s for the CPT group and 0.43 (0.34) m/s for the SWIFT Cast group. Differences, after accounting for minimization factors, were insignificant at outcome (P = .345) and follow-up (P = .360). Conclusion and implications. SWIFT Cast did not enhance the benefit of CPT, but the control group had greater use of another AFO. However, SWIFT Cast remains a clinical option because it is low cost and custom-made by therapists who can readily adapt it during the rehabilitation period.

Subjective measures in sit-to-stand task in post-stroke hemiparesis: comment on Brière, Nadeau, Lauzière, and Gravel (2013)

In a recent study, Brière, Nadeau, Lauzière, and Gravel (2013 ) examined the perceptions of individuals post-stroke on their weight-bearing distribution and knee effort distribution in sit-to-stand tasks. The present comment emphasized the importance of the feeling of post-stroke hemiparesis in sit-to-stand task and identified areas of improvements of the target study.

The effects of two different ankle-foot orthoses on gait of patients with acute hemiparetic cerebrovascular accident

Objective. To compare the effects of two types of ankle-foot orthoses on gait of patients with cerebrovascular accident (CVA) and to evaluate their preference in using each AFO type. Design. Thirty individuals with acute hemiparetic CVA were tested without an AFO, with an off-the-shelf carbon AFO (C-AFO), and with a custom plastic AFO (P-AFO) in random order at the time of initial orthotic fitting. Gait velocity, cadence, stride length, and step length were collected using an electronic walkway and the subjects were surveyed about their perceptions of each device. Results. Subjects walked significantly faster, with a higher cadence, longer stride, and step lengths, when using either the P-AFO or the C-AFO as compared to no AFO (P < 0.05). No significant difference was observed between gait parameters of the two AFOs. However, the subjects demonstrated a statistically significant preference of using P-AFO in relation to their balance, confidence, and sense of safety during ambulation (P < 0.05). Moreover, if they had a choice, 50.87 ± 14.7% of the participants preferred the P-AFO and 23.56 ± 9.70% preferred the C-AFO. Conclusions. AFO use significantly improved gait in patients with acute CVA. The majority of users preferred the P-AFO over the Cf-AFO especially when asked about balance and sense of safety.