The influence of an ankle foot orthosis on the percentage of weight loading during standing tasks in stroke patients

Post-stroke ankle-foot orthoses: Examining referral trends in the Scottish multi-disciplinary team

PURPOSE

As per the Best Practice Statement: Use of Ankle-Foot Orthoses Following Stroke (BPS), members of the stroke multidisciplinary team should refer stroke patients with mobility problems to orthotics. Therefore, the objectives of this study were to (1) assess awareness of the BPS; (2) assess referral patterns and trends; and (3) identify barriers to referral to the Orthotic Service in Scotland.

METHODS

An online survey of the stroke MDT, working in Scotland, whose current role involves work with stroke patients. A survey was distributed via the Scottish Stroke Allied Health Professionals Forum, Scottish Stroke Nurses Forum, British Association of Stroke Physicians, and Scottish Stroke Managed Clinical Networks.

RESULTS

Statistically significant association was found between: Awareness of BPS and NHS Board Area; Profession and whether clinicians have referred to orthotics; Confidence in assessment criteria and profession; Referral to departments other than Orthotics and profession.

CONCLUSION

Physiotherapists are relied upon by members of the Stroke MDT to identify mobility problems and refer to Orthotics. The BPS should be re-disseminated, particularly to the East of Scotland and GPs, to improve awareness of referral criteria. Reduced waiting list times and joint physiotherapist-orthotist clinics may reduce referral barriers to the Orthotic Service.

A user-centered qualitative study on experiences with ankle-foot orthoses and suggestions for improved design

BACKGROUND

Improving ankle-foot orthosis design can best be done by implementing a user-centered approach.

OBJECTIVE

To provide insight into the ideas of ankle-foot orthosis users with flaccid ankle muscle paresis on the importance of activities and suggestions for an improved ankle-foot orthosis design.

STUDY DESIGN

A focus-group discussion with eight ankle-foot orthosis users (57 ± 5 years, 50% female).

METHODS

Main inclusion criteria were as follows: ⩾18 years, unable to stand on tip-toe and unable to lift toes. Main exclusion criterion was spasticity of lower extremity muscles. Transcribed data were coded according to the International Classification of Functioning, Disability and Health. Thematic analysis with inductive approach was chosen to order and interpret codes.

RESULTS

Ankle-foot orthosis users ranked walking the most important activity followed by sitting down/standing up from a chair. Their opinion was that ankle-foot orthoses facilitate walking and standing. Ankle-foot orthosis users suggested that an improved ankle-foot orthosis design should balance between stability and flexibility.

CONCLUSION

Current ankle-foot orthoses facilitate walking which was the most important activity according to ankle-foot orthosis users. An improved ankle-foot orthosis design should enable walking and should optimize between stability and flexibility dependent on the activity and the paresis severity. Clinical relevance Experienced users of ankle-foot orthosis agreed that matching ankle-foot orthosis functions to daily-life activities is a trade-off between stability and flexibility. An improved ankle-foot orthosis design should at least enable level walking.

The influence of an ankle-foot orthosis on the spatiotemporal gait parameters and functional balance in chronic stroke patients

[Purpose] Observational study investigating the influence of various ankle-foot orthoses on the spatiotemporal gait parameters and functional balance in chronic stroke patients. [Subjects and Methods] Fifteen chronic stroke patients participated in this study after providing informed consent. Two groups of patients were differentiated based on the Timed Up and Go Test. Patients were tested in three different conditions: with standard prefabricated ankle-foot orthosis (Maramed), with individualized ankle-foot orthosis (Y-tech), and without any ankle-foot orthrosis. Spatiotemporal gait parameters were obtained by walking on an instrumented walkway (GAITRite(®)) at usual and fastest speed. Balance was assessed with Timed Up and Go Test, Step Test, and Four Square Step Test. [Results] Maramed and Y-tech significantly improved the spatiotemporal parameters while walking at usual and maximal speed (single support time affected side; double support time affected side and step length unaffected side). The Y-tech in addition improved velocity and cadence. Among the balance tests, only the Timed Up and Go test showed improvements in favor of Maramed and Y-tech. [Conclusion] Patients benefited from wearing orthosis at both usual and maximal speed, irrespective of whether they wore Maramed or Y-tech. Only severe stroke patients benefited from wearing an orthoses compared to mild impaired group.