Abstract
Background: Several studies have examined the benefits of ankle foot orthosis (AFO) in patients with hemiparesis, but little is known about their effects in patients with peripheral nerve palsy. The purpose of this study was to compare the effects of AFO on functional ambulation in patients with hemiplegia and unilateral lower-extremity palsy. Subjects and methods: This study design was Case control study in rehabilitation units of five hospitals in Japan. The study subjects were 50 normal subjects (control), 49 patients with post-stroke hemiparesis (PSH), and 13 with lower extremity palsy (LEP) due to peripheral nerve palsy. Functional ambulation was assessed with AFO and without AFO by 10-meter maximum walking speed (10 MMWS) and the distance walked in a 6-minute walking test (6 MWT). Functional balance was assessed using the Berg balance scale. Results: The 10 MMWS test showed significantly lower walking speed in PSH and LEP without AFO compared with the control group, and that the speed was faster in the two patient groups with AFO than without AFO. The distance walked during the 6 MWT was significantly shorter in PSH and LEP than the control, but it increased significantly in both groups after wearing the AFO. Furthermore, the significant difference between the control and LEP groups disappeared after wearing the AFO. The Berg balance scale was significantly lower in PSH and LEP groups compared with the control group, but improved significantly with AFO. Conclusion: The results suggest that AFO is beneficial for patients with PSH and those with LEP through improvement of walking distance, walking speed, and functional balance. Many physicians and technicians often avoid the use AFO. However, AFO improved not only walking ability but also functional balance in both groups of patients. Physicians and technicians are encouraged to consider the use of AFO in LEP.
Highlights
In Japan, there are estimated 1,235,000 individuals with stroke who receive continuous medical care in hospitals [1]
The results suggest that ankle foot orthosis (AFO) is beneficial for patients with post-stroke hemiparesis (PSH) and those with lower extremity palsy (LEP) through improvement of walking distance, walking speed, and functional balance
The 10-meter maximum walking speed was significantly slower in the PSH (0.50 ± 0.41 m/sec) and LEP (1.11 ± 0.31 m/sec) groups without AFO compared with the control group (1.88 ± 0.45 m/sec)
Summary
In Japan, there are estimated 1,235,000 individuals with stroke who receive continuous medical care in hospitals [1]. Abnormal motor control and limb deformities are common complications in patients with stroke. The mobility of many stroke survivors is limited [4], and most identify walking as a top priority in any rehabilitation program [5]. Impaired walking in stroke is due to various factors such as muscle weakness, spasticity, and discoordination of lower limb muscle activity [6]. In addition to impeding endurance, gait impairment limits walking distance and velocity, which reduces quality of life of stroke survivors. Slow walking velocity is associated with limitation in home and community activities, increased risk of falls [7], and increased mortality [8]. The purpose of this study was to compare the effects of AFO on functional ambulation in patients with hemiplegia and unilateral lower-extremity palsy
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