Efeito de uma ortótese tornozelo-pé na marcha e na mobilidade após AVC - estudo clínico

Abstract

Introduction : The aim of the present study was to analyze the effect of an ankle-foot orthosis on walking and mobility of stroke patients with equinus and/or varus foot. Material and Methods : Nineteen subacute/chronic stroke patients with equinus and/or varus foot which were able to walk without assistance were assessed with and without an ankle-foot orthosis. Physical performance was tested with Fugl-Meyer, mobility was assessed using the timed up & go test and gait measurements were performed with a portable GAITRite system®. Results : There was a tendency of improvement on mobility and temporo-spatial parameters when using ankle-foot orthosis expressed by a timed up & go test decrease (43.00 to 39.77 s, p = 0.064), a speed improvement (32.10 to 42.00 cm/s, p = ns), a cadence increase (64.40 to 70.00 steps/ minute, p = ns), a cycle time decrease (1.86 to 1.71 s, p = ns) and a base of support decrease (14.67 to 14.55 cm, p = ns), although without significant difference. The positive difference in cadence with orthosis use had moderate correlation with a low Fugl-Meyer assessment lower extremity score (CC = -0.616). The positive difference in velocity with ankle-foot orthosis use had moderate correlation with its use before testing (CC = 0.600). Conclusion : According to the present study, there is a tendency that supports the use of an ankle-foot orthosis to improve mobility, temporo-spatial parameters and gait symmetry. However, the impact of this orthosis was inconclusive, as these differences were not statically significant. It is known that small improvements in walking cadence may represent important functional benefits. Our research shows the use of an ankle-foot orthosis, namely the more impaired patients with lowest Fugl-Meyer lower extremity score, are those that benefit more. The correlation between the previous using of ankle-foot orthosis with a speed improvement seems to demonstrate the importance of training. There is a need for further well-designed randomized, controlled clinical trials, with larger samples, to establish better scientific evidence for walking effects related to ankle-foot orthosis wearing on stroke patients with equinus and/or varus foot.