Using 3-Dimensional Motion Analysis to Optimize Treatment Planning for a Patient With Dropfoot: Case Report.

Abstract

This study demonstrated the use of computerized motion analysis to assist in evidence-based clinical decision-making. A 15-year-old girl who had right hemiparesis after a stroke was referred for 3-dimensional computerized motion analysis to determine the effect of 3 devices intended to control her dropfoot and to assist in developing a treatment plan. Four conditions were tested and compared: barefoot, lateral support ankle brace, functional electrical stimulation (FES) device, and dropfoot cuff. Kinematics showed the right ankle had significant dropfoot during swing phase (32.7degrees of plantarflexion at terminal swing) in barefoot. The lateral support ankle brace, FES device, and dropfoot cuff reduced terminal swing plantarflexion to 27.2degrees, 17.6degrees, and 15.3degrees, respectively, though ankle kinematics remained abnormal because of inadequate dorsiflexion. Improvements in gait variable score with FES (-8.2degrees) or dropfoot cuff (-8.7degrees) were significantly more than that with the lateral support brace (-2.2degrees), and the difference in gait variable score between FES and dropfoot cuff was insignificant. Compared with the barefoot condition, the lateral support brace condition did not show a clinically significant difference in gait profile score; however, the gait profile scores of both FES and dropfoot cuff conditions showed clinically significant improvement (-1.7degrees and -2.1degrees, respectively). Objective data delineated subtle changes among 3 devices and led to the recommendation to discontinue the lateral support ankle brace, continue using her night ankle-foot orthosis and FES device, with the dropfoot cuff as a backup when she feels leg fatigue or skin irritation, and consider serial casting or surgical calf lengthening. Computerized motion analysis provides quantitative evaluation of subtle differences in the effect of braces with different designs, which are hard for the human eye to discern. The objective data inform and validate treatment decision-making. The recommendations were made as a result of evidence-based practice.