Use Of Ankle-foot Orthoses Research Articles

Comparison of three ankle—foot orthosis configurations for children with spastic diplegia

This study compared the functional efficacy of three commonly prescribed ankle–foot orthosis (AFO) configurations (solid [SAFO], hinged [HAFO], and posterior leaf spring [PLS]). Sixteen independently ambulatory children (10 males, six females; mean age 8 years 4 months, SD 2 years 4 months; range 4 years 4 months to 11 years 6 months) with spastic diplegia participated in this study. Four children were classified at level I of the Gross Motor Function Classification System (GMFCS; Palisano et al. 1997); the remaining 12 were at level II. Children were assessed barefoot (BF) at baseline (baseline assessment of energy consumption was performed with shoes on, no AFO) and in each orthotic configuration after three months of use, using gait analysis, oxygen consumption, and functional outcome measures. AFO use did not markedly alter joint kinematics or kinetics at the pelvis, hip, or knee. All AFO configurations normalized ankle kinematics in stance, increased step/stride length, decreased cadence, and decreased energy cost of walking. Functionally, all AFO configurations improved the execution of walking/running/jumping skills, upper extremity coordination, and fine motor speed/dexterity. However, the quality of gross motor skill performance and independence in mobility were unchanged. These results suggest that most children with spastic diplegia benefit functionally from AFO use. However, some children at GMFCS level II demonstrated a subtle but detrimental effect on function with HAFO use, shown by an increase in peak knee extensor moment in early stance, excessive ankle dorsiflexion, decreased walking velocity, and greater energy cost. Therefore, constraining ankle motion by using a PLS or SAFO should be considered for most, but not all, children with spastic diplegia.

Gait Retraining Post Stroke

A major component of stroke rehabilitation focuses on gait restoration. The purpose of this review is to examine the efficacy of a variety of gait retraining techniques currently in clinical use, including strength training, functional electrical stimulation, treadmill training, partial body-weight support, EMG biofeedback, and splinting of the lower extremity. Forty-eight studies evaluating six gait enhancement techniques were reviewed. There is either strong or moderate evidence to support the use of strength training, EMG/biofeedback, and functional electrical stimulation as an adjunctive therapy in gait training, and there is either limited or conflicting evidence to support the use of ankle-foot orthosis, treadmill training, and partial body-weight support.

Peroneal neuropathy from Ankle-Foot orthoses

Mononeuropathies are uncommon in childhood but can be a cause of significant disability. A considerable proportion of pediatric peroneal palsies arise as iatrogenic complications of casting, footboards, and intraoperative positioning. This article provides a description of a patient who developed bilateral peroneal palsies after cardiac transplantation. Factors predisposing this patient to neuropathy included hemophilia and prolonged immobilization, with focal involvement of the peroneal nerves being likely related to the use of ankle-foot orthoses. Peroneal nerve palsies are a significant, but potentially avoidable, iatrogenic complication of lower-extremity orthoses.

Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: a retrospective study.

The purpose of this study was to determine the effect clinically prescribed ankle-foot orthoses (AFOs) have on the temporal-spatial parameters of gait, as compared with barefoot walking in children with cerebral palsy. A retrospective chart review of data collected between 1995 and 1999 in our motion analysis laboratory was performed. A retrospective chart review of 700 patients revealed 115 patients (mean age 9 years) who had a primary diagnosis of CP (diplegia n=97, hemiplegia n=18). All were wearing clinically prescribed hinged or solid AFOs at the time of undergoing a three dimensional gait analysis. In line with our standard clinical practice, data for both conditions (braced and barefoot walking) were collected the same day by the same examiner. Statistical analyses indicated the temporal and spatial gait parameters of velocity, stride length, step length, and single limb stance were significantly increased (p<0.001) with the use of AFOs versus barefoot walking. Cadence was the only parameter found to not be statistically different.

Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy:a retrospective study

The purpose of this study was to determine the effect clinically prescribed ankle‐foot orthoses (AFOs) have on the temporal‐spatial parameters of gait, as compared with barefoot walking in children with cerebral palsy. A retrospective chart review of data collected between 1995 and 1999 in our motion analysis laboratory was performed. A retrospective chart review of 700 patients revealed 115 patients (mean age 9 years) who had a primary diagnosis of CP (diplegia n=97, hemiplegia n=18). All were wearing clinically prescribed hinged or solid AFOs at the time of undergoing a three dimensional gait analysis. In line with our standard clinical practice, data for both conditions (braced and barefoot walking) were collected the same day by the same examiner. Statistical analyses indicated the temporal and spatial gait parameters of velocity, stride length, step length, and single limb stance were significantly increased (p&lt;0.001) with the use of AFOs versus barefoot walking. Cadence was the only parameter found to not be statistically different.

Immediate and long-term effects of ankle-foot orthosis on muscle activity during walking: A randomized study of patients with unilateral foot drop

Geboers JF, Drost MR, Spaans F, Kuipers H, Seelen HA. Immediate and long-term effects of ankle-orthosis on muscle activity during walking: a randomized study of patients with unilateral foot drop. Arch Phys Med Rehabil 2002;83:240-5. Objectives: To determine (1) whether use of an ankle-foot orthosis (AFO) by patients with ankle dorsiflexor paresis leads to decreased muscle activity, immediately or 6 weeks after AFO use, and (2) whether this decrease (if present) differs between healthy and paretic subjects. Design: Cross-sectional and longitudinal randomized case-control study. Setting: Rehabilitation research center in the Netherlands. Participants: Fourteen healthy persons and 29 patients with foot drop. Interventions: Muscle activity was measured by surface electromyography. Electromyographic reproducibility was tested in 14 healthy volunteers walking with and without AFO. Acute changes in muscle activity from AFO use were compared between the 14 healthy persons and the 29 patients with foot drop. Adaptation effects of AFO use after 6 weeks were studied in 29 patients, randomly chosen 16 of whom had started using an AFO at the first measurement. Main Outcome Measures: Amount of change in mean rectified electromyographic activity (δ value) between walking with and without AFO. Follow-up measurements were conducted after 3 and 6 weeks. Results: Correlation coefficients, reflecting within-subject reproducibility, varied between.68 and.96 (mean,.86). In patients and healthy subjects, tibialis anterior muscle activity decreased by 7% and 20% (P =.01, P =.04), respectively, when using an AFO. In patients, this decrease was measured in the overall activity during the gait cycle; in healthy subjects, it was measured in the first 15% of the gait cycle. Overall electromyographic activity did not change during 6 weeks; δ values per muscle did not change during follow-up in the AFO group. Conclusion: AFO use immediately reduced muscle activity of the ankle dorsiflexors. However, using an AFO for 6 weeks did not lead to a generally lower electromyographic activity level nor did the amount of activity reduction accumulate in comparison with patients who did not use an AFO. It is, therefore, safe to use an AFO, even with recently paretic patients. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Ankle-foot orthoses: effect on gait in children with cerebral palsy

Purpose: In this study our aim was to evaluate the effectiveness of Ankle-Foot Orthoses (AFOs) on gait function in patients with spastic cerebral palsy for whom orthoses were indicated to control dynamic equines deformity. Method: Twenty-four spastic cerebral palsied patients with dynamic equines deformity were included in the study. Videotape recordings were performed to each patient on the same day with barefoot and AFOs. Temporal distance factors including velocity, cadence, stride length, stride width and Clinical Gait Assessment Score (CGAS) were compared across two conditions. Results: The use of AFOs during gait, produced a statistically significant increase in velocity (p=0.011) and stride length (p<0.001), no significant difference in cadence (p=0,501), and stride width (p=0.796), and a significant decrease in CGAS (p<0.001), compared to barefoot condition. Conclusions: Cerebral palsied children with dynamic equines deformities can benefit from AFOs for ambulation.

Physical and functional correlations of ankle-foot orthosis use in the rehabilitation of stroke patients

Teasell RW, McRae MP, Foley N, Bhardwaj A. Physical and functional correlations of ankle-foot orthosis use in the rehabilitation of stroke patients. Arch Phys Med Rehabil 2001;82:1047-9. Objective: To examine factors associated with the use of ankle-foot orthoses (AFOs) in stroke patients undergoing rehabilitation. Design: Retrospective cohort study of the frequency of AFO use. Setting: Inpatient rehabilitation unit. Participants: Consecutive stroke patients (n = 423) admitted to an inpatient rehabilitation unit over a 10-year period. Intervention: Discharge with AFO. Main Outcome Measures: Functional outcome measurement scores of patients who were and who were not prescribed an AFO were examined. The groups were compared by using admission and discharge Chedoke-McMaster Stroke Impairment Inventory (CM; each measure analyzed separately), FIM™ instrument (walking, stairs, overall measures), and Berg Balance Scale scores. Results: Ninety-three of the 423 patients (22%) were discharged with an AFO. Overall, they scored consistently lower than patients who were discharged without an AFO. Statistically significant differences (p <.001) were noted between AFO users and nonusers in admission and discharge scores in the arm, hand, leg, and foot components of the CM and the FIM stairs and walking component scores. Average admission and discharge Berg scores differed between the 2 groups (p =.005, p =.013, respectively). Overall FIM scores were also significantly different both at admission and discharge (p <.001, p =.025, respectively). Conclusion: Use of AFOs at discharge was associated with significantly lower admission and discharge CM scores of the arm, hand, leg, and foot; FIM walking and stairs scores; total FIM scores; and Berg Balance Scale scores. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Evaluation of effect of ankle-foot orthosis use on strength restoration of paretic dorsiflexors

Geboers JFM, Janssen-Potten YJM, Seelen HAM, Spaans F, Drost MR. Ankle-foot orthosis and reduction of strength restoration of paretic ankle dorsiflexion. Arch Phys Med Rehabil 2001;82:856-60. Objective: To assess whether a difference exists in restoration of strength between patients with a recent paresis of the dorsiflexors of the ankle using an ankle-foot orthosis (AFO) and patients without an AFO. Design: Prospective case-control study. Setting: Patients from regional hospitals, tested in a rehabilitation research center. Participants: Twenty-nine patients with a recent (6wk-1yr) peripheral paresis, alternately assigned to a group using an AFO or a control group. There was no significant difference in duration of the paresis and in torque at entering the study (T0) between the 2 groups. Interventions: The use of an ankle-foot orthosis. Main Outcome Measures: Isometric torque production of ankle dorsiflexors, expressed as ratio of paretic and healthy side, in 2 measurement sessions, over a period of 6 weeks (T0-T6) with the ankle in 0° and 30° plantarflexion. Results: Both groups had significant restoration of strength ± standard deviation between T0 and T6 in 30° flexion: non-AFO group 17% ± 15%, AFO group 9% ± 12%. No significant difference existed between the 2 groups (30° p =.56). No significant shift in strength ratio 0°:30° occurred (AFO group p =.82). Conclusion: The use of an orthosis does not influence restoration of strength in patients with a recent peripheral paresis of the ankle dorsiflexors.

The Effects of a Dorsiflexion-Stopped Ankle-Foot Orthosis on Walking in Individuals with Incomplete Spinal Cord Injury

After incomplete spinal cord injury, the plantar flexor (PF) muscles commonly are weakened, compromising forward progression of body weight over the foot. One means of counteracting this deficit is by the use of an ankle-foot orthosis (AFO). Some clinicians have hesitated to prescribe an AFO, concerned that its use reduces PF activity and limits strength improvements. The purpose of this study was to determine the effect of a dorsiflexion-stopped AFO on walking characteristics following incomplete spinal cord injury with PF weakness. Walking patterns were compared for nine individuals walking in an AFO and in shoes. Use of an AFO significantly increased gait velocity, lengthened stride length, and improved stance knee position without altering muscle activity patterns in the calf or quadriceps. These results suggest that use of a dorsiflexion-stopped AFO improved walking patterns without hampering muscle activity.

Nerve injuries in total hip arthroplasty.

Nerve injury occurs in 1% to 2% of patients who undergo total hip arthroplasty and is more frequent in patients who need acetabular reconstruction for dysplasia and those undergoing revision arthroplasty. Injury to the peroneal division of the sciatic nerve is most common, but the superior gluteal, obturator, and femoral nerves can also be injured. Nerve injury can be classified as neurapraxia, axonotmesis, or neurotmesis. The worst prognosis is seen in patients with complete motor and sensory deficits and in patients with causalgic pain. Prevention is of overriding importance, but use of ankle-foot orthoses and prompt management of pain syndromes can be useful in the treatment of patients with nerve injury. Electrodiagnostic studies hold promise in complex cases; however, their intraoperative role requires objective, prospective, controlled scientific study before routine use can be recommended.

Ankle-foot orthoses for preambulatory children with spastic diplegia.

We evaluated the effect of articulating and solid ankle-foot orthoses (AFOs) on the transitional movement of sit-to-stand for 15 children aged 2-5 years with spastic diplegia and dynamic equinus. Kinematic and kinetic data were collected for each child. The time to reach stable standing was determined by using a force plate. Seven children were comparable to age-matched normals while barefoot and were slowed by the use of AFOs. Eight patients were more than 1 standard deviation slower than normals while barefoot. All were significantly (p < 0.003) improved by the use of articulating AFOs. The clinical difference between these groups was the presence of equinus during stable standing while barefoot for patients aided by AFOs, whereas the second group remained plantigrade barefoot. We conclude that children with spastic diplegia with uncontrolled dynamic equinus benefit from the use of articulating AFOs for the movement of sit-to-stand.