Use Of Ankle-foot Orthoses Research Articles

Pengaruh Penggunaan Afo Fleksibel Terhadap Keseimbangan Dinamis Pada Hemiparetic Cerebrovascular Accident (CVA)

Abstract Background: Stroke or Cerebrovascular Accident (CVA) is a primary neurologic problem in the United States and in the World. There are approximately 2 million people surviving from strokes that have a disability of 40% need help in daily activities (Brunener & Suddarth, 2002). The restoration of the functioning of the limbs and the ability to move within a community is a top priority for individual adoption after experiencing CVA. Ankle Foot Orthosis (AFO) can be used by someone with a CVA hemiparetic to help restrain ambulation abilities. AFO can prevent drop foot, controls the ankle in the coronal and sagittal areas during standing and walking and improves the stability of the knee during ambulation. Method: This research use cross sectional study method to find out what happened now by using correlative design design research. The researcher discusses the strength of the relationship between variables that is dynamic balance in drop foot because CVA, when using AFO Flexible. This data is obtained from direct measurement of dynamic balance of Flexible AFO users using Time up and go Test. Results :Differences in the effect of AFO on the dynamic balance of Hemiaretic Cerebrovascular Accident (CVA) patients in the intervention and control group. The results showed the average dynamic balance of hemiaretic cerebrovascular accident patients in the intervention group (28.20) while the mean equilibrium was maintained in the control group (12.80). The result of statistical test with man whitney showed p value 0,000 <0,05 so there was difference of influence of AFO use to dynamic balance of Hemiaretic Cerebrovascular Accident (CVA) patient in intervention group and control group. This means that the more frequently the patient uses AFO in daily activities it can improve the optimal dynamic balance and can perform activities independently. Conclusion: There is a difference in the effect of AFO on the dynamic balance of Hemiaretic Cerebrovascular Accident (CVA) patients in the intervention and control group with p value 0,000 <0.05.

LONG-TERM BENEFIT OF CUSTOM-MADE ANKLE-FOOT ORTHOSES (AFO) TO IMPROVE GAIT AND BALANCE IN OLDER ADULTS

Objective: It is well established that ankle-foot-orthoses (AFO) is an effective footwear intervention to stabilize ankle joint, which in turn could improve balance and self-confidence during walking in older adults. However, its long term benefit, daily use acceptability, and mechanism of action are still debated. Methods: Ambulatory older adults (n=44, age=74.7 ± 6.4, BMI: 28.5 ± 5.6, 70% female, 64% history of fall) were randomly assigned (ratio=1:1) to AFO intervention + New-Balance shoes (AFO-G: Moor-Balance Brace with custom-made footplate) or New-Balance shoes alone (Shoe-G). Both groups were asked to wear the received footwear daily, for one year. Gait and balance were measured using validated devices at baseline, 6-month follow-up, and conclusion of the program. Results: Improvement in gait was significant at 6-month follow-up in the AFO-G with the largest effect size observed for stride velocity (16%, Cohens’ d=0.51, p=0.016). Small but none-significant improvement in gait was observed for the Shoe-G. Among balance parameters, large effect sizes were observed for both ankle-stability and center-of-mass (COM) sway in the AFO-G (d=1.08–1.24, p 0.050). The daily average of wearing the received footwear was 6.2 hours and 4.8 hours, for AFO-G and Shoe-G, respectively. Conclusion: This study confirmed that daily use of AFO is practical and effective to improve gait and balance. This could be explained by ankle stability and enhanced proprioception feedback provided by AFO. This in turn may lead to improve self-confidence during walking and thus improving gait speed over time.

Study on the design development of a multi joint ankle foot orthosis.

[Purpose] The purpose of this study was to investigate the effects of a newly designed multi joint ankle-foot orthosis on the gait and dynamic balance of stroke patients having foot drop. [Participants and Methods] This study was investigated 10 participants who were diagnosed with stroke. Patients were evaluated based on a 10-meter walk test, timed up and go test and Berg balance scale after each participant wore a plastic ankle-foot orthosis and a multi joint ankle-foot orthosis (AFO) that consisted of orthosis joints (having poster-stop joint and Klenzak joint functions). [Results] The 10-meter walk test, timed up and go test and Berg balance scale showed significant differences in the orthosis with the Klenzak joint function. [Conclusion] The appropriate use of Klenzak AFO of the newly designed multi joint AFO is expected to have a positive effect on improving the gait and balancing ability of stroke patients having foot drop.

Prolonged stretching of the ankle plantarflexors elicits muscle-tendon adaptations relevant to ankle gait kinetics in children with spastic cerebral palsy

Tissue related ankle hyper-resistance has been reported to contribute to equinus gait in children with spastic cerebral palsy. Hence, ankle plantarflexor stretching programs have been developed in order to restore passive ankle dorsiflexion. Despite high quality evidence on the limited effects of stretching on passive joint mobility, further muscle-tendon adaptations have been reported which may impact gait performance. As such, children with spastic cerebral palsy subject to long-term manual static stretching achieved dorsiflexion gains through the reduction of muscle and fascicle strain whilst preserving tendon strain, and prolonged use of ankle-foot orthoses achieved similar dorsiflexion gains through increased tendon strain whilst preserving muscle and fascicle strain. The latter concurred with normalization of early stance plantarflexor moment yet reductions in push-off plantarflexor moment given the increase in tendon compliance. Therefore, similar limited gains in passive ankle joint mobility in response to stretching may be achieved either by preserving/restoring optimal muscle-tendon function, or at the expense of muscle-tendon function and thus contributing gait impairments. The largest increase in ankle passive joint mobility in children with SCP has been obtained through prolonged plantarflexor stretching through ankle casting combined with botulinum neurotoxin type A. However, to our knowledge, there are no published studies on muscle-tendinous adaptations to ankle casting combined with botulinum toxin type A and its effect on ankle joint gait kinetics. Therefore, we hypothesized that ankle casting elicits muscle-tendon adaptations which concur with altered ankle joint kinetics during the stance phase of gait in children with SCP. More information is needed about the relationships between muscle structure and function, and the effect of specific interventions designed to alter muscle properties and associated functional outcomes in children with spastic cerebral palsy.

Six-Minute Walk Test Performance in Persons With Multiple Sclerosis While Using Passive or Powered Ankle-Foot Orthoses

ObjectiveTo determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS). DesignShort-term intervention. SettingUniversity research laboratory. ParticipantsParticipants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO. InterventionsThree 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb. Main Outcome MeasuresDistance walked and metabolic cost of transport were recorded during each 6MWT and compared between footwear conditions. ResultsEach participant completed all three 6MWTs within the experimental design. PPAFO use resulted in a shorter 6MWT distance than did a passive AFO or shoe use. No differences were observed in metabolic cost of transport between footwear conditions. ConclusionsThe current embodiment of this PPAFO did not improve endurance walking performance during the 6MWT in a sample of participants with gait impairment due to MS. Further research is required to determine whether expanded training or modified design of this powered orthosis can be effective in improving endurance walking performance in persons with gait impairment due to MS.

Effect of ankle foot orthosis on gait parameters and functional ambulation in patients with stroke.

This study aims to investigate the effect of ankle foot orthosis (AFO) on temporospatial parameters, ankle kinematics, and functional ambulation level in patients with stroke. Records of 286 adult patients with stroke assessed in the gait and motion analysis laboratory between April 2005 and January 2013 were reviewed. The data of 28 patients (16 males, 12 females; mean age 43.2±15.9 years; range 20 to 72 years) who were analyzed with and without AFO during the same session were selected for the study. Temporospatial parameters (walking speed, cadence, opposite foot contact, double support time, single support time, step time, and step length) and ankle kinematics (ankle dorsiflexion at initial contact and midswing) were measured using the Vicon 512 motion analysis system. The video and medical records of patients were examined to determine their ambulation level according to Functional Ambulation Category. Walking speed, cadence, and ankle dorsiflexion at initial contact and midswing were significantly increased while walking with AFO compared to walking barefoot (p<0.05). There were significant reduction in step time and significant increase in step length and opposite foot contact with AFO on the affected side (p<0.05). Single support time reduced significantly with AFO on the unaffected side (p<0.05). Functional Ambulation Category score improved significantly with use of AFO (p<0.05). The use of AFO has positive effects on gait parameters and functional ambulation in patients with stroke.

Six-month effects of early or delayed provision of an ankle-foot orthosis in patients with (sub)acute stroke: a randomized controlled trial

Objective: To study the six-month clinical effects of providing ankle-foot orthoses at different moments (early or delayed) in (sub)acute stroke; this is a follow-up to a published trial. Design: Randomized controlled trial. Setting: Rehabilitation centre. Subjects: Unilateral hemiparetic stroke subjects maximal six weeks post-stroke with indication for ankle-foot orthosis use. Interventions: Subjects were randomly assigned to early (at inclusion; week 1) or delayed provision (eight weeks later; week 9). Outcome measures: Functional tests assessing balance and mobility were performed bi-weekly for 17 weeks and at week 26. Results: In all, 33 subjects were randomized. No differences at week 26 were found between both groups for any of the outcome measures. However, results suggest that early provision leads to better outcomes in the first 11–13 weeks. Berg Balance Scale (P = 0.006), Functional Ambulation Categories (P = 0.033) and 6-minute walk test (P < 0.001) showed significantly different patterns over time. Clinically relevant but statistically non-significant differences of 4–10 weeks in reaching independent walking with higher balance levels were found, favouring early provision. Conclusion: No six-month differences in functional outcomes of providing ankle-foot orthoses at different moments in the early rehabilitation after stroke were found. Results suggest that there is a period of 11–13 weeks in which early provision may be beneficial, possibly resulting in early independent and safe walking. However, our study was underpowered. Further research including larger numbers of subjects is warranted.

Evaluating the Effects of Ankle-Foot Orthosis Mechanical Property Assumptions on Gait Simulation Muscle Force Results.

Musculoskeletal modeling and simulation techniques have been used to gain insights into movement disabilities for many populations, such as ambulatory children with cerebral palsy (CP). The individuals who can benefit from these techniques are often limited to those who can walk without assistive devices, due to challenges in accurately modeling these devices. Specifically, many children with CP require the use of ankle-foot orthoses (AFOs) to improve their walking ability, and modeling these devices is important to understand their role in walking mechanics. The purpose of this study was to quantify the effects of AFO mechanical property assumptions, including rotational stiffness, damping, and equilibrium angle of the ankle and subtalar joints, on the estimation of lower-limb muscle forces during stance for children with CP. We analyzed two walking gait cycles for two children with CP while they were wearing their own prescribed AFOs. We generated 1000-trial Monte Carlo simulations for each of the walking gait cycles, resulting in a total of 4000 walking simulations. We found that AFO mechanical property assumptions influenced the force estimates for all the muscles in the model, with the ankle muscles having the largest resulting variability. Muscle forces were most sensitive to assumptions of AFO ankle and subtalar stiffness, which should therefore be measured when possible. Muscle force estimates were less sensitive to estimates of damping and equilibrium angle. When stiffness measurements are not available, limitations on the accuracy of muscle force estimates for all the muscles in the model, especially the ankle muscles, should be acknowledged.

Role of ankle foot orthosis in improving locomotion and functional recovery in patients with stroke: A prospective rehabilitation study.

Objective:To study role of ankle foot orthosis (AFO) in improving locomotion and functional recovery after stroke.Setting:Neurological Rehabilitation Department of a university research tertiary hospital.Patients and Methods:AFO and activity based rehabilitation.Main Outcome Measures:Distance (meters) covered during the 6-minute walk test (6MWT) and speed (meter/second) during the 10-meter walk test. Functional abilities assessed using Functional Independence Measure (FIM®).Results:Twenty-six patients (21 male) with stroke (mean duration 196.7 days, range 45–360 days) and mean age of 41.6 years (range 18–65 years, standard deviation [SD] 12.5) were included. Fourteen had right hemiplegia. The mean length of stay in the unit was 26.5 days (range 18–45 days, SD 5.5). All patients had equinus deformity with spastic foot drop and were provided with AFO. Walking endurance with 6MWT was 90 m on admission (without AFO). At discharge, it improved to 174 m with AFO and 121 m without AFOs (P < 0.001-with and without AFO at discharge). Walking speed improved from 0.4 m/s (admission) to 0.51 m/s with AFO, P = 0.004 and 0.45 m/s without AFO, P = 0.015) at discharge. Nine patients (34.6%) had clinically important difference-minimal clinically important difference (>0.16 m/s speed gain; >50 m endurance gain) at discharge. The mean FIM® score on admission was 84.3 ± 18.6. At discharge FIM® improved to 101.9 ± 13.7 (P < 0.001).Conclusions:Use of AFOs improve gait parameters significantly in only one-third stroke patients in the study when combined with activity-based inpatient-rehabilitation.

Are Gait Indices Sensitive Enough to Reflect the Effect of Ankle Foot Orthosis on Gait Impairment in Cerebral Palsy Diplegic Patients?

Neuromuscular impairments may compromise gait function in patients with cerebral palsy (CP). As such, ambulatory children with CP often use ankle foot orthosis (AFO) to facilitate and optimize their ability to walk.The aim of this study was to evaluate whether the different gait indices, the Gillette Gait Index (GGI), the Gait Deviation Index (GDI), and the Gait Profile Score (GPS), reflect the improved gait that was previously shown using AFO. A retrospective analysis of 53 studies on children with spastic diplegic CP. All had undergone a comprehensive gait study and were analyzed while walking, both barefoot and with their braces, in the same session.Kinematic and temporal spatial data were determined and summarized by 3 methods: GPS, GDI, and GGI. Significant differences were found between the barefoot condition and the AFO conditions for temporal and kinematic parameters: changes in GGI, GDI, and GPS were not statistically significant, with an improvement of 9.33% in GGI (P=0.448) and no change in GDI and GPS. The use of AFO in diplegic CP children caused a statistically significant improvement in temporal and kinematic parameters. Interestingly, it was found that this improvement was not reflected by GGI, GDI, or GPS.These findings might suggest that gait indices, as outcome measures, may sometimes not reflect all the effects of specific interventions. Level III-retrospective study.

Ankle Foot Orthosis Improves Functional Ambulation and Balance in Patients with Peripheral Nerve Palsy

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.

Effect of using orthoses on prolonging ambulation in patients with Duchenne Muscular Dystrophy: review of literature

The walking ability of patients with Duchenne muscular dystrophy gradually decreases due to advancing weakness and muscle contracture. Lower limb orthoses are often prescribed in an attempt to prolong ambulation in these patients. Objective: To perform a literature review in order to verify the relationship between using orthoses and prolonging ambulation. Method: A literature review was performed in the PUBMED, PEDRO, and SCIELO databases with the keywords orthoses, bracing, gait, gait loss, ambulation, and Duchenne muscular dystrophy. Results: In 14 selected articles the prescription of knee-ankle-foot orthoses (KAFO) (also called long orthoses) and anklefoot orthoses (AFO) was identified, always associated with another therapeutic intervention. Most studies have reported that the use of such a device prolongs ambulation. Conclusion: The use of orthoses, regardless of type, prolongs ambulation, because it delays the progress of muscle contracture. Thus, the early use of AFO is recommended in order to minimize the functional impairment characteristic of the disease

Use of the ICF to investigate impairment, activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities

Purpose: This study investigated differences in impairment, activity limitation, participation restrictions and psychological distress between participants using ankle-foot orthoses (AFOs) as recommended, participants who did not use AFOs as recommended and participants who did not know recommendations for use. Method: Adults (n = 157) fitted with an AFO by an NHS Orthotic Service in Scotland completed a postal questionnaire that measured impairment, activity limitations participation restrictions and psychological distress using scales from the RAND 36-Item Health Survey 1.0 and the Hospital Anxiety and Depression Scale (HADS). Results: 41% of participants used their AFOs as recommended, 32% did not use their AFOs as recommended and 27% did not know the recommendations for use. Participants using AFOs as recommended reported lower levels of impairment and activity limitations, indicated by higher energy levels (p = 0.005), higher physical functioning (p = 0.005), lower role-limitations due to emotional problems (p = 0.001) and lower levels of anxiety (p = 0.003) compared to people not using AFOs as recommended. Conclusion: Health professionals need to ensure whether patients understand the recommendations for use of their AFO. Additionally, the results of the study support the value of evaluating patients’ psychological well-being to gain a better understanding of AFO use.Implications for RehabilitationParticipants who reported using AFOs as recommended had significantly lower levels of impairment, activity limitations and anxiety compared to those who did not use their AFO as recommended.In this study, 27% of participants did not know recommendations for use of AFOs. Health professionals should give consideration as to how information, regarding wearing instructions and use of AFOs, is provided to people who are prescribed AFOs.Psychological outcomes in orthotics are rarely assessed. However, this study demonstrates there is a value in measuring psychological outcomes in orthotic management.

Immediate Effect of Fabric Ankle Foot Orthosis on Balance in Children With Unilateral Cerebral Palsy

Balance control deficits have been indicated to be a primary problem among cerebral palsy (CP) patients. Fabric ankle foot orthosis (AFO) can allow more efficient balance control by facilitating proprioception. The purpose of this study was to investigate the immediate effect of fabric AFO on balance, compared to a barefoot condition in children with unilateral CP. Twelve children with unilateral CP participated in this study. Their balance ability was evaluated using pediatric balance scale and bubble test. Both pediatric balance scale and bubble test showed significant improvement with the use of the fabirc AFO (p<.05). The fabric AFO could improve functional balance ability, and promote better balance among children with unilateral CP. We demonstrated that fabric AFO contributed to improving balance among children with unilateral CP, classified as Gross Motor Function Classification System level Ⅰ and Ⅱ. Consequently, fabric AFO might be an assistive device leading to the improvement of balance instead of the typical AFOs.

Effects of ankle-foot orthoses on functional recovery after stroke: a propensity score analysis based on Japan rehabilitation database.

ObjectivesThe purpose of the present study was to investigate potential effects of ankle–foot orthoses (AFOs) on the functional recovery of post-acute stroke patients following rehabilitation.Subjects and MethodsThis study is a retrospective cohort study. Participants were in-hospital stroke patients registered in the Japan Rehabilitation Database between 2005 and 2012. A total of 1862 patients were eligible after applying exclusion criteria. Propensity score analysis was applied to adjust for potential bias and to create two comparable groups. An additional subset analysis focused on Functional Independence Measure (FIM) scores on admission.ResultsIn this sample, 30.7% of 1863 eligible patients were prescribed AFOs. Propensity score matched analysis showed that patients with AFOs had significantly higher scores than those without them for discharge FIM (mean: 91.3 vs 85.8; p=0.02), FIM gain (mean: 28.9 vs 23.5; p<0.001), and FIM efficiency (mean: 0.27 vs 0.22; p<0.001). Inverse probability weighting analysis showed similar results. In the subset analysis, patients with AFOs had significantly higher discharge FIM compared with those without them in the low admission FIM subgroup only. In addition, patients with AFOs performed independent exercise more than those without them (p<0.001).ConclusionsThese data suggest that stroke survivors may have better functional recovery if they are prescribed an AFO than if they are not prescribed an AFO. The use of AFOs is considered to be a feasible option to improve functional recovery of stroke rehabilitation patients.

Role of ankle foot orthoses in functional stability of individuals with stroke

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke. Methods: Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO. Results: When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p < 0.05). Conclusions: The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke.Implications for RehabilitationFunctional stability is impaired in individuals with stroke.Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control.Individuals with stroke improved their functional stability while they were provided with AFOs.Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.

Effects of AFO use on walking in boys with Duchenne muscular dystrophy: a pilot study.

Although bracing in the late ambulatory stage of Duchenne muscular dystrophy (DMD) has been described, the effects of ankle-foot orthoses (AFOs) in earlier stages have not been evaluated. The aim of this pilot study was to describe the effects of dynamic response AFO (DR-AFO) use in boys with DMD who are ambulatory. Using a crossover design, 3 boys were randomly assigned to either a 2-week DR-AFO or a placebo intervention. Phases were separated by a 1-week washout period. Primary outcomes were time to walk 10 m and a 6-Minute Walk Test. With DR-AFO use, declines in 10-m walk time (median decline = 0.8 s) and 6-Minute Walk Distance (median = 25.0 m) occurred. Parental report suggested that the use of DR-AFOs increased falls in 2 of 3 participants. This pilot study does not support the use of DR-AFOs by boys with DMD who are ambulatory.

Determination of loads carried by polypropylene ankle-foot orthoses: a preliminary study.

Ankle-foot orthoses (AFOs) are prescribed for the management of gait-related problems. Prescription of AFOs is based on empirical techniques due to the low level of evidence-based research on their efficacy, but primarily poor understanding of their mechanical characteristics. This study aimed to establish a method that would allow the quantification of the contribution of AFOs in the control of the ankle joint during gait. A possible way of achieving this aim would be to measure strain on the AFO during walking by the use of strain gauges. Following successful experimentation with the application of strain gauges to polypropylene tensile specimens, an AFO was instrumented by attaching strain gauges to it so as to allow the moment generated on the AFO in the sagittal plane about the ankle to be measured. Walking trials using this AFO on an able-bodied subject indicated good step-to-step repeatability. The use of an instrumented AFO in conjunction with kinematic and kinetic data acquisition would allow the contribution of the AFO and the residual anatomical loads to be determined. The advantage of such procedure over previously reported ones resides on the use of the actual orthosis being worn by patients thereby conducting tests under real-life situations. It is believed that such analysis of the load actions of an orthosis, which may in future be carried out in three dimensions, would allow a better understanding of the interaction between the leg and the orthosis. This should ultimately enhance AFO prescription criteria and help in optimising patient/device matching.

Ortesis pasiva tobillo-pie de uso nocturno en la prevención del pie equino en la parálisis cerebral

IntroductionEquinus, the most common deformity in patients with cerebral palsy, increases instability and impairs gait and adaptation to a wheelchair. Correction of equinus benefits walking children and aids proper placement of the foot on the footrest of a wheelchair. It also allows the possibility of using conventional footwear in children with no ability to walk. The aim of this study was to assess whether the use of an ankle-foot orthosis at night, keeping the foot in orthoposition, can prevent or delay the onset of equinus and thus prevent or delay tendon lengthening surgery. Material and methodsWe performed a retrospective observational study based on a chart review of 90 patients diagnosed with cerebral palsy treated with a nocturnal ankle-foot orthosis in the Children's Rehabilitation Unit at Hospital Virgen Macarena in Spain. ResultsOf the 90 patients treated with nocturnal ankle-foot orthosis, 88.9% achieved the dorsiflexion necessary for ambulation (≥10°) or adequate adaptation to a wheelchair and footwear (≥0°). Only 9 patients (10%) did not achieve the intended objectives with the use of the splint. ConclusionPreventive treatment with a rigid ankle-foot orthosis is a widely accepted practice that constitutes a first-line option in the treatment of cerebral palsy. Systematic and persistent use of a nocturnal ankle-foot orthosis can delay the onset of equinus in cerebral palsy and can delay or avoid surgery, with a clear functional benefit.

Immediate Influence of Carbon Composite Ankle-Foot Orthoses on Balance and Gait in Individuals with Peripheral Neuropathy

Currently, limited data exist supporting the use of ankle-foot orthoses (AFOs) on improving balance and gait in individuals with peripheral neuropathy (PN), and no studies have evaluated the effects of carbon composite AFOs in this population. The primary purpose of this study was to determine the immediate effects of carbon composite AFOs on postural control, dynamic balance, and gait in individuals with PN. Twelve subjects with neuropathy completed a single session of testing in this observational study. The subjects performed a battery of tests including quiet standing and limits of stability (LOS) force plate posturography, the Mini Balance Evaluation Systems Test (Mini-BESTest), gait speed, as well as the Timed Up and Go (TUG), both with and without carbon composite AFOs. The subjects exhibited significantly less sway in the anterior-posterior (p = 0.012) and medial-lateral (p = 0.047) sway directions with eyes closed while wearing the AFOs but experienced a reduction in anterior-posterior LOS (p = 0.000). There were no group differences for the Mini-BESTest, gait speed, and TUG; however, individual subjects experienced both positive and negative changes that exceeded minimally important change (MIC) values for the Mini-BESTest and gait speed. The results suggest that carbon composite AFOs have an immediate effect on balance in individuals with PN. In general, improvements in static postural control were observed when the AFOs were worn, but the effects on dynamic measures of balance and gait were more variable. Because of these trade-offs and variability, clinicians should evaluate how AFOs influence individual patients with the use of standardized measures that include a variety of dynamic balance and gait measures.