Dynamic Ankle-foot Orthoses Research Articles

Impact of plantar flexion resistive moment of dynamic ankle foot orthosis on measures of center of pressure and clinical gait outcomes in individuals with post-stroke hemiparesis

BackgroundAn ankle-foot orthosis (AFO) with plantar flexion resistance (PFR) can improve the first rocker function during gait, but the incremental changes in the resistive moment on balance and gait have not been well identified. ObjectivesTo investigate the effect of changing the PFR moment of dynamic AFO (DAFO) on measures of the center of pressure (COP) and clinical gait outcomes in individuals with post-stroke hemiparesis. MethodIn this randomized repeated measure study of 36 stroke individuals, the customized DAFO using foot drop ankle units set in three PFR situations (low, medium, and high) was evaluated. The balance parameters for COP measures were investigated by HUMAC® Balance & Tilt System. Gait parameters and ankle kinematics were recorded using the 3D motion analysis through force platform and optoelectronic system. The comparison was made using a parametric ANOVA test and the P value was set at 0.05 for statistical significance. ResultsSignificant differences were observed for COP average velocity (1.30 ± 0.64, 1.10 ± 0.05, and 1.37 ± 0.43), COP path length (43.3 ± 4.6, 33.4 ± 4.3, and 36.3 ± 5.4), walking velocity (11.0 ± 3.1, 13.2 ± 4.4, and 9.9 ± 3.5), and cadence (31.5 ± 2.0, 33.0 ± 3.1, and 29.0 ± 1.6) respectively for low, medium and high PFR settings (P < 0.05). Except for the COP path length and cadence, posthoc multiple comparisons revealed significant differences between low and medium (P < 0.05) and medium and high (P < 0.05) PFR grades. PFR with medium resistance demonstrated near-normal maximal peak ankle dorsiflexion (mean deviation of 8 degrees, P < 0.05). ConclusionMedium PFR grade should be encouraged since it can enhance balance parameters like path length and average velocity of COP, increase cadence and average velocity during gait, and improve maximal peak ankle dorsiflexion.

Military Service Members with Major Lower Extremity Fractures Return to Running with a Passive-dynamic Ankle-foot Orthosis: Comparison with a Normative Population.

Lower extremity fractures represent a high percentage of reported injuries in the United States military and can devastate a service member's career. A passive dynamic ankle-foot orthosis (PD-AFO) with a specialized rehabilitation program was initially designed to treat military service members after complex battlefield lower extremity injuries, returning a select group of motivated individuals back to running. For high-demand users of the PD-AFO, the spatiotemporal gait parameters, agility, and quality of life is not fully understood with respect to uninjured runners. Do patients who sustained a lower extremity fracture using a PD-AFO with a specialized rehabilitation program differ from uninjured service members acting as controls, as measured by (1) time-distance and biomechanical parameters associated with running, (2) agility testing (using the Comprehensive High-level Activity Mobility Predictor performance test and Four Square Step Test), and (3) the Short Musculoskeletal Function Assessment score. We conducted a retrospective data analysis of a longitudinally collected data registry of patients using a PD-AFO from 2015 to 2017 at a single institution. The specific study cohort were patients with a unilateral lower extremity fracture who used the PD-AFO for running. Patients had to be fit with a PD-AFO, have completed rehabilitation, and have undergone a three-dimensional (3-D) running analysis at a self-selected speed at the completion of the program. Of the 90 patients who used the PD-AFO for various reasons, 10 male service members with lower extremity fractures who used a PD-AFO for running (median [range] age 29 years [22 to 41], height 1.8 meters [1.7 to 1.9], weight 91.6 kg [70 to 112]) were compared with 15 uninjured male runners in the military (median age 33 years [21 to 42], height 1.8 meters [1.7 to 1.9], weight 81.6 kg [71.2 to 98.9]). The uninjured runners were active-duty service members who voluntarily participated in a gait analysis at their own self-selected running speeds; to meet eligibility for inclusion as an uninjured control, the members had to be fit for full duty without any medical restrictions, and they had to be able to run 5 miles. The controls were then matched to the study group by age, weight, and height. The primary study outcome variables were the running time-distance parameters and frontal and sagittal plane kinematics of the trunk and pelvis during running. The Four Square Step Test, Comprehensive High-level Activity Mobility Predictor scores, and Short Musculoskeletal Function Assessment scores were analyzed for all groups as secondary outcomes. Nonparametric analyses were performed to determine differences between the two groups at p < 0.05. For the primary outcome, patients with a PD-AFO exhibited no differences compared with uninjured runners in median (range) running velocity (3.9 meters/second [3.4 to 4.2] versus 4.1 meters/second [3.1 to 4.8], median difference 0.2; p = 0.69), cadence (179 steps/minute [169 to 186] versus 173 steps/minute [159 to 191], median difference 5.8; p = 0.43), stride length (2.6 meters [2.4 to 2.9] versus 2.8 meters [2.3 to 3.3], median difference 0.2; p = 0.23), or sagittal plane parameters such as peak pelvic tilt (24° [15° to 33°] versus 22° [14° to 28°], median difference 1.6°; p = 0.43) and trunk forward flexion (16.2° [7.3° to 23°) versus 15.4° [4.2° to 21°), median difference 0.8°; p > 0.99) with the numbers available. For the secondary outcomes, runners with a PD-AFO performed worse in Comprehensive High-level Activity Mobility Predictor performance testing than uninjured runners did, with their four scores demonstrating a median (range) single-limb stance of 35 seconds (32 to 58) versus 60 seconds (60 to 60) (median difference 25 seconds; p < 0.001), t-test result of 15 seconds (13 to 20) versus 13 seconds (10 to 14) (median difference 2 seconds; p < 0.001), and Illinois Agility Test result of 22 seconds (20 to 25) versus 18 seconds (16 to 20) (median difference 4; p < 0.001). Edgren side step test result of 20 meters (16 to 26) versus 24 meters (16 to 29) (median difference 4 meters; p = 0.11) and the Four Square Step Test of 5.5 seconds (4.1 to 7.2) versus 4.2 seconds (3.1 to 7.3) (median difference 1.3 seconds; p = 0.39) were not different between the groups with an effect size of 0.83 and 0.75, respectively. The results of our study demonstrate that service members run with discernible differences in high-level mobility and demonstrate inferior self-reported patient functioning while having no differences in speed and biomechanics compared with their noninjured counterparts with the sample size available. This study is an early report on functional gains of highly motivated service members with major lower extremity injuries who use a PD-AFO and formalized therapy program to run. Level III, therapeutic study.

645 Adjustable Dynamic Ankle Foot Orthosis for Recovery of Functional Mobility

Abstract Introduction We present a case of a 23-year-old woman with primary-onset peroneal nerve impairment following diagnosis of purpura fulminans involving 30% total body surface area, who was treated in our burn center. Medical complexity required a unique rehabilitation intervention. The purpose of this case study is to demonstrate the effectiveness of a dynamic ankle-foot orthosis (AFO) to recover functional ambulation. Methods Upon initial evaluation and during weekly re-evaluations, a physical therapist (PT) and an occupational therapist (OT) measured active range of motion (AROM), passive range of motion (PROM), and strength. Absent to trace common peroneal nerve function was identified bilaterally 8 days after admission. The patient underwent 41 surgeries and spent 231 days in the burn intensive care unit. Medical complications included 3 episodes of acute respiratory distress syndrome and septic shock, acute renal failure requiring 150 days of continuous renal replacement therapy, and 51 ventilator days. Due to post-operative restrictions and/or medical complications, lower-extremity ROM was restricted for 63 days and supine position was restricted for 49 days. Rehabilitation interventions included PROM, AROM and continuous passive motion. Weight-bearing activities included a tilt table, Moveo™, standing frame, transfer and gait training with a rolling walker (RW). Positional interventions were sitting in a Total Lift Chair, serial casting, and custom AFO fabrication. Results On hospital day 215 the patient ambulated 15 feet using a platform walker and required assistance of 4 staff to support the ankle and foot. On hospital day 229, static custom AFOs were implemented and the patient ambulated 325 feet with contact guard assist (CGA). The static AFOs required frequent re-fabrication due to daily ROM progress. Adjustable dynamic AFOs were fabricated to decrease resource burden. With the dynamic AFOs, the patient progressed to 745 feet CGA on hospital day 258. The patient discharged to an acute rehabilitation center on hospital day 260. Conclusions Extensive medical, surgical and positional restrictions required innovative interventions by a multidisciplinary team. This resulted in the fabrication of dynamic custom AFOs for gait training. Utilization of these AFOs significantly increased activity tolerance and ambulation distance, and enabled eventual discharge to a rehabilitation center.

Impact of a dynamic ankle orthosis on acute pain and function in patients with mechanical foot and ankle pain

BackgroundOver two million Americans visit the doctor each year for foot and ankle pain stemming from a degenerative condition or injury. Ankle-foot orthoses can effectively manage symptoms, but traditional designs have limitations. This study investigates the acute impact of a novel “dynamic ankle-foot orthosis” (“orthosis”) in populations with mechanical pain (from motion or weight-bearing). MethodsWith and without the brace, participants (n = 25) performed standing, over-ground level walking, treadmill level walking, stair ascent, stair descent, single leg hold, squat, and sitting. Instrumented insoles captured in-shoe vertical forces and a visual analog scale was used to assess pain levels during each activity. Subsequently, the self-perceived impact of the orthosis on the patient's symptoms and function was ranked on a scale from −10 (most worsened) to +10 (most improved). FindingsPeak in-shoe force was reduced during level and stair walking (P < 0.05). Average perceived pain was 1.2 to 1.6 points lower in the orthosis than the unbraced control for the active tasks. The majority of participants reported that the brace improved their symptoms (n = 19), while a smaller group reported that the brace did not affect their symptoms (n = 5), although average function scores were improved for both groups (+2.4 to +4.5). The group of individuals with improved symptoms included cases of osteoarthritis, tendon dysfunction, chronic pain, sprains, and nerve disorders. InterpretationThe orthosis effectively improved pain symptoms and improved the ability of impaired individuals to complete functional activities of daily living such as level walking and stair walking.

Wearing Time for Lower-Limb Orthoses in Users with Pathological Gait Due to Neurological Disorder—Influences of Orthotic Concepts

ABSTRACT Introduction Lower-limb orthoses are usually part of conservative therapy in patients with pathological gait due to neurological disorders. A modular design, defined as a detachable combination of different orthotic designs, offers the possibility to adapt orthosis functionality to individual needs. Currently, however, knowledge about the actual impact of modularity on wearing times is limited. The aim of the present study was therefore to examine the wearing time of modular and nonmodular orthoses to determine whether there are differences between the different orthotic concepts of the lower limb on weekdays and weekends and whether modularity affects wearing time. Material and Methods In this prospective clinical study, 53 patients with neurological gait disorder were included. All wore modular or nonmodular orthoses in one of these three groups: dynamic ankle-foot orthoses (DAFOs), ankle-foot orthoses (AFOs), and knee-ankle-foot orthoses (KAFOs). Wearing time was recorded by temperature sensors for 3 months. Data analysis included both descriptive and further parametric statistical testing (t-test for dependent and independent samples) as well as Pearson correlations. A univariate analysis of variance was used when comparing multiple groups. Results Participants wore DAFOs and AFOs, but not KAFOs, significantly longer on weekdays. Wearing time correlated significantly between weekdays and weekends for all groups. There is no significant difference in the mean daily wearing time between the groups. Modularity influenced the wearing time only for the DAFO/AFO combination. Conclusion Orthotic design and anatomic height affect the average daily wearing time. A change in wearing behavior between weekdays and weekends and influences by modularity can be found solely in DAFOs and AFOs.

Additional Effects of Shank Adaptations in Children with Bilateral Spastic Cerebral Palsy

ABSTRACT Introduction Conservative therapy for bilateral spastic cerebral palsy (BSCP) regularly includes a modular orthosis setup with dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS). Additional effects by this modular supply have not been studied so far. The goal was thus an exploratory investigation of what effects can be expected by supplementing a DAFO with an additional MSS. Materials and Methods Ten children with BSCP were fitted with DAFO and MSS. Dynamic elastic shank adaptations (DESAs) and ground reaction force AFOs (GRAFOs) were used, depending on the participants' individual needs. Participants underwent a gait analysis after supply and 3 months later. Data analysis included a descriptive analysis and further statistical testing using a Friedman test and post hoc Wilcoxon rank test. Results The Gillette Gait Index (GGI) improved significantly with MSS compared with barefoot and DAFO, the Gait Deviation Index (GDI) only comparing DAFO to MSS. However, no further changes had occurred at follow-up, and for the Gait Profile Score (GPS), not at all. Step length, velocity, cadence, stance duration, and step width changed significantly after supply. Kinematic changes developed at ankle, knee, hip, and trunk. However, only minor changes had occurred at follow-up. Conclusions DAFOs and MSS show positive effects, as observed in spatiotemporal parameters, gait indices, and kinematic data. Most kinematic effects occur at the ankle and knee joint. MSS produces additional effects, with a particular emphasis on the extending effect on the knee in terminal stance. Only minor beneficial effects on kinematic parameters of knee and trunk during swing phase occur after a familiarization phase. The changes in the spatiotemporal parameters imply a slight deterioration.

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach.

Objective To date there is only limited knowledge about the wearing time of orthoses. Ankle-foot orthoses (AFOs) have not been studied with this research question. Additional influences of the orthotic design as well as weekdays and the weekend are also unknown. Design Monocentric, clinically prospective intervention study. Patients Inclusion of 10 patients with bilateral spastic cerebral palsy. Methods Equipment of all subjects with a dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS, dynamic elastic shank adaptation or ground reaction AFO). Integration of temperature sensors for recording the wearing time for a period of 3 months. Results The actual wearing time was below the recommendations on actually worn days as well as the average of the entire study period. In addition, the actual usage in terms of days and hours was well below the recommendations. The wearing time showed differences between weekdays and weekend. Differences between DAFO and MSS were not detectable. Conclusion The actual usage behavior of ankle-foot orthoses differs from the recommendations of the prescriber. This applies to both DAFOs and modular use with shank supplies. Environmental factors may have a significant impact on wearing times on weekdays and the weekend.

The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy

BackgroundTreatment of cerebral palsy includes an interdisciplinary concept and in more severe cases the well-established multi-level surgery (MLS). Different kinds of orthoses are typically part of postoperative treatment but there is a lack of knowledge about their additional benefit. Research questionDo ankle foot orthoses lead to an additional, measurable improvement of gait after MLS? Methods20 children with bilateral spastic cerebral palsy (9 retrospective, 11 in a postoperative clinical routine) were included. All had a preoperative gait analysis before MLS. Postoperatively, they were fitted with different ankle foot orthoses (AFO), depending on their individual needs. Dynamic ankle foot orthoses (DAFO), combined DAFO with additional dynamic, elastic shank adaptation (DESA) and ground reaction force AFOs (GRAFO) were used. Patients underwent a second gait analysis 1.5 (± 0.6) years postoperatively barefoot and with orthoses. Data analysis included testing for normal distribution (Shapiro-Wilk-Test) and further nonparametric statistical testing on basis of a Wilcoxon Single-Rank Test. ResultsThe operation produced changes in the hip, knee and ankle joint, and the pelvis. Spatiotemporal parameters showed significant changes due to additional use of the orthoses. Further, additional kinematic changes occurred at the hip, knee and ankle joint as well as the foot. The Gillette Gait Index (GGI) improved significantly by supplementary orthoses, but not by surgery alone. The Gait Profile Score (GPS) and Gait Deviation Index (GDI) rather showed changes due to the surgery. SignificanceMLS significantly improves GPS and GDI more than a year after surgery, which can be interpreted as an improvement in gait pattern. In contrast, the GGI is improved by additional postoperative orthotic treatment, which implies that walking ability itself has improved, rather than the gait pattern. Orthoses show a positive additional effect on surgical results at different anatomical levels. Spatiotemporal parameters are positively influenced solely by additional orthotic support.

State of the Prescription Process for Dynamic Ankle-Foot Orthoses

Purpose of Review Dynamic ankle-foot orthoses (AFOs) are assistive devices that can be prescribed to individuals with mobility limitations to support and align joints. Dynamic AFOs are a category of passive AFOs that can control ankle motion to address both ankle joint range of motion limitations and ankle muscle weakness. This control of motion is achieved through the dynamic AFO’s functional characteristics, namely bending stiffness, which need to be customized to each individual’s needs. However, current conventions for customizing dynamic AFOs for each individual are variable and often not clearly documented. The purpose of this review was to synthesize the current state of customizing functional characteristics of dynamic AFOs to provide a foundation for ultimately optimizing the prescription of AFOs.

Outcomes Associated With the Intrepid Dynamic Exoskeletal Orthosis (IDEO): A Systematic Review of the Literature.

High-energy lower extremity trauma is a consequence of modern war and it is unclear if limb amputation or limb salvage enables greater recovery. To improve function in the injured extremity, a passive dynamic ankle-foot orthosis, the Intrepid Dynamic Exoskeletal Orthosis (IDEO), was introduced with specialized return to run (RTR) therapy program. Recent research suggests, these interventions may improve function and return to duty rates. This systematic literature review sought to rate available evidence and formulate empirical evidence statements (EESs), regarding outcomes associated with IDEO utilization. PubMed, CINAHL, and Google Scholar were systematically searched for pertinent articles. Articles were screened and rated. EESs were formulated based upon data and conclusions from included studies. Twelve studies were identified and rated. Subjects (n = 487, 6 females, mean age 29.4 year) were studied following limb trauma and salvage. All included studies had high external validity, whereas internal validity was mixed because of reporting issues. Moderate evidence supported development of four EESs regarding IDEO use with specialized therapy. Following high-energy lower extremity trauma and limb salvage, use of IDEO with RTR therapy can enable return to duty, return to recreation and physical activity, and decrease pain in some high-functioning patients. In higher functioning patients following limb salvage or trauma, IDEO use improved agility, power and speed, compared with no-brace or conventional bracing alternatives.

Effect of ankle-foot orthoses on gait in children with cerebral palsy: A meta-analysis

Different ankle-foot orthoses (AFO) are often prescribed in children with cerebral palsy (PC) although their efficiency on gait remains unclear. (1) To determine the effect of AFOs on gait in children with CP and (2) to evaluate the effect of each types of AFO. Studies in English with control condition (barefoot or shoes) assessing effect of AFO about children with CP gait were search on the Pubmed, CINAHL+, Web of Science, Cochrane Library databases. Quality of each study was assessed by modified PEDRO scale. Only studies with a score more than 4 were selected. 10 gait parameters were extracted in each study. Effect size and 95% confidence interval were calculated for each parameter. Seventeen studies (490 subjects) were included. Comparing AFOs to control condition, stride length increased (15 studies) d = 1.04 [95% CI: 0.69; 1.38], velocity increased (16 studies) d = 0.27 [95% CI: 0.14; 0.41], cadence decreased (15 studies) d = −0.69, [95% CI: −0.95; −0.43]. Ankle dorsiflexion increased at initial contact (11 studies) d = 1.64, [95% CI: 1.16; 2.11] and in swing phase (7 studies) d = 5.21, [95% CI: 1.91; 8.52]. Ankle power generation in stance phase decreased (6 studies) d = −0.26, [95% CI: −0.38; −0.14]. The duration of tibialis anterior activation and energy data did not changed significantly. Four types of orthosis were found: dynamic AFO, hinged AFO, solid AFO, supra-malleolar orthosis. Hinged AFO was the orthosis that improved the greater number of gait parameters and was the only one to improve velocity with an effect size > 0.8 (large effect). This study shows clinically significant effect of AFO on stride length, ankle dorsiflexion at initial contact and swing phase. Hinged AFO seems to have the greatest effect on gait. New data are needed to refine the choice of the orthosis according to the child gait pattern.

Manipulation and orthosis in the management of congenital talipes equinovarus

Background: There have been controversies regarding the ideal treatment method for congenital talipes equinovarus (CTEV). It is now accepted that conservative management is the first line of management. Aims: To find out if manipulation and maintenance of the correction achieved with a dynamic CTEV orthosis can correct CTEV deformities. Study Settings: Department of Physical Medicine and Rehabilitation in a tertiary care teaching institute, Imphal. Study Design: Intervention study without comparison group. Materials and Methods: Fifteen patients (twenty-one CTEV feet) were enrolled in the study. Manipulation with the head of talus as fulcrum was performed without any attempt to separately correct cavus and other deformities from the beginning. This procedure was repeated ten times for a minimum of three sittings daily. Correction so achieved was maintained with a dynamic CTEV orthosis manufactured with polypropylene plastic. The CTEV orthosis was worn throughout the day except during manipulations and bathing. Roentgenography was performed before the start and at the end of the treatment to assess improvement. Statistical Analysis: Wilcoxon signed-rank test was used to assess the improvement in the radiological angles from baseline to the last follow-up. Results: The differences in the paired X-ray angles [talocalcaneal angle-lateral (TCA-LAT), tibiocalcaneal angle-lateral (TibCA), talocalcaneal angle-anteroposterior (TCA-AP), talo-first metatarsal angle-anteroposterior (TMT)] between the baseline and the sixth follow-up were statistically significant (P < 0.001). Conclusion: Proper daily manipulation by a caregiver and maintenance of correction with appropriately designed dynamic ankle-foot orthosis is a practical and effective means of correcting CTEV deformity.

How does ankle-foot orthosis stiffness affect gait in patients with lower limb salvage?

Ankle-foot orthoses (AFOs) are commonly prescribed during rehabilitation after limb salvage. AFO stiffness is selected to help mitigate gait deficiencies. A new custom dynamic AFO, the Intrepid Dynamic Exoskeletal Orthosis (IDEO), is available to injured service members but prescription guidelines are limited. In this study we ask (1) does dynamic AFO stiffness affect gait parameters such as joint angles, moments, and powers; and (2) can a given dynamic AFO stiffness normalize gait mechanics to noninjured control subjects? Thirteen patients with lower limb salvage (ankle arthrodesis, neuropathy, foot/ankle reconstruction, etc) after major lower extremity trauma and 13 control subjects who had no lower extremity trauma and wore no orthosis underwent gait analysis at a standardized speed. Patients wore their custom IDEO with posterior struts of three different stiffnesses: nominal (clinically prescribed stiffness), compliant (20% less stiff), and stiff (20% stiffer). Joint angles, moments, powers, and ground reaction forces were compared across the varying stiffnesses of the orthoses tested and between the patient and control groups. An increase in AFO compliance resulted in 20% to 26% less knee flexion relative to the nominal (p = 0.003) and stiff (p = 0.001) conditions, respectively. Ankle range of motion and power generation were, on average, 56% (p < 0.001) and 63% (p < 0.001), respectively, less than controls as a result of the relatively fixed ankle position. Patients with limb salvage readily adapted to different dynamic AFO stiffnesses and demonstrated few biomechanical differences among conditions during walking. None of the stiffness conditions normalized gait to controls. The general lack of differences across a 40% range of strut stiffness suggests that orthotists do not need to invest large amounts of time identifying optimal device stiffness for patients who use dynamic AFOs for low-impact activities such as walking. However, choosing a stiffer strut may more readily translate to higher-impact activities and offer less chance of mechanical failure.

Long-Term Outcomes of a Dynamic Ankle-Foot Orthosis on Gait Characteristics of a Service Member With Incomplete Nerve Injury to the Lower Extremity: A Case Report

This case study reports a 5-year follow-up of a 32-year-old male service member who suffered polytrauma in 2007 following a Humvee rollover in Afghanistan. The service member's injured left lower extremity was salvaged, but severe damage to the lumbosacral plexus and significant injuries to the pelvis, hip, and femur resulted in near total paralysis and foot drop of the left lower limb. Two years of multiple substandard ankle-foot orthotic devices pushed him to investigate a dynamic ankle-foot orthotic (DAFO) with energy storing capability, which allowed him to remain on active duty and deploy for a second tour while wearing the device. The anecdotal improvements described by this service member prompted a biomechanical analysis of walking and running gait, comparing a shoes only condition to the DAFO. Results of gait analysis demonstrated an improvement in spatial-temporal parameters in both walking and running, improved sagittal angles and moments at the ankle, knee, and hip, greater ankle stability through decreased dorsiflexion excursion, and a marked increase in ankle power while running. Most notably, the service member credits this device for substantial improvement in quality of life including total cessation of pain medication and return to regular vigorous activity.

Influence of ankle-foot orthoses on kinematic segmental covariation among stroke patients

To evaluate the effect of ankle-foot orthosis on lower limbs kinematic segmental covariation (KSC) among stroke patients. Ten chronic hemiparetic spastic stroke patients presenting with a lack of ankle dorsiflexion were assessed with instrumented gait analysis under three conditions: wearing a shoe, with a prefabricated ankle-foot orthosis (AFO), and with a dynamic AFO. Kinematic parameters were recorded and computed KSC was calculated according to Borghese's methodology. Contrary to the prefabricated AFO, the dynamic AFO improved KSC of the paretic side. We observed a high correlation between the external mechanical work and the affected side's KSC. In the unaffected side, KSC was globally unchanged. In stroke patients, wearing a dynamic AFO improves KSC of the paretic lower limb only.

Development of Dynamic Ankle Foot Orthosis for Therapeutic Application

In a population of aging with low birth rate, many elderly become bedridden because of their suffering from injuries or diseases that require a long period to heal and rehab. We developed the lowest cost of production while provides the highest performance and reliable prototype. The selective 27 parts were identified and used in this project including the cabling assembly for wiring. The other selective 14 parts are using other polymer materials such Acrylontrile Butadine Styrene (ABS) and Polypropylene. The alpha prototype was produced using FDM (Fuse Deposition Modeling). The model is fabricated by using real scale of (1:1) for the chosen conceptual design. Engineering drawing is the last process in design stage, where the final prototype must be verified as according to requirement and the related problem rise have been solved. The effective cost reduction newly designed DAFO is presented in this study. The functional test was conducted in the laboratory and based on human testify. The performance was good even though the prototype using rapid prototype materials. The controller board also functions as it programmed. The DC motor was performed a job based on signal provide by two (2) limit switch at the bottom part of lower foot. As a conclusion, The development of cost-effective new mechanism of dynamic ankle-foot orthosis was successfully fabricated in this current study. Further evaluation need to be tested accordingly prior to use as important device in rehabilitation therapy.

The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial

Objective: To investigate the short- and long-term effects of dynamic ankle foot orthoses on functional ambulation activities in chronic hemiparetic patients. Design: Randomized controlled trial. Setting: University’s neurological rehabilitation outpatient clinic and orthotics department. Subjects: Twenty-eight chronic hemiparetic patients of level 3–5 according to Functional Ambulation Classification and with a maximum spasticity level of 3 according to Modified Ashworth Scale, were randomly assigned to the study and control groups. Interventions: The control group (n = 14) was assessed with tennis shoes whereas the study group (n = 14) was assessed initially with tennis shoes and after three months with dynamic ankle foot orthosis. Measures: Functional Reach, Timed Up and Go, Timed Up Stairs, Timed Down Stairs, gait velocity and Physiological Cost Index. Results: In the initial assessment no difference was found between the groups for any of the measured parameters (P > 0.05). After three months, intergroup comparisons while the patients in the study group were wearing dynamic ankle-foot orthosis showed a significant difference in favour of the study group for Timed Up Stairs 12.00 (10.21) seconds study versus 15.00 (7.29) seconds control group; for gait velocity 0.99 (0.45) m/s study versus 0.72 (0.20) m/s control group and for Physiological Cost Index 0.12 (0.06) beats/min study versus 0.28 (0.13) beats/min control group (P < 0.05). No difference was found between the groups for Functional Reach, Timed Up and Go, Timed Down Stairs (P > 0.05). Conclusion: Chronic hemiparetic patients may benefit from using dynamic ankle-foot orthosis.

The effects of dynamic ankle-foot orthoses on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait

Purpose. To investigate the effects of dynamic ankle-foot orthoses (DAFOs) on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait and to inquire whether wearing a DAFO for 3 months has a carryover effect.Method. Fourteen chronic hemiparetic patients who could walk independently with or without a cane were the subjects of the study. Patients were assessed initially with tennis shoes and were given custom fabricated DAFOs which they wore for three months and were retested under two conditions: with tennis shoes only and with DAFOs worn in these shoes. All patients were assessed for weight bearing percentage of the affected side, cadence, step length of the involved and uninvolved sides, step width, functional reach, timed up and go, timed down stairs, timed up stairs, physiologic cost index and velocity.Results. Comparison of initial and third month assessments with shoes only condition showed that there was no significant improvement for the measured parameters. When comparison was made at the third month while patients were wearing tennis shoes only and when they were wearing DAFO's in their shoes there was a significant difference in favour of the condition where patients were wearing DAFOs.Conclusion. The benefits of using DAFOs in chronic hemiparetic patients are lost when the patients are not wearing their orthoses.

Brace Evaluation in Children with Diplegic Cerebral Palsy with a Jump Gait Pattern

Brace prescription for children with diplegic cerebral palsy challenges the clinician with a variety of options and little evidence for rational decisions. Previous studies have indicated that ankle-foot orthoses improve toe-walking, but it is unclear if any brace is better than another. The goal of the present study was to compare the effectiveness of hinged and dynamic ankle-foot orthoses in terms of improving gait and motor function in a homogeneous group of children with diplegic cerebral palsy exhibiting a jump gait pattern. Fifteen children (mean age, 7.5 years) with spastic diplegic cerebral palsy who were able to walk independently with a jump gait pattern and twenty children (mean age, 10.6 years) with normal gait participated in the study. Standardized Gross Motor Function Classification System scores, Pediatric Outcomes Data Collection Instrument scores, and gait data were collected, analyzed, and compared. The subjects were tested while barefoot and while wearing hinged and dynamic ankle-foot orthoses. Data were analyzed to detect differences among these conditions. Significant improvements in gait metrics were seen during brace wear. No significant differences were seen between the two different braces used. The barefoot and braced conditions differed most significantly in terms of ankle kinematics and kinetics. Among the patients with cerebral palsy, no significant differences in the standardized outcome measurements were found between the braced and unbraced conditions or between the two braced conditions. Our data suggest that gait improves with brace wear in children with cerebral palsy with a level-I Gross Motor Function Classification System score. The Pediatric Outcomes Data Collection Instrument and the Gross Motor Function Measure were not sensitive to brace treatment in the population studied. The hinged and dynamic braces were equally effective for improving ankle kinematics and kinetics in these relatively highly functioning children with cerebral palsy.

Effects of Rigid and Dynamic Ankle-Foot Orthoses on Normal Gait

As shown through posturographic data, wearing an ankle-foot orthosis (AFO) causes a backward shift in healthy subjects of the mean position of the center of pressure under the limb wearing it, and difficulty in controlling these displacements. This study evaluated whether this particular positioning influenced gait independent of a neurological disorder. Two AFO models, with different mechanical concepts (a rigid-AFO (R-AFO) and dynamic-AFO (D-AFO)), were worn by 11 healthy subjects required to walk on a 12-m electronic mat. Velocity, step time and step length were assessed for each of the five conditions where subjects walked barefoot, and wearing R-AFO or D-AFO (without and with slight and greater stiffness at the elastic band). Spatial and temporal characteristics of each support were also analyzed. Although wearing R-AFO disturbed velocity, step length and time with an asymmetry between sides, wearing the D-AFO only affected a support characteristic (midline length: length between the pivot points of the two dimensional sensor structure of heel and toe area). No effect was seen when modifying the stiffness of the D-AFO model. Even though the posturographic data might partly explain this behavior, wearing an orthosis caused different effects on normal gait parameters. These features should be useful when prescribing an ankle-foot orthosis by differentiating what alterations are due to the orthosis and which are due to the gait disorder.