Effect Of Ankle-foot Orthosis Research Articles

Effects of ankle-foot orthosis with dorsiflexion resistance on the quasi-joint stiffness of the ankle joint and spatial asymmetry during gait in patients with hemiparesis

BackgroundReduced ankle quasi-joint stiffness affects propulsion in the paretic side of patients with hemiparesis, contributing to gait asymmetry. We investigated whether the use of an ankle-foot orthosis with dorsiflexion resistance to compensate for reduced stiffness would increase quasi-joint stiffness and spatiotemporal symmetry in patients with hemiparesis. MethodsSeventeen patients walked along a 7-m walkway in both ankle-foot orthosis with dorsiflexion resistance and control (i.e., ankle-foot orthosis) conditions. Dorsiflexion resistance by spring and cam was set to increase linearly from zero-degree ankle dorsiflexion. Gait data were analyzed using a three-dimensional motion analysis system. FindingsAnkle-foot orthosis with dorsiflexion resistance significantly increased the quasi-joint stiffness in the early and middle stance phase (P = 0.028 and 0.040). Furthermore, although ankle power generation in the ankle-foot orthosis with dorsiflexion resistance condition was significantly lower than in the control condition (P = 0.003), step length symmetry significantly increased in the ankle-foot orthosis with dorsiflexion resistance condition (P = 0.016). There was no significant difference in swing time ratio between conditions. InterpretationApplying dorsiflexion resistance in the paretic stance phase increased quasi-joint stiffness but did not lead to an increase in ankle power generation. On the other hand, applying dorsiflexion resistance also resulted in a more symmetrical step length, even though the ankle joint power generation on the paretic side did not increase as expected. Future research should explore whether modifying the magnitude and timing of dorsiflexion resistance, considering the biomechanical characteristics of each patients' ankle joint during gait, enhances ankle joint power generation.

Utility and effectiveness of ankle-foot orthoses in individuals with hemiparesis: a literature review on cerebral palsy and stroke

Utility and effectiveness of ankle-foot orthoses in individuals with hemiparesis: a literature review on cerebral palsy and stroke

Effects of ankle-foot orthosis on gait pattern and spatiotemporal indices during treadmill walking in hemiparetic stroke.

Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in post-stroke gait, a three-dimensional motion analysis of gait pattern was conducted. Forty patients with hemiparesis were enrolled. A three-dimensional motion analysis system was used to analyze patients' treadmill walking with/without an AFO. Outcome measures were 12 abnormal gait indices (forefoot contact, knee extensor thrust, retropulsion of the hip, flexed-knee gait, medial whip in the stance phase, circumduction gait, hip hiking, insufficient knee flexion during the swing phase, excessive lateral shifting of the trunk, contralateral vaulting, excessive hip external rotation, and posterior pelvic tilt), calculated using kinematic data and spatiotemporal indices, and the symmetry index of double-stance and single-stance time and step length. Forefoot contact (without AFO vs. with AFO: 71.0 vs. 65.8, P < 0.001), circumduction gait (65.0 vs. 57.9, P < 0.001), and contralateral vaulting (78.2 vs. 72.2, P = 0.003) were significantly reduced, whereas excessive hip external rotation (53.7 vs. 62.8, P = 0.003) significantly increased during walking with an AFO. Hip hiking (77.1 vs. 71.7) showed marginal reduction with the use of AFO ( P = 0.096). The absolute symmetry index of double-stance time (21.9 vs. 16.1, P = 0.014) significantly decreased during walking with an AFO. AFO effectively mitigates abnormal gait patterns typical of hemiparetic gait. A 3D motion analysis system with clinically oriented indices can help assess intervention efficacy for gait abnormalities.

Effects of ankle-foot orthoses on different gait patterns in children with spastic cerebral palsy: A statistical parametric mapping study.

Ankle-foot orthoses (AFOs) are a common treatment to correct gait deviations in children with spastic cerebral palsy (SCP). Studies on the outcome of AFOs on gait often do not account for different gait patterns. The aim of this study was to investigate the effects of AFOs on specific gait patterns in children with cerebral palsy. Retrospective, unblinded, controlled, cross-over study. Twenty-seven children with SCP were assessed in the conditions walking barefoot or with shoes and AFO. AFOs were prescribed based on usual clinical practice. Gait patterns for each leg were classified as excess ankle plantarflexion in stance (equinus), excess knee extension in stance (hyperextension), or excess knee flexion in stance (crouch). Differences in spatial-temporal variables and sagittal kinematics and kinetics of the hip, knee, and ankle between the 2 conditions were determined using paired t-tests and statistical parametric mapping, respectively. The effect of AFO-footwear neutral angle on knee flexion was tested using statistical parametric mapping regression. AFO use improved spatial-temporal variables and reduced ankle power generation in preswing. For "equinus" and "hyperextension" gait patterns, AFOs decreased ankle plantarflexion in preswing and initial swing and decreased ankle power in preswing. Ankle dorsiflexion moment increased in all gait pattern groups. Knee and hip variables did not change in any of the 3 groups. AFO-footwear neutral angle had no effect on changes in sagittal knee angle. Although improvements in spatial-temporal variables were seen, gait deviations could only partially be corrected. Therefore, AFO prescriptions and design should individually address specific gait deviations and their effectiveness in children with SCP should be controlled.

The effects of ankle-foot orthoses with plantar flexion stop and plantar flexion resistance using rocker-sole shoes on stroke gait: A randomized-controlled trial.

Objectives This study aims to evaluate the effect of two ankle-foot orthoses (AFOs), AFO with plantar flexion stop (AFO-PlfS), and AFO with plantar flexion resistance (AFO-PlfR), while wearing standard shoes and rocker-sole shoes. Patients and methods Between November 2017 and July 2018, in this randomized-controlled study, a total of 20 stroke patients (8 males, 12 females; mean age: 48.1 years; range, 33 to 65 years) in chronic phase were randomized to AFO groups (AFO-PlfS group, n=10 and AFO-PlfR group, n=10). Each group received the allocated AFO along with two kinds of shoes (standard shoe and rocker shoe) for a two-week adaptation. Two effects were separately evaluated: The orthotic effect and rocker shoe effect were defined as the evaluation of using an AFO wearing standard shoe compared to only standard shoe, and evaluation of using an AFO wearing rocker shoe compared to an AFO wearing standard shoe, respectively. The gait of each group was measured by three-dimensional motion analysis. Results A significant orthotic effect was found in both AFO groups in spatiotemporal parameters and maximum ankle dorsiflexion in the single-support phase. Additionally, the AFO-PlfR group showed a significant improvement in the parameters related to the first rocker of gait, but not for AFO-PlfS group concerning the orthotic effect. The rocker shoe effect was found in significant reduction of peak ankle plantar flexor moment and power ankle generation during preswing for both AFO groups. Conclusion According to the orthotic effect, an AFO-PlfR can create better function in the improvement of parameters related to the first rocker. Although a rocker shoe can facilitate rollover for weight progression in the third rocker of gait, it cannot make a strong push-off function in stroke survivors.

Moderate effect of ankle foot orthosis versus ground reaction ankle foot orthosis on balance in children with diplegic cerebral palsy.

The children with diplegic cerebral palsy (CP) commonly have abnormal alignment of lower extremities affecting their abilities of keeping balance. Orthoses are one of the many approaches that can be prescribed to improve balance and walking in diplegic children. This study was conducted to assess the moderate effect of solid ankle foot orthosis (AFO) vs. the ground reaction ankle foot orthosis (GRAFO) on balance in children with diplegic CP. A randomized controlled trial. Thirty children with spastic diplegic CP from both genders participated in this study; their ages were between 6 and 9 years. They were divided randomly into two study groups of equal numbers; the first study group A received the regular physical therapy program besides wearing the AFO for successive three months. The second study group B received the regular physical therapy program besides wearing the GRAFO for successive 3 months. All childrens' balance was evaluated before starting the treatment program and after 3 months by using the Biodex balance system (anteroposterior and mediolateral stability indices). There were significant improvement of all stability indices in both groups (P < 0.05), with significant difference between groups when comparing post-treatment mean values of the measured indices in favor to study group B (P < 0.05). The GRAFO achieved more balance control in children with spastic diplegic CP compared with solid AFO.

Effects of Ankle Foot Orthoses on the Gait Patterns in Children with Spastic Bilateral Cerebral Palsy: A Scoping Review.

Background: Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. Methods: A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. Results: We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO. Conclusions: Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.

The effect of ankle-foot orthosis on ankle kinematics in individuals after stroke: A systematic review and meta-analysis.

To evaluate whether ankle-foot orthosis (AFO) has a beneficial effect on dorsiflexion angle increase during the swing phase among individuals with stroke and patient-important outcomes in individuals with stroke. Randomized controlled trials (RCTs), randomized crossover trials, and cluster RCTs until May 2020 were researched through CENTRAL, MEDLINE, EMBASE, PEDro, CINAHL, and REHABDATA databases. Studies reporting on AFO use to improve walking, functional mobility, quality of life, and activity limitations and reports of adverse events in individuals with stroke were included. Two independent reviewers extracted the data and assessed the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. Fourteen trials that enrolled 282 individuals with stroke and compared AFO with no AFO were included. Compared with no AFO, AFO could increase the dorsiflexion angle of ankle joints during walking (mean difference [MD, 3.7°]; 95% confidence interval [CI], 2.0-5.3; low certainty of evidence). Furthermore, AFO could improve walking ability (walking speed) (MD, 0.09 [m/s]; 95% CI, 0.06-0.12; low certainty of evidence). No study had reported the effects of AFO on quality of life, adverse events, fall frequency, and activities of daily life. Our findings suggest that AFO improved ankle kinematics and walking ability in the short term; nonetheless, the evidence was characterized by a low degree of certainty.

Effects of ankle-foot orthoses on the stability of post-stroke hemiparetic gait.

Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on gait stability. To investigate the effects of ankle-foot orthoses on post-stroke gait stability. An experimental study with repeated measurements of gait parameters with and without orthosis. Inpatients and outpatients in the Fujita Health University Hospital, Toyoake, Japan. Thirty-two patients (22 males; mean age 48.3±20.0 years) with post-stroke hemiparesis participated in the study. Three-dimensional treadmill gait analysis was performed with and without ankle-foot orthosis for each participant. Spatiotemporal parameters, their coefficient of variation, and margin of stability were evaluated. Toe clearance, another major target of orthosis, was also examined. The effect of orthosis in the patients with severe (not able to move within the full range of motion, defying gravity) and mild ankle impairment (able to move within the full range but have problem with speed and/or smoothness of the ankle movement) was compared. In the total group comparison, the decrease in the coefficient of variation of step width (P=0.012), and margin of stability on the paretic side (P=0.023) were observed. In the severe ankle impairment groups, the decreased in the coefficient of variation of the non-paretic step length (P=0.007), stride length (P=0.037), and step width (P=0.033) and margin of stability on the paretic side (P=0.006) were observed. No significant effects were observed in the mild ankle impairment group; rather, the coefficient of variation of non-paretic step length increased with the use of orthosis in this group (P=0.043); however, toe clearance increased with the use of ankle-foot orthosis (P=0.041). Ankle-foot orthoses improved gait stability indices; however, the effect was either not significant or showed possible worsening in the patients with mild ankle impairment, while the effect on toe clearance was significant. These results suggest that the effects of using orthoses in patients with mild impairment should be carefully evaluated. Understanding the effects of ankle-foot orthoses on the stability of post-stroke gait and their relationship with ankle impairment severity may support clinical decision-making while prescribing orthosis for post-stroke hemiparesis.

Comparison the effect of kinetic parameters of innovative storing-restoring hybrid passive (comfort gait) ankle-foot orthosis (AFO) with posterior leaf spring AFO in drop-foot patients: a prospective cohort study

Background: Drop-foot syndrome is a disorder in which the dorsiflexor muscles are weakened or completely paralyzed, leading to foot slapping after the initial contact and foot-dragging during the swing phase. Passive and hybrid passive ankle-foot orthoses (AFOs) are often prescribed as an intervention for this disorder; however, the effects of these AFOs on kinetic parameters during the gait of drop-foot patients seem unclear. This study aimed to compare the affected lower limb joints of ankle, knee, and hip kinetics parameters (moments and powers) during walking in drop-foot patients using an innovative AFO storing-restoring hybrid passive AFO, named “Comfort Gait” and posterior leaf spring (PLS) AFO. Methods: Ten drop-foot patients were recruited in the current study to walk at a comfortable self-selected speed while wearing two different AFO selections. Kinetic parameters with a motion capture system were obtained for these patients. Results: The results of this study revealed a significant increase in the peak values of kinetic parameters of the lower limb of the affected side (ankle, knee, and hip moments and powers) with the innovative designed AFO when compared to PLS AFO (P&lt;0.05). Conclusions: The significant increase of kinetic parameters in drop foot with use of the Comfort Gait as compared to the PLS AFO might suggest the effectiveness of this innovative AFO in improving the gait of foot drop patients more than the use of PLS AFO. Level of Evidence: Level II

Immediate Effects of Ankle-Foot Orthosis Using Wire on Static Balance of Patients with Stroke with Foot Drop: A Cross-Over Study.

The aim of this study was to investigate the immediate static balance effects of bare foot, UD-Flex ankle–foot orthosis (AFO), and AFO using wire (AOW) of patients with stroke with foot drop. Seventeen patients with stroke with foot drop (8 men and 9 women) were randomized to three conditions (bare foot, UD-Flex AFO, or AOW made with a flexible material). Static balance was assessed using the Zebris (Zebris GmbH, Isny, Germany) and BioRescue (RM Ingenierie, Rodez, France) pressure platform by a single examiner, who did not design the AOW. The order of testing with the equipment was random. The center of pressure path length (mm) measured using Zebris showed significant differences among the three conditions (bare foot, 484.47 ± 208.42; UD-Flex AFO, 414.59 ± 144.43; AOW, 318.29 ± 157.60) (p < 0.05). The bare-foot condition was not significantly different from the UD-Flex AFO condition (p > 0.05), but was significantly different from the AOW condition (p < 0.05). The surface area ellipse (mm2) measured using BioRescue showed significant differences among the three conditions (bare foot, 241.35 ± 153.76; UD-Flex AFO, 277.41 ± 381.83; AOW, 68.06 ± 48.98) (p < 0.05). The bare-foot condition was not significantly different from the UD-Flex AFO condition (p > 0.05), but the AOW condition was significantly different from the bare-foot (p < 0.05) and from the UD-Flex AFO conditions (p < 0.05). We suggest using the AOW made of flexible materials and wire instead of the UD-Flex AFO to improve immediate static balance of patients with stroke with foot drop after stroke. Further studies on the effects of dynamic balance and gait are required.

The Effect of Ankle Foot Orthosis' Design and Degree of Dorsiflexion on Achilles Tendon Biomechanics-Tendon Displacement, Lower Leg Muscle Activation, and Plantar Pressure During Walking.

Background: Following an Achilles tendon rupture, ankle foot orthoses (AFO) of different designs are used to protect the healing tendon. They are generally designed to protect against re-rupture by preventing undesired dorsiflexion and to prevent elongation by achieving plantarflexion in the ankle. There is limited knowledge of the biomechanical effects of different AFO designs and ankle angles on the tendon and lower leg muscles.Hypothesis: The hypothesis was that non-uniform displacement in the Achilles tendon, lower leg muscle activity, and plantar pressure distribution would be affected differently in different designs of AFO and by varying the degree of dorsiflexion limitation.Study Design: Controlled laboratory study.Methods: Ultrasound of the Achilles tendon, EMG of the lower leg muscles and plantar pressure distribution were recorded in 16 healthy subjects during walking on a treadmill unbraced and wearing three designs of AFO. Ultrasound speckle tracking was used to estimate motion within the tendon. The tested AFO designs were a rigid AFO and a dorsal brace used together with wedges and an AFO with an adjustable ankle angle restricting dorsiflexion to various degrees.Results: There were no significant differences in non-uniform tendon displacement or muscle activity between the different designs of AFO. For the rigid AFO and the adjustable AFO there was a significant reduction in non-uniform displacement within the tendon and soleus muscle activity as restriction in dorsiflexion increased.Conclusion: The degree of dorsiflexion allowed within an AFO had greater effects on Achilles tendon displacement patterns and muscle activity in the calf than differences in AFO design. AFO settings that allowed ankle dorsiflexion to neutral resulted in displacement patterns in the Achilles tendon and muscle activity in the lower leg which were close to those observed during unbraced walking.

Effect of ankle-foot orthosis on level walking in healthy subjects.

An ankle-foot orthosis is often prescribed in the rehabilitation of patients with neurological motor disorders such as hemiparesis. However, walking with a unilateral ankle-foot orthosis may not be effectively achieved just by trying to reproduce normal intact walking with a symmetrical gait pattern. Understanding skills to facilitate walking gait with a unilateral ankle-foot orthosis has implications for better rehabilitative interventions to help restore walking ability in patients with stroke. We, therefore, analyzed the kinematics and ground reaction forces of walking with and without an ankle-foot orthosis in healthy subjects to infer the possible skills to facilitate walking gait with a unilateral ankle-foot orthosis. Adult male participants were asked to walk with and without an ankle-foot orthosis across two force platforms set in a wooden walkway, and body kinematics and ground reaction force profiles in the sagittal plane were simultaneously recorded. We found that the forward tilting angle of the trunk at the time of toe-off of the leg with the ankle-foot orthosis was significantly larger than that of the leg without the ankle-foot orthosis, to adaptively compensate for the loss of ankle joint mobility due to the unilateral ankle-foot orthosis. Furthermore, the peak vertical ground reaction force at heel-contact was significantly larger in the leg without the ankle-foot orthosis than in the leg with the ankle-foot orthosis owing to the fact that the stance phase duration of the leg with the ankle-foot orthosis was relatively shorter. Such information may potentially be applied to facilitate walking training in stroke patients wearing a unilateral ankle-foot orthosis.

Effect of Ankle-foot Orthoses on Balance Confidence

Effect of Ankle-foot Orthoses on Balance Confidence

P2-15-12. Effects of ankle foot orthosis on motor modules during walking in patients after stroke

P2-15-12. Effects of ankle foot orthosis on motor modules during walking in patients after stroke

The effect of ankle-foot orthoses on fall/near fall incidence in patients with (sub-)acute stroke: A randomized controlled trial.

Falls are commonly reported post-stroke. Ankle-foot orthoses (AFOs) are often provided to improve safety and walking, but the effect of their use in the reduction of falls after stroke is unknown. A randomized controlled trial (RCT) on the effects of AFO-provision after stroke was performed. Effects on clinical scales, 3D-gait kinematics and muscle-activity were previously reported. This paper aims to study the effects of AFO-provision on occurrence and circumstances of falls/near falls. The RCT included unilateral hemiparetic stroke patients. AFOs were provided either early (study week 1) or delayed (study week 9). Both groups were compared in the first eight weeks of the study and diaries were used to register falls/near falls and their circumstances. Follow-up measurements were performed in week 9–52, in which both groups were provided with AFOs. Functional Ambulation Categories and Berg Balance Scale were assessed to determine walking independence and balance, respectively. Last known scores were noted in case of an incident. Thirty-three subjects were included (16 early, 17 delayed). In week 1–8, the early group, who were provided with AFOs, fell significantly more frequently compared with the delayed group, 11 versus 4 times, respectively (Incidence Rate Ratio = 2.9, p = 0.039). Out of the falls recorded in the early group, 63.6% occurred without wearing AFOs. Most of these falls occurred during transfers (36.4%) and standing (27.3%), and notably it were the subjects who did not have independent walking ability. No differences were found for near falls in week 1–8, or for falls/near falls in week 9–52. Six severe consequences (including fractures) were reported from a fall. To conclude, the subjects provided with AFOs early after stroke reported a higher number of falls, compared to the subjects that had not yet been provided with AFOs. However, in the subjects provided with AFOs, 63.6% of the falls occurred whilst without wearing the AFO. Furthermore, the majority of these incidents took place whilst subjects had no independent walking ability. This raises an interesting question of the importance of careful instructions to patients and their relatives, and the influence of potential cognitive impairments on the ability of the subjects to take on these instructions.

An Effect of Ankle Foot Orthosis on the Muscle Activity of Drop Foot Patient, A Case Study

An Effect of Ankle Foot Orthosis on the Muscle Activity of Drop Foot Patient, A Case Study

Effect of ankle-foot orthosis with a built-in spring on muscle activity during the sit-to-stand movement in healthy individuals.

[Purpose] This study aimed to evaluate the influence of a newly developed ankle-foot orthosis with a built-in spring on the activity of lower limb muscles during the sit-to-stand movement. [Participants and Methods] This cross-sectional study recruited 20 male volunteers. The sit-to-stand movement (rising from a chair) was performed under three conditions: no ankle-foot orthosis (NA), ankle-foot orthosis with no spring (NS), and ankle-foot orthosis with a built-in spring (SP). Muscle activity during the sit-to-stand movement was measured using surface electrodes placed on the vastus medialis, tibialis anterior, medial gastrocnemius, and soleus muscles. Root mean square and integral value were calculated from the raw data, and statistical analysis was performed using SPSS version 24.0. [Results] The electromyography data of the vastus medialis, medial gastrocnemius, and soleus muscles showed a significant decrease in muscle activity in the SP condition, whereas the activity of the tibialis anterior muscle increased significantly in the SP condition compared to that in the NA and NS conditions. [Conclusion] Our data showed that the use of an ankle-foot orthosis with a built-in spring affected not only the muscle activity at the ankle joint but also the activity of the knee joint extensor muscle. It is possible that the control of the ankle joint motion affects movement above the knee joint; this finding may help development new physical therapy techniques. Further research is warranted in this regard.

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 &amp; 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 &lt;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 &lt;0.05.

O 019 - Do Botulinum Toxin-A and lower leg casting alter calf muscle and tendon lengths in children with spastic cerebral palsy?

IntroductionAnkle joint hyper-resistance in children with spastic cerebral palsy (SCP) is commonly treated with Botulinum Toxin-A (BoNT-A) injections in the medial gastrocnemius (MG) combined with lower-leg casting. The overall aim of this combined treatment is to reduce spasticity and increase range of motion (1). Since hyper-resistance assessment mainly focuses on the joint level, whereas the treatment is directed at the muscle, it is worthwhile investigating the individual effects of BoNT-A and casting on MG and tendon lengths, to provide insight into the working mechanisms and to help improving treatment efficacy. Research questionWhat are the effects of BoNT-A injections and lower-leg casting on the MG and tendon lengths, at resting position and maximum dorsiflexion, in children with SCP? MethodsChildren with SCP were assigned by minimization to receive either two weeks of lower-leg casts (n = 12, mean age 8.27 years; GMFCS-level I-III) or MG BoNT-A injections (n = 11, mean age: 6.75 years; GMFCS-level I-III). Data was acquired by 3D-freehand-ultrasound (2) at baseline and two weeks post-intervention with the knee in flexion (30.9° ± 3.7°) and the ankle in resting position and maximum dorsiflexion (maxDF). The same assessor extracted muscle and tendon lengths from the 3D reconstructions twice, and the standard error of measurement (SEM) was quantified. Muscle tendon unit (MTU) length was calculated as the summation of muscle (ML) and tendon length (TL). The change in ML and TL between rest and maxDF was used to calculate extensibility. Within-group treatment effect was evaluated with Wilcoxon signed rank tests and treatment differences, with Mann-Whitney U tests. Post-treatment changes were considered significant when >SEM and p < 0.05. ResultsAt baseline, groups did not differ for age, joint angles and lengths. Post-casting, resting angle, maxDF, MTU and TL at maxDF significantly increased. While two weeks post-BoNT-A-injection only MTU length and ML at rest significantly increased. There was no treatment effect on the extensibility. The change in maxDF, and ML at rest were significantly larger post-casting compared to post-BoNT-A. Similarly, the post-treatment change in MTU length at maxDF was significantly larger after casting compared to BoNT-A. DiscussionThe results suggest that two weeks casting resulted in increased maxDF and MTU-length by increased TL (or compliance). This confirms previous research on the effects of ankle foot orthoses on MG morphology (3). BoNT-A on the other hand, affected the muscle’s resting length, however without gain in extensibility or MTU-length. This emphasizes the requirement to combine both treatments, but also cautions the use of stretching casts for having adverse effects on the tendon. The treatment-effects on the MTU on the long-term and their carry over effect to gait is material for further investigation.