Effect Of Ankle-foot Orthosis Research Articles

The effects of an ankle foot orthosis on cerebral palsy gait: A multiple regression analysis.

The aim of this study was twofold. Firstly, to develop a multiple regression normalization (MR) strategy to decorrelate physical properties and walking speed from spatiotemporal gait data in healthy children; and secondly, to use this MR approach to identify the effect of a solid ankle foot orthosis (AFO) on gait in children with cerebral palsy (CP). Spatiotemporal gait data during self-selected walking were obtained from 51 children with diplegic CP and 34 aged-matched healthy controls. Data were normalized using standard dimensionless equations (DS) and a MR approach. Stride length, stance time, swing time, and double support time were significantly different between children with CP and healthy controls using DS (p<;0.05); however, only stride length and swing time were significantly different when children with CP walked with and without an AFO. Normalizing gait data using DS demonstrated significant differences in cadence and step time in children with CP when wearing an AFO compared to the controls (p<;0.05). In contrast, MR normalization revealed significant differences in all spatiotemporal parameters between children with CP with and without an AFO, except double support time. After MR normalization, spatiotemporal parameters in children wearing an AFO became closer to those of the controls, except for double support time. The MR approach presented will assist in evaluating the effectiveness of conservative interventions such as AFOs in children with CP, as well as in surgery, and may be useful in gait classification using machine learning.

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.

Effect of ankle-foot orthosis on weight bearing of chronic stroke patients performing various functional standing tasks.

[Purpose] This study examined how an ankle-foot orthosis (AFO) influences the weight-bearing of chronic stroke patients during the performance of five functional standing tasks. [Subjects and Methods] Sixteen patients with stroke participated in this experiment. The subjects performed functional standing tasks with or without the AFO and weight bearing was measured during the tasks. [Results] Patients showed increased weight-bearing ability on the affected side during wearing the AFO in all tasks, and there were significant differences among Tasks 1, 2, and 3. Patients showed a small amount of increased weight bearing on the unaffected side while wearing the AFO in all tasks except for Task 2. [Conclusion] ADL-related functional standing tasks with AFO increased the weight bearing.

Effectiveness of Single Functional Electrical Stimulation in Neurological Patients with Ankle-Foot Orthoses

Background: Drop foot is a distal deficiency common in patients with central nervous system diseases that makes clearance difficult during swing phase, contributes to inefficient gait compensations contribute to increase incidence of falls and energy expenditure. Aim of this study is to evaluate the effectiveness of a single application of functional electrical stimulation compared with ankle-foot orthoses in patients with drop foot. Methods: Patients enrolled were unable to walk and to perform test without ankle-foot orthoses. They were evaluated by 10-meters walk test, obstacles test, up-and-down stair test, six-minute walk test and gait analysis with inertial sensors. All tests were performed with ankle-foot orthoses and with no ankle-foot orthoses and application of single functional electrical stimulation. Results: Thirteen patients (8 males and 5 females) were recruited for this study out of 41 potential subjects. Data collected were processed by Student’s t test and by Wilcoxon test for paired observations and by Student’s t test and Mann-Whitney test for independent samples. P ≤ 0.05 were considered significant. For each test suitable effect sizes (Cohen’s d, and Pearson’s r) were calculated. Analysis of results with ankle-foot orthoses and with no anklefoot orthoses and application of single functional electrical stimulation showed no statistically significant difference in all test. Conclusions: The use of single functional electrical stimulation showed same effects of ankle-foot orthoses on walking capacity and motor performance in chronic neurological diseases. More studies would be required to assess the long term effectiveness of functional electrical stimulation and to evaluate if its application in acute-phase may be used in association with traditional treatment.

The Effects of Ankle Foot Orthosis on Static Balance in Hemiplegic Stroke Patients

The purpose of this study was to investigate the changes of postural control and the effect of ankle foot orthosis (AFO) on the static balance in patients with post-stroke hemiplegia. Fourteen hemiplegic stroke patients with independent ambulation more than 10 m were included. The movement of center of gravity (COG) during static postural control was measured with Biodex Balance System SD<SUP>®</SUP> (Biodex Medical System, New York, USA) at three different conditions (barefoot, shoes and AFO) randomly for three times on same condition. Percent (%) time in quadrant(anterior, posterior, left and right), overall, anterior-posterior and medio-lateral movement index were measured. COG were distributed to the right and posterior quadrant during static standing for maintaining postural stability in patients with post-stroke hemiplegia, and this patterns were not changed with shoes or AFO application. There was tendency of weight shift to the sound side for maintaining postural stability in hemiplegic patients, but not statistically significant. Application of AFO displayed lower overall (p<0.002), anterior-posterior (p<0.008) and medio-lateral instability index scores (p<0.008) than barefoot. The impaired static postural control in patients with post-stroke hemiplegia was improved with AFO application.

Effect of ankle-foot orthosis on postural control after stroke: A systematic review

IntroductionStroke is currently the main cause of permanent disability in adults. The impairments are a combination of sensory, motor, cognitive and emotional changes that result in restrictions on the ability to perform basic activities of daily living (BADL). Postural control is affected and causes problems with static and dynamic balance, thus increasing the risk of falls and secondary injuries. The purpose of this review was to compile the literature to date, and assess the impact of ankle-foot orthosis (AFO) on postural control and gait in individuals who have suffered a stroke. DevelopmentThe review included randomised and controlled trials that examined the effects of AFO in stroke patients between 18 and 80 years old, with acute or chronic evolution. No search limits on the date of the studies were included, and the search lasted until April 2011. The following databases were used: Pubmed, Trip Database, Cochrane library, Embase, ISI Web Knowledge, CINHAL and PEDro. Intervention succeeded in improving some gait parameters, such as speed and cadence. However it is not clear if there was improvement in the symmetry, postural sway or balance. ConclusionsBecause of the limitations of this systematic review, due to the clinical diversity of the studies and the methodological limitations, these results should be considered with caution.

Effects of ankle foot orthoses (AFOs) on body functions and activities: a systematic review

Effects of ankle foot orthoses (AFOs) on body functions and activities: a systematic review

Effects of ankle-foot orthoses on mediolateral foot-placement ability during post-stroke gait.

Accurate and precise mediolateral foot placement is important for balance during gait, but is impaired post stroke. Mediolateral foot placement may be improved with ankle-foot orthosis use. The purpose of this study was to determine whether an ankle-foot orthosis improves mediolateral foot-placement ability during post-stroke ambulation. Crossover trial with randomized order of conditions tested. The accuracy and precision of mediolateral foot placement was quantified while subjects targeted four different randomized step widths. Subjects were tested with and without their regular non-rigid ankle-foot orthosis in two separate visits (order randomized). While ankle-foot orthosis use corrected foot and ankle alignment (i.e. significantly decreased mid-swing plantar flexion, p = 0.000), effects of ankle-foot orthosis use on hip hiking (p = 0.545), circumduction (p = 0.179), coronal plane hip range of motion (p = 0.06), and mediolateral foot-placement ability (p = 0.537) were not significant. While ankle-foot orthosis-mediated equinovarus correction of the affected foot and ankle was not associated with improved biomechanics of walking (i.e. proximal ipsilateral hip kinematics or mediolateral foot-placement ability), it may affect other aspects of balance that were not tested in this study (e.g. proprioception, cerebellar, vestibular, and cognitive mechanisms). Studies that investigate the effect of ankle-foot orthosis on gait can help advance stroke rehabilitation by documenting the specific gait benefits of ankle-foot orthosis use. In this study, we investigated the effect of ankle-foot orthosis use on mediolateral foot-placement ability, an aspect of gait important for maintaining balance.

Effect of ankle-foot orthosis with and without wearing shoes on functional mobility in post-stroke hemiplegic subjects: A comparative study

Effect of ankle-foot orthosis with and without wearing shoes on functional mobility in post-stroke hemiplegic subjects: A comparative study

Effect of ankle foot orthosis on energy expenditure index and gait speed in spastic cerebral palsy children: an observational study

Background: Ankle Foot Orthosis (AFO) is a frequently prescribed intervention modality which plays an important role in the management of gait abnormality. The most typical use of AFOs is to optimize the normal dynamics of walking by applying mechanical constraint to the ankle to control motion &amp; at the same time provide more efficient gait. Solid AFOs are most commonly prescribed to reduce excessive plantar flexion in stance &amp; to prevent or eliminate equinus position. So, purpose of this study is to determine whether use of AFO affect the gait speed &amp; energy expenditure in cerebral palsy children or not. Methods: a convenient sample of 21 subjects diagnosed with spastic cerebral palsy with presence of spasticity of planter flexors (Modified Ashworth Scale &lt;3) with GMFCS level 1, 2 &amp; 3 were included. Informed consent of parents was taken. Children who had undergone surgical correction within 6 month of testing or botulinum toxin injection of spastic planter flexors or any other lower extremity muscle within 3 months were excluded. For 10 meter walk test child was made to walk barefooted then given 10 minute rest &amp; made to walk again for 10 meters with AFO. Their heart rate (Resting &amp; after walking) &amp; time taken for walk were taken each time &amp; energy expenditure index (walking HR-resting HR/distance) &amp; gait speed (distance/time) were calculated. Results: Mean Energy Expenditure Index (EEI) with barefoot was 158.8 ± 2.37 &amp; with AFO was 370.4 ± 3.93. Speed with barefoot was 0.22 ± 0.16 &amp; with AFO was 0.148 ± 0.18. There was significant difference in gait speed &amp; EEI between the groups &amp; P value was &lt;0.05. Conclusion: There is increase in EEI &amp; decrease in gait speed in children with spastic cerebral palsy with the use of AFO.

Effects of Ankle Foot Orthosis on Post-stroke Hemiplegic Gait -A Meta-analysis-

Effects of Ankle Foot Orthosis on Post-stroke Hemiplegic Gait -A Meta-analysis-

Role of ankle foot orthoses in the outcome of clinical tests of balance

Purpose: The purpose of this study was to investigate the effect of ankle foot orthoses (AFOs) on the outcome of balance assessment. Methods: Ten healthy subjects participated in clinical tests of balance with and without bilateral ankle foot orthoses (AFOs). The following clinical tests were performed: the Modified Clinical Test of Sensory Interaction on Balance (MCTSIB), the Limits of Stability (LOS) and the Functional Reach test. Results: A statistically significant effect of AFOs was seen in the outcomes of the MCTSIB test (p = 0.042), LOS test (p = 0.021) and Reach test (p = 0.003). Conclusions: The results indicate that the use of AFOs may impede the performance of clinical tests of balance. This outcome should be taken into consideration while performing balance evaluations with patient populations in the clinic.Implications for RehabilitationAnkle foot orthoses (AFOs) are effective means of improving ambulation in patients.The use of AFOs may influence the outcome of clinical tests of balance.The role of AFOs should be taken into consideration while performing balance evaluations in the clinic.

Effects of ankle foot orthosis in stiff knee gait in adults with hemiplegia

Stroke survivors present a less efficient gait compared to healthy subjects due to abnormal knee flexion during the swing phase of gait, associated with spasticity of the rectus femoris muscle and overactivity of the ankle plantarflexors. It is relevant to understand the effect of the ankle foot orthosis (AFO) on gait in individuals with plantarflexor spasticity. The aim of this study was to compare the knee kinematics with an AFO/footwear combination and barefoot in post-stroke subjects with plantarflexor spasticity.Ten subjects with chronic hemiplegia were measured. Two kinematic variables were assessed during the swing phase of the paretic limb: knee flexion angle at toeoff and peak knee flexion angle. We also analyzed gait speed and step length of the non-paretic limb. All variables were obtained with and without the orthosis. Kinematic data were acquired using a motion capture system (ELITE). Subjects wearing an AFO showed significant improvements in gait speed (0.62m/s (0.08 SD) vs. 0.47m/s (0.13 SD) (p=0.007)), step length of the non-paretic limb (42cm (5.9 SD) vs. 33.5cm (6.6 SD) (p=0.005)) and peak knee flexion angle during the swing phase: 30.7° (14.1° SD) vs. 26.3° (11.7° SD) p=0.005. No significant differences were obtained in the knee flexion angle at toeoff between no AFO and AFO conditions.We described benefits with AFO/footwear use in the kinematics of the knee, the step length of the non-paretic limb, and the gait velocity in hemiplegic subjects after mild to moderate stroke. We conclude that the use of an AFO can improve the gait pattern and increase velocity in these subjects.

Effect of Ankle-Foot Orthoses on the Sagittal Plane Displacement of the Center of Mass in Patients With Stroke Hemiplegia: A Pilot Study

Background: Ankle-foot orthoses (AFOs) have been reported to have positive effects on the temporal-spatial parameters and kinematics and kinetics of gait in patients with stroke. The center of mass (COM) may be used to represent whole body movement and energy cost in gait, and therefore COM movement would also be positively influenced with use of an appropriate AFO. Objective: To investigate the effect of AFOs on the sagittal plane displacement of the COM in patients with stroke hemiplegia. Methods: Five male subjects with stroke hemiplegia participated in this pilot study. The trajectory of the COM in the sagittal plane, gait speed, bilateral step length, step width, and bilateral stance time were analyzed while participants ambulated under 2 test conditions: with an AFO or with footwear only. The height of the 2 peaks of the vertical displacement of the COM in a gait cycle was subsequently measured and normalized to body height. Statistical analyses were conducted using a nonparametric Friedman test. Results: Gait speed, bilateral step length, and the normalized peak height of the vertical COM trajectory during stance phase on the affected leg all revealed statistically significant increases (P < .05), and step width showed significant decreases (P < .05) under the AFO condition when compared to the footwear-only condition. Conclusions: An AFO may influence the vertical displacement of the COM in patients with stroke hemiplegia. The results of this pilot study therefore suggested that vertical movement of COM could potentially serve as a useful parameter to evaluate the effect of an AFO.

The effects of ankle foot orthoses on energy recovery and work during gait in children with cerebral palsy

BackgroundStudies suggest that 50% of children with cerebral palsy are prescribed ankle foot orthoses. One of the aims of ankle foot orthosis use is to aid in walking. This research examined the effects that ankle foot orthoses have on the energy recovery and the mechanical work performed by children with cerebral palsy during walking. MethodsTwenty-one children with spastic diplegia walked with and without their prescribed bilateral ankle foot orthoses. Ten of the subjects wore articulated (hinged) orthoses and 11 subjects wore solid orthoses. Three dimensional kinematic data were collected and between and within group repeated measures ANOVAs were applied to the dependent measures. FindingsThe results were similar for both groups. There was an increase in stride length, energy recovery, and potential energy and the kinetic energy variation. There was no change in the mechanical work performed to walk or the normalized center of mass vertical excursion. Unfortunately, the increase in energy recovery did not alter the external work, as it was offset by increased variation in the potential and kinetic energies of the center of mass. There was a great deal of variability in the measured work, with both large increases and decreases in the work of individual subjects when wearing orthoses. InterpretationThese results suggest that current ankle foot orthoses can reduce the work to walk, but do not do so for many children with cerebral palsy. This research suggests that ankle foot orthosis prescription could be aided by measuring the mechanical work during walking.

A comparison of ankle foot orthoses with foot abduction orthoses to prevent recurrence following correction of idiopathic clubfoot by the Ponseti method

The Ponseti method of clubfoot management requires a period of bracing in order to maintain correction. This study compared the effectiveness of ankle foot orthoses and Denis Browne boots and bar in the prevention of recurrence following successful initial management. Between 2001 and 2003, 45 children (69 feet) with idiopathic clubfeet achieved full correction following Ponseti casting with or without a tenotomy, of whom 17 (30 clubfeet) were braced with an ankle foot orthosis while 28 (39 clubfeet) were prescribed with Denis Browne boots and bar. The groups were similar in age, gender, number of casts and tenotomy rates. The mean follow-up was 60 months (50 to 72) in the ankle foot orthosis group and 47 months (36 to 60) in the group with boots and bars. Recurrence requiring additional treatment occurred in 25 of 30 (83%) of the ankle foot orthosis group and 12 of 39 (31%) of the group with boots and bars (p < 0.001). Additional procedures included repeat tenotomy (four in the ankle foot orthosis group and five in the group treated with boot and bars), limited posterior release with or without tendon transfers (seven in the ankle foot orthosis group and two in the group treated with boots and bars), posteromedial releases (nine in the orthosis group) and midfoot osteotomies (five in the orthosis group, p < 0.001). Following initial correction by the Ponseti method, children managed with boots and bars had far fewer recurrences than those managed with ankle foot orthoses. Foot abduction appears to be important to maintain correction of clubfeet treated by the Ponseti method, and this cannot be achieved with an ankle foot orthosis.

Research Recommendations and Considerations

The State of the Science Conference on the effects of ankle-foot orthoses (AFOs) on balance concluded with a discussion of future recommendations and considerations for the topic. Recommendations and discussions were organized according to the four broad domains including 1) task or the activities most anticipated for a given patient care scenario, 2) AFO design or the physical characteristics of the provided intervention, 3) functional impairment or the diagnoses and presentations of the subjects, and 4) outcomes assessment or the established means by which the treatment effect will be formally observed and documented. Future research will be challenged by the considerable overlap of these domains with respect to individual balance considerations. The effect of AFOs on balance has been largely overlooked, both in clinical practice and research laboratories. Therefore, the need for future research in this area to inform clinical decision making is immense.

Prevalence of Balance Compromise in Commonly Treated Patient Populations: An Introduction to the Academy's State of the Science Conference on the Effects of Ankle-Foot Orthoses on Balance

Prevalence of Balance Compromise in Commonly Treated Patient Populations: An Introduction to the Academy's State of the Science Conference on the Effects of Ankle-Foot Orthoses on Balance

The Effect of Ankle-Foot Orthoses on Balance: A Clinical Perspective

Balance is established and maintained by a complex integration of motor and sensory systems. When these systems are impaired, balance can be altered and function will be disrupted. The ankle-foot orthosis (AFO) represents an intervention that may improve balance and functional deficits. However, there is limited evidence related to the effect of AFOs on balance to guide clinical decision making. To determine how AFOs can best address the issues of imbalance and functional compromise, it is important for clinicians to consider the following factors: patient expectations and task relevance, effects on the body's center of mass, fatigue, area of contact as it pertains to the base of support, proprioception, and balance preservation outside of normalized ambulation. A better understanding of these factors will help to identify realistic treatment objectives and optimize outcomes associated with the provision of AFOs.

AAOP State-of-the-Science Evidence Report: The Effect of Ankle-Foot Orthoses on Balance—A Systematic Review

Ankle-foot orthoses (AFOs) are typically designed to limit the motion of the ankle joint in one or more planes. Given that balance may be compromised when joint range of motion is restricted, an understanding of the relative effects of AFOs on balance performance is clinically relevant. The aim of this systematic review was to evaluate existing evidence related to the effects of AFOs on static and dynamic balance. A search of appropriate medical databases was conducted, and 37 articles were found to satisfy predetermined inclusion criteria. Articles were categorized under two main areas: those investigating the use of AFOs designed for sporting applications (sports orthoses, 18 studies) and those investigating orthoses that are intended to facilitate ambulation in subjects with locomotor disorders (ambulatory orthoses, 19 studies). Combined results suggest that sports orthoses may facilitate certain aspects of balance in subjects with ankle instability and that balance is unlikely to be compromised when able-bodied subjects wear AFOs as a prophylactic measure. No evidence exists to suggest that any one design of sports orthosis is superior to another in terms of performance on balance measures. Results of studies involving ambulatory orthoses indicated that their effects on balance were largely dependent on the design characteristics of the orthosis used. Rigid AFOs seemed to facilitate static balance tasks, although the level of confidence in this outcome was relatively low. Under dynamic conditions, rigid AFOs seemed to compromise balance for the tested populations; confidence in this outcome was rated as moderate. A high level of confidence was ascribed to the statement that leaf spring AFOs, which allow controlled motion in the sagittal plane, seemed to facilitate both static and dynamic balance in the studied cohorts.