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.