Author
Rajesh Kumar Mohanty, Priyanka Behera, Pabitra Kumar Sahoo, Sakti Prasad Das
Keywords
Ankle Foot Orthosis; Foot Drop; Gait; Kinematics; Kinetics; Stroke
Abstract
Ankle foot orthoses (AFOs) are usually used for patients with hemiplegic foot drop after stroke to provide support in walking. While the literature provides important information on the beneficial effect of the AFOs, there is still a need for more data describing the impact of different designs of AFOs on gait of subjects during rehabilitation phase after stroke. The aim of this study was to compare the clinical efficacy of two designs of AFOs (Solid and Hinged) on specific gait parameters, kinematics and kinetics during gait by subjects with hemiplegic foot drop after stroke. Thirty subjects with hemiplegic foot drop after stroke participated in this study. Comparison of gait pattern was performed in barefoot, solid and hinged AFO walking conditions. Temporal-spatial, kinematic and kinetic data were collected using force platform (version BTS P-6000, Italy) and six high definition optoelectronic cameras with reflective markers (BTS SMART-DX 6000, Italy) in gait and motion analysis lab. Though subjects walked faster, with a higher cadence and step lengths, when using solid AFO as compared to hinged AFO, the difference was non-significant ( > 0.05). Significant difference was observed between gait parameters, kinematics and kinetics of either ankle foot orthosiss compared to barefoot (P < 0.05). Significant difference was observed between two AFOs in mean increase in dorsiflexion at initial contact, peak ankle dorsiflexion during stance, ankle power at push off and peak vertical ground reaction. These findings suggest that, compared to barefoot an AFO yields better gait and thus more effectively manage footdrop, however difference between uses of its variants has almost no impact. Further research to explore the potential utility of these designs of AFOs is indicated.
References
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[26] Young-In Hwanga, Duk-Hyun Anb and Won-Gyu Yoo. Effects of the Dual AFO on gait parameters in stroke patients. NeuroRehabilitation 31; 2012: 387–393.
[27] Shin YJ, Lee DH, Kim MK. The effect of newly designed multi joint ankle foot orthosis on the gait and dynamic balance of stroke patients with foot drop. J Phys Ther Sci. 29(11); 2017:1899–1902.
[28] Doğan, Asuman & Mengüllüoğlu, Münire & Özgirgin, Neşe. Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients. Disability and rehabilitation. 33; 2010: 1433-9.
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[33] L. A. Ferreira, H. P. Neto, L. A. Grecco et al., “Effect of ankle-foot orthosis on gait velocity and cadence of stroke patients: a systematic review,” Journal of Physical Therapy Science. 25(11); 2013: 1503–1508.
[34] H. Abe, A. Michimata, K. Sugawara, N. Sugaya, and S.-I. Izumi, “Improving gait stability in stroke hemiplegic patients with a plastic ankle-foot orthosis,” Tohoku Journal of Experimental Medicine. 218(3); 2009: 193–199.
[35] Hesse S, Luecke D, Jahnke M, Mauritz KH. Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis. Int J Rehabil Res. 19; 1996: 133–141.
[36] Aliyeh Daryabor, Mokhtar Arazpour. Effect of different design of AFO on gait in patients with stroke;a systematic review. Gait and posture . 62; 2018: 268-279
[37] Burdett R, Borello-France D, Blatchly C, Potter C. Gait comparison of subjects with hemiplegia walking unbraced, with ankle-foot orthosis, and with Air-Stirrup brace. Phys Ther. 68(8); 1988: 1197-203.
[38] Hesse S, Werner C, Matthias K, Stephen K, Berteanu M. Non-velocity-related effects of a rigid double-stopped ankle-foot orthosis on gait and lower limb muscle activity of hemiparetic subjects with an equinovarus deformity. Stroke. 30(9); 1999: 1855-61.
[39] Fatone S, Hansen A. Effect of ankle-foot orthosis on roll-over shape in adults with hemiplegia. J Rehabil Res Dev. 44(1); 2007: 11-20.
[40] Mulroy SJ, Eberly VJ, Gronely JK, Weiss W & Newsam CJ. Effect of ankle foot orthosis design on walking after stroke: Impact of ankle plantar flexion contracture. Prosthet Orthot Int. 34(3); 2010: 277–292
[41] Kobayashi T, Leung AKL, Akazawa Y and Hutchins SW. Effect of ankle-foot orthoses on the sagittal plane displacement of the center of mass in patients with stroke hemiplegia: a pilot study. Top Stroke Rehabil 19; 2012: 338–344.
[42] Yamamoto SA, Fuchi MB and Yasui TC. Change of rocker function in the gait of stroke patients using an ankle foot orthosis with an oil damper: Immediate changes and the short-term effects. Prosthet Orthot Int.; 35; 2011: 350–359
[2] Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 380; 2012: 2095-2128
[3] Feigin VL, Forouzanfar MH, Krishnamurthi R, et al; Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and regional burden of stroke during 1990– 2010: findings from the Global Burden of Disease Study 2010. Lancet 383; 2014: 245–254.
[4] Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 8; 2009: 355–369.
[5] Robert Teasell. Musculoskeletal complications of Hemiplegia Following Stroke. Seminars in Arthritis and Rheumatism 20(6); 1991: 385-395
[6] Balaban, B., & Tok, F. Gait Disturbances in Patients with Stroke. PM&R, 6(7); 2014: 635–642.
[7] Cheng PT, Chen CL, Wang CM, Hong WH. Leg muscle activation patterns of sit-to-stand movement in stroke patients. Am J Phys Med Rehabil. 83; 2004:10–16.
[8] Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia. Arch Phys Med Rehabil. 90; 2009:810–818.
[9] Franceschini M, Massucci M, Ferrari L, Agosti M, Paroli C. Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait. Clin Rehabil. 17; 2003: 368–372.
[10] Eng JJ, Tang PF. Gait training strategies to optimize walking ability in people with stroke: a synthesis of the evidence. Expert Rev Neurother.7(10); 2007 :1417–1436.
[11] Wang RY, Lin PY, Lee CC, Yang YR. Gait and balance performance improvements attributable to ankle-foot orthosis in subjects with hemiparesis. Am J Phys Med Rehabil 86(7); 2007: 556-562.
[12] Caillet F, Mertens P, Rabaséda S, Boisson D. Three dimensional gait analysis and controlling spastic foot on stroke patients. Ann Readapt Med Phys 46(3); 2003: :119-131.
[13] Gök H, Küçükdeveci A, Altinkaynak H, et al. Effects of ankle-foot orthoses on hemiparetic gait. Clin Rehabil. 17(2); 2003: 137-139.
[14] Rao N, Chaudhuri G, Hasso D, et al. Gait assessment during the initial fitting of an ankle foot orthosis in individuals with stroke. Disabil Rehabil Assist Technol 3(4); 2008: 201-207.
[15] Lewallen, J., Miedaner, J., Amyx, S., & Sherman, J. Effect of Three Styles of Custom Ankle Foot Orthoses on the Gait of Stroke Patients While Walking on Level and Inclined Surfaces. JPO Journal of Prosthetics and Orthotics, 22(2); 2010: 78–83.
[16] Sankaranarayan H, Gupta A, Khanna M, Taly AB, Thennarasu K. Role of ankle foot orthosis in improving locomotion and functional recovery in patients with stroke: A prospective rehabilitation study. J Neurosci Rural Pract. 7(4); 2016: 544–549.
[17] Pavlik, A. J. The Effect of Long-Term Ankle-Foot Orthosis Use on Gait in the Poststroke Population. JPO Journal of Prosthetics and Orthotics, 20(2); 2004: 49–52.
[18] Farmani F, Mohseni-Bandpei MA, Bahramizadeh M, Aminian Gh, Nikoo MR, Sadeghi-Goghari M. Effectof rocker bar ankle foot orthosis on functional mobility in post-stroke hemiplegic patients: Timed up and go and gait speed assessments. Iranian Rehabilitation Journal. 14(1); 2016 :31-34.
[19] Bulley, C., Shiels, J., Wilkie, K., & Salisbury, L. User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke. Physiotherapy, 97(3); 2011: 226–233.
[20] Patricia M. Kluding, Kari Dunning, Michael w Dell, Jivan Ginosian, Jody feld. Foot drop stimulation versus Ankle foot orthosis after stroke .Journal of Stroke . 44(6); 2013: 1660-1669
[21] Sheffler, L. R., Bailey, S. N., Wilson, R. D., & Chae, J. Spatiotemporal, Kinematic, and Kinetic Effects of a Peroneal Nerve Stimulator Versus an Ankle Foot Orthosis in Hemiparetic Gait. Neurorehabilitation and Neural Repair, 27(5); 2012: 403–410.
[22] Ring H, Treger I, Gruendlinger L, Hausdorff JM. Neuroprosthesis for footdrop compared with an ankle-foot orthosis: effects on postural control during walking. J Stroke Cerebrovasc Dis. 18(1); 2009: 41-47
[23] Karen J. Nolan, Krupa K. Savaliaa, Mathew Yarossia and Elie P. Elovic. Evaluation of a dynamic ankle foot orthosis in hemiplegic gait: A case report. NeuroRehabilitation. 27; 2010: 343–35
[24] Tyson, S. F., & Thornton, H. A. The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users’ opinions. Clinical Rehabilitation, 15(1); 2001: 53–58.
[25] Rao, N., Chaudhuri, G., Hasso, D., D’Souza, K., Wening, J., Carlson, C., & Aruin, A. S. Gait assessment during the initial fitting of an ankle foot orthosis in individuals with stroke. Disability and Rehabilitation: Assistive Technology, 3(4); 2008: 201–207.
[26] Young-In Hwanga, Duk-Hyun Anb and Won-Gyu Yoo. Effects of the Dual AFO on gait parameters in stroke patients. NeuroRehabilitation 31; 2012: 387–393.
[27] Shin YJ, Lee DH, Kim MK. The effect of newly designed multi joint ankle foot orthosis on the gait and dynamic balance of stroke patients with foot drop. J Phys Ther Sci. 29(11); 2017:1899–1902.
[28] Doğan, Asuman & Mengüllüoğlu, Münire & Özgirgin, Neşe. Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients. Disability and rehabilitation. 33; 2010: 1433-9.
[29] Zollo L, Zaccheddu N, Ciancio AL, Morrone M, Bravi M, Santacaterina F, et al.Comparative analysis and quantitative evaluation of ankle-foot orthoses for foot drop in chronic hemiparetic patients. Eur J Phys Rehabil Med 51(2); 2015: 185-96.
[30] Rao N, Wening J, Hasso D, Gnanapragasam G, Perera P, Srigiriraju P, Aruin AS. The effects of two different ankle-foot orthoses on gait of patients with acute hemiparetic cerebrovascular accident. Rehabil Res Pract. 2014; 2014:301469.
[31] H. S. Jorgensen, H. Nakayama, H. O. Raaschou, J. Vive-Larsen, M. Stoier, and T. S. Olsen, “Outcome and time course of recovery in stroke, part II: time course of recovery: the Copenhagen Stroke Study,” Archives of Physical Medicine and Rehabilitation, 76(5); 1995: 406–412.
[32] E. Cakar, O. Durmus, L. Tekin, U. Dincer, and M. Z. Kiralp, “The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients,” European Journal of Physical and Rehabilitation Medicine. 46(3); 2010: 363–368.
[33] L. A. Ferreira, H. P. Neto, L. A. Grecco et al., “Effect of ankle-foot orthosis on gait velocity and cadence of stroke patients: a systematic review,” Journal of Physical Therapy Science. 25(11); 2013: 1503–1508.
[34] H. Abe, A. Michimata, K. Sugawara, N. Sugaya, and S.-I. Izumi, “Improving gait stability in stroke hemiplegic patients with a plastic ankle-foot orthosis,” Tohoku Journal of Experimental Medicine. 218(3); 2009: 193–199.
[35] Hesse S, Luecke D, Jahnke M, Mauritz KH. Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis. Int J Rehabil Res. 19; 1996: 133–141.
[36] Aliyeh Daryabor, Mokhtar Arazpour. Effect of different design of AFO on gait in patients with stroke;a systematic review. Gait and posture . 62; 2018: 268-279
[37] Burdett R, Borello-France D, Blatchly C, Potter C. Gait comparison of subjects with hemiplegia walking unbraced, with ankle-foot orthosis, and with Air-Stirrup brace. Phys Ther. 68(8); 1988: 1197-203.
[38] Hesse S, Werner C, Matthias K, Stephen K, Berteanu M. Non-velocity-related effects of a rigid double-stopped ankle-foot orthosis on gait and lower limb muscle activity of hemiparetic subjects with an equinovarus deformity. Stroke. 30(9); 1999: 1855-61.
[39] Fatone S, Hansen A. Effect of ankle-foot orthosis on roll-over shape in adults with hemiplegia. J Rehabil Res Dev. 44(1); 2007: 11-20.
[40] Mulroy SJ, Eberly VJ, Gronely JK, Weiss W & Newsam CJ. Effect of ankle foot orthosis design on walking after stroke: Impact of ankle plantar flexion contracture. Prosthet Orthot Int. 34(3); 2010: 277–292
[41] Kobayashi T, Leung AKL, Akazawa Y and Hutchins SW. Effect of ankle-foot orthoses on the sagittal plane displacement of the center of mass in patients with stroke hemiplegia: a pilot study. Top Stroke Rehabil 19; 2012: 338–344.
[42] Yamamoto SA, Fuchi MB and Yasui TC. Change of rocker function in the gait of stroke patients using an ankle foot orthosis with an oil damper: Immediate changes and the short-term effects. Prosthet Orthot Int.; 35; 2011: 350–359
Received : 20 February 2020
Accepted : 02 July 2020
Published : 26 July 2020
DOI: 10.30726/esij/v7.i3.2020.73012
1. Different Ankle Foot Orthosis Design in Subjects with Foot Drop after Stroke