%0 Journal Article
%T Ambulatory Function and Perception of Confidence in Persons with Stroke with a Custom-Made Hinged versus a Standard Ankle Foot Orthosis
%A Ang谷lique Slijper
%A Anna Danielsson
%A Carin Will谷n
%J Rehabilitation Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/206495
%X Objective. The aim was to compare walking with an individually designed dynamic hinged ankle foot orthosis (DAFO) and a standard carbon composite ankle foot orthosis (C-AFO). Methods. Twelve participants, mean age 56 years (range 26每72), with hemiparesis due to stroke were included in the study. During the six-minute walk test (6MW), walking velocity, the Physiological Cost Index (PCI), and the degree of experienced exertion were measured with a DAFO and C-AFO, respectively, followed by a Stairs Test velocity and perceived confidence was rated. Results. The mean differences in favor for the DAFO were in 6MW 24.3 m (95% confidence interval [CI] 4.90, 43.76), PCI ˋ0.09ˋbeats/m (95% CI ˋ0.27, 0.95), velocity 0.04ˋm/s (95% CI ˋ0.01, 0.097), and in the Stairs Test ˋ11.8 s (95% CI ˋ19.05, ˋ4.48). All participants except one perceived the degree of experienced exertion lower and felt more confident when walking with the DAFO. Conclusions. Wearing a DAFO resulted in longer walking distance and faster stair climbing compared to walking with a C-AFO. Eleven of twelve participants felt more confident with the DAFO, which may be more important than speed and distance and the most important reason for prescribing an AFO. 1. Introduction Hemiparesis is one of the most common impairments after stroke that contributes to reduced gait performance. The ability to walk is a primary goal for people with stroke and most stroke survivors regain the ability to walk [1]. Hemiplegic gait is characterized by decreased walking speed [2, 3] and energy inefficiency [2, 4]. Persons with hemiparesis walk significantly slower than healthy persons and after 6 months reach only 40每50% of the distance of age-matched healthy persons [5, 6]. As an adjunct to therapy, ankle-foot orthoses (AFO) are frequently used, although evidence is limited that an AFO improves elements of gait [7每11]. In one study, 22% of the stroke patients at a rehabilitation unit were discharged with an AFO [12]. An AFO can increase walking speed [8, 10, 13每15], improve walking stairs [8, 12], possibly decrease energy cost [14每16], and can be applied to partially correct the gait pattern [17, 18]. The swing phase of gait is especially facilitated by using an AFO, by compensating for excessive plantarflexion, lack of knee flexion, and toe extension [17, 18]. AFOs with support around the foot/ankle can improve the medio-lateral stability of the ankle during the standing phase [18]. In many hospitals in Sweden, when more stability in anterior/posterior direction around the ankle is needed, prefabricated carbon composite
%U http://www.hindawi.com/journals/rerp/2012/206495/