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 26–72), 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 ？0.09？beats/m (95% CI ？0.27, 0.95), velocity 0.04？m/s (95% CI ？0.01, 0.097), and in the Stairs Test ？11.8 s (95% CI ？19.05, ？4.48). 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 40–50% 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 [7–11]. 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, 13–15], improve walking stairs [8, 12], possibly decrease energy cost [14–16], 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
References
[1]
H. S. Jorgensen, H. Nakayama, H. O. Raaschou, and T. S. Olsen, “Recovery of walking function in stroke patients: the Copenhagen stroke study,” Archives of Physical Medicine and Rehabilitation, vol. 76, no. 1, pp. 27–32, 1995.
[2]
R. L. Waters and S. Mulroy, “The energy expenditure of normal and pathologic gait,” Gait & Posture, vol. 9, no. 3, pp. 207–231, 1999.
[3]
C. L. Richards, F. Malouin, and C. Dean, “Gait in stroke: assessment and rehabilitation,” Clinics in Geriatric Medicine, vol. 15, no. 4, pp. 833–855, 1999.
[4]
P. Zamparo, M. P. Francescato, G. De Luca, L. Lovati, and P. E. di Prampero, “The energy cost of level walking in patients with hemiplegia.,” Scandinavian Journal of Medicine & Science in Sports, vol. 5, no. 6, pp. 348–352, 1995.
[5]
C. M. Dean, C. L. Richards, and F. Malouin, “Walking speed over 10 metres overestimates locomotor capacity after stroke,” Clinical Rehabilitation, vol. 15, no. 4, pp. 415–421, 2001.
[6]
P. S. Pohl, P. W. Duncan, S. Perera et al., “Influence of stroke-related impairments on performance in 6-minute walk test,” Journal of Rehabilitation Research and Development, vol. 39, no. 4, pp. 439–444, 2002.
[7]
S. Hesse, C. Werner, K. Matthias, K. Stephen, and M. Berteanu, “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, vol. 30, no. 9, pp. 1855–1861, 1999.
[8]
D. C. M. de Wit, J. H. Buurke, J. M. M. Nijlant, M. J. Ijzerman, and H. J. Hermens, “The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial,” Clinical Rehabilitation, vol. 18, no. 5, pp. 550–557, 2004.
[9]
M. Pohl and J. Mehrholz, “Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients,” Clinical Rehabilitation, vol. 20, no. 4, pp. 324–330, 2006.
[10]
R. Y. Wang, L. L. Yen, C. C. Lee, P. Y. Lin, M. F. Wang, and Y. R. Yang, “Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations,” Clinical Rehabilitation, vol. 19, no. 1, pp. 37–44, 2005.
[11]
S. F. Tyson and L. Rogerson, “Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients' opinion,” Archives of Physical Medicine and Rehabilitation, vol. 90, no. 3, pp. 475–479, 2009.
[12]
R. W. Teasell, M. P. McRae, N. Foley, and A. Bhardwaj, “Physical and functional correlations of ankle-foot orthosis use in the rehabilitation of stroke patients,” Archives of Physical Medicine and Rehabilitation, vol. 82, no. 8, pp. 1047–1049, 2001.
[13]
H. G？k, A. Kü？ükdeveci, H. Altinkaynak, G. Yavuzer, and S. Ergin, “Effects of ankle-foot orthoses on hemiparetic gait,” Clinical Rehabilitation, vol. 17, no. 2, pp. 137–139, 2003.
[14]
A. Danielsson and K. S. Sunnerhagen, “Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis,” Journal of Rehabilitation Medicine, vol. 36, no. 4, pp. 165–168, 2004.
[15]
D. J. Bregman, J. Harlaar, C. G. Meskers, and Groot V. de, “Spring-like ankle foot orthoses reduce the energy cost of walking by taking over ankle work,” Gait & Posture, vol. 35, pp. 148–153, 2012.
[16]
M. Franceschini, M. Massucci, L. Ferrari, M. Agosti, and C. Paroli, “Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait,” Clinical Rehabilitation, vol. 17, no. 4, pp. 368–372, 2003.
[17]
J. Leung and A. M. Moseley, “Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia,” Physiotherapy, vol. 89, no. 1, pp. 39–60, 2003.
[18]
J. F. Lehmann, S. M. Condon, R. Price, and B. J. DeLateur, “Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses,” Archives of Physical Medicine and Rehabilitation, vol. 68, no. 11, pp. 763–771, 1987.
[19]
D. Cattaneo, F. Marazzini, A. Crippa, and R. Cardini, “Do static or dynamic AFOs improve balance?” Clinical Rehabilitation, vol. 16, no. 8, pp. 894–899, 2002.
[20]
J. Romkes and R. Brunner, “Comparison of a dynamic and a hinged ankle-foot orthosis by gait analysis in patients with hemiplegic cerebral palsy,” Gait & Posture, vol. 15, no. 1, pp. 18–24, 2002.
[21]
M. F. Diamond and K. J. Ottenbacher, “Effect of a tone-inhibiting dynamic ankle-foot orthosis on stride characteristics of an adult with hemiparesis,” Physical Therapy, vol. 70, no. 7, pp. 423–430, 1990.
[22]
J. Dieli, E. Ayyappa, and S. Hornbeak, “Efect of dynamic AFOs on three hemiplegic adults,” Journal of Prosthetics and Orthotics, vol. 9, no. 2, pp. 82–89, 1997.
[23]
K Mueller, M. Cornwall, T. McPoil, D. Mueller, and J. Barnwell, “Effect of a tone-inhibiting dynamic ankle-foot orthosis on the foot-loading pattern of a hemiplegic adult: a preliminary studie,” Journal of Prosthetics & Orthotics, vol. 4, pp. 86–91, 1992.
[24]
K. J. Nolan, K. K. Savalia, M. Yarossi, and E. P. Elovic, “Evaluation of a dynamic ankle foot orthosis in hemiplegic gait: a case report,” NeuroRehabilitation, vol. 27, no. 4, pp. 343–350, 2010.
[25]
S. Erel, F. Uygur, Simsek I. Engin, and Y. Yakut, “The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial,” Clinical Rehabilitation, vol. 25, pp. 515–523, 2011.
[26]
E. Suat, U. Fatma, and B. Nilgün, “The effects of dynamic ankle-foot orthoses on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait,” Disability and Rehabilitation, vol. 33, pp. 2605–2611, 2011.
[27]
N. Hylton, Dynamic Orthotic Concepts: Background and Experiences, Orthopaedie-Technik, Dortmund, Germany, 2000.
[28]
S. F. Tyson and H. A. Thornton, “The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users' opinions,” Clinical Rehabilitation, vol. 15, no. 1, pp. 53–58, 2001.
[29]
S. Hesse, D. Luecke, M. T. Jahnke, and K. H. Mauritz, “Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis,” International Journal of Rehabilitation Research, vol. 19, no. 2, pp. 133–141, 1996.
[30]
J. MacGregor, “The evaluation of patient performance using long-term ambulatory monitoring technique in the domiciliary environment,” Physiotherapy, vol. 67, no. 2, pp. 30–33, 1981.
[31]
G. A. V. Borg, “Psychophysical bases of perceived exertion,” Medicine and Science in Sports and Exercise, vol. 14, no. 5, pp. 377–381, 1982.
[32]
G. Borg, Borg's Perceived Exertion and Pain Scales, Human Kinetics, New York, NY, USA, 1998.
[33]
A. R. Fugl-Meyer, L. Jaasko, I. Leyman, and S. Olsson, “The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance,” Scandinavian Journal of Rehabilitation Medicine, vol. 7, pp. 13–31, 1975.
[34]
R. W. Bohannon and M. B. Smith, “Interrater reliability of a modified Ashworth scale of muscle spasticity,” Physical Therapy, vol. 67, no. 2, pp. 206–207, 1987.
[35]
R. W. Bohannon, M. G. Horton, and J. B. Wikholm, “Importance of four variables of walking to patients with stroke,” International Journal of Rehabilitation Research, vol. 14, no. 3, pp. 246–250, 1991.
[36]
U. B. Flansbjer, A. M. Holmb？ck, D. Downham, C. Patten, and J. Lexell, “Reliability of gait performance tests in men and women with hemiparesis after stroke,” Journal of Rehabilitation Medicine, vol. 37, no. 2, pp. 75–82, 2005.
[37]
K. Hagberg, R. Tranberg, R. Zugner, and A. Danielsson, “Reproducibility of the physiological cost index among individuals with a lower-limb amputation and healthy adults,” Physiotherapy Research International, vol. 00, pp. 1–9, 2010.
[38]
E. Fredrickson, R. L. Ruff, and J. J. Daly, “Physiological Cost Index as a proxy measure for the oxygen cost of gait in stroke patients,” Neurorehabilitation and Neural Repair, vol. 21, no. 5, pp. 429–434, 2007.
[39]
A. Danielsson, C. Willén, and K. S. Sunnerhagen, “Measurement of Energy Cost by the Physiological Cost Index in Walking After Stroke,” Archives of Physical Medicine and Rehabilitation, vol. 88, no. 10, pp. 1298–1303, 2007.
[40]
A. Dogan, M. Mengüllüoglu, and N. ？zgirgin, “Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients,” Disability and Rehabilitation, vol. 33, pp. 1433–1439, 2011.
