Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia
By Fatone, Stefania; Gard, Steven A.; Malas, Bryan S.; Archives of Physical Medicine and Rehabilitation, Vol. 90, No. 5, pp. 810-818Publication Date: May 2009
Study investigated the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal-plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia. Study participants were 16 adults with poststroke hempiplegia ranging in age between 43 and 66 years and a control group of 12 adults of similar age without disabilities. Participants with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90-degree plantar flexion stop and full-length foot-plate, conventionally-aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO, tibia vertical, with three-quarter-length foot-plate and three-quarter-length heel-height compensated AFO (3/4 AFO). Gait of participants in the control group was measured on a single occasion to provide a normal reference. Results showed walking speed to be unaffected by the different conditions in participants with hemiplegia. Compared with the no-AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing and changed the peak knee moment in early stance from flexor to extensor. Both AFOs with full-length foot plates significantly increased the peak stance-phase plantar flexor moment compared with no AFO and resulted in a peak knee-extensor moment in early stance that was significantly greater than that of the control group, whereas the 3/4 AFO resulted in ankle dorsiflexion during stance and swing that was significantly less than that of the control group. Findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar-flexion stop may be considered to improve early-stance knee moments for people with poststroke hemiplegia.
Published by: W.B. Saunders Company, a division of Elsevier Health Sciences (Website:http://us.elsevierhealth.com)
American Academy of Physical Medicine and Rehabilitation (Web Site: http://www.aapmr.org/ )
American Congress of Rehabilitation Medicine (Web Site: http://www.acrm.org )
Link to text: http://www.archives-pmr.org/article/S0003-9993(09)00122-1
