Ambulatory Function and Perception of Confidence in Persons with Stroke with a Custom-Made Hinged versus a Standard Ankle Foot Orthosis

Angélique Slijper, Anna Danielsson, Carin Willén, Angélique Slijper, Anna Danielsson, Carin Willén

Abstract

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.

Figures

Figure 1
Figure 1
(a) Individually designed hinged ankle foot orthoses (DAFO), (b) Carbon composite ankle foot orthoses (C-AFO).
Figure 2
Figure 2
Individual walking distances (6MW) with DAFO and C-AFO, respectively.

References

    1. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Recovery of walking function in stroke patients: the Copenhagen stroke study. Archives of Physical Medicine and Rehabilitation. 1995;76(1):27–32.
    1. Waters RL, Mulroy S. The energy expenditure of normal and pathologic gait. Gait & Posture. 1999;9(3):207–231.
    1. Richards CL, Malouin F, Dean C. Gait in stroke: assessment and rehabilitation. Clinics in Geriatric Medicine. 1999;15(4):833–855.
    1. Zamparo P, Francescato MP, De Luca G, Lovati L, di Prampero PE. The energy cost of level walking in patients with hemiplegia. Scandinavian Journal of Medicine & Science in Sports. 1995;5(6):348–352.
    1. Dean CM, Richards CL, Malouin F. Walking speed over 10 metres overestimates locomotor capacity after stroke. Clinical Rehabilitation. 2001;15(4):415–421.
    1. Pohl PS, Duncan PW, Perera S, et al. Influence of stroke-related impairments on performance in 6-minute walk test. Journal of Rehabilitation Research and Development. 2002;39(4):439–444.
    1. 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. 1999;30(9):1855–1861.
    1. de Wit DCM, Buurke JH, Nijlant JMM, Ijzerman MJ, Hermens HJ. The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial. Clinical Rehabilitation. 2004;18(5):550–557.
    1. Pohl M, Mehrholz J. Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients. Clinical Rehabilitation. 2006;20(4):324–330.
    1. Wang RY, Yen LL, Lee CC, Lin PY, Wang MF, Yang YR. Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations. Clinical Rehabilitation. 2005;19(1):37–44.
    1. Tyson SF, Rogerson L. 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. 2009;90(3):475–479.
    1. Teasell RW, McRae MP, Foley N, Bhardwaj A. Physical and functional correlations of ankle-foot orthosis use in the rehabilitation of stroke patients. Archives of Physical Medicine and Rehabilitation. 2001;82(8):1047–1049.
    1. Gök H, Küçükdeveci A, Altinkaynak H, Yavuzer G, Ergin S. Effects of ankle-foot orthoses on hemiparetic gait. Clinical Rehabilitation. 2003;17(2):137–139.
    1. Danielsson A, Sunnerhagen KS. Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis. Journal of Rehabilitation Medicine. 2004;36(4):165–168.
    1. Bregman DJ, Harlaar J, Meskers CG, de GrootV. Spring-like ankle foot orthoses reduce the energy cost of walking by taking over ankle work. Gait & Posture. 2012;35:148–153.
    1. 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. Clinical Rehabilitation. 2003;17(4):368–372.
    1. Leung J, Moseley AM. Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia. Physiotherapy. 2003;89(1):39–60.
    1. Lehmann JF, Condon SM, Price R, DeLateur BJ. Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses. Archives of Physical Medicine and Rehabilitation. 1987;68(11):763–771.
    1. Cattaneo D, Marazzini F, Crippa A, Cardini R. Do static or dynamic AFOs improve balance? Clinical Rehabilitation. 2002;16(8):894–899.
    1. Romkes J, Brunner R. Comparison of a dynamic and a hinged ankle-foot orthosis by gait analysis in patients with hemiplegic cerebral palsy. Gait & Posture. 2002;15(1):18–24.
    1. Diamond MF, Ottenbacher KJ. Effect of a tone-inhibiting dynamic ankle-foot orthosis on stride characteristics of an adult with hemiparesis. Physical Therapy. 1990;70(7):423–430.
    1. Dieli J, Ayyappa E, Hornbeak S. Efect of dynamic AFOs on three hemiplegic adults. Journal of Prosthetics and Orthotics. 1997;9(2):82–89.
    1. Mueller K, Cornwall M, McPoil T, Mueller D, Barnwell J. 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. 1992;4:86–91.
    1. Nolan KJ, Savalia KK, Yarossi M, Elovic EP. Evaluation of a dynamic ankle foot orthosis in hemiplegic gait: a case report. NeuroRehabilitation. 2010;27(4):343–350.
    1. Erel S, Uygur F, Engin SimsekI, Yakut Y. The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial. Clinical Rehabilitation. 2011;25:515–523.
    1. Suat E, Fatma U, Nilgün B. The effects of dynamic ankle-foot orthoses on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait. Disability and Rehabilitation. 2011;33:2605–2611.
    1. Hylton N. Dynamic Orthotic Concepts: Background and Experiences. Dortmund, Germany: Orthopaedie-Technik; 2000.
    1. Tyson SF, Thornton HA. The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users’ opinions. Clinical Rehabilitation. 2001;15(1):53–58.
    1. Hesse S, Luecke D, Jahnke MT, Mauritz KH. Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis. International Journal of Rehabilitation Research. 1996;19(2):133–141.
    1. MacGregor J. The evaluation of patient performance using long-term ambulatory monitoring technique in the domiciliary environment. Physiotherapy. 1981;67(2):30–33.
    1. Borg GAV. Psychophysical bases of perceived exertion. Medicine and Science in Sports and Exercise. 1982;14(5):377–381.
    1. Borg G. Borg's Perceived Exertion and Pain Scales. New York, NY, USA: Human Kinetics; 1998.
    1. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scandinavian Journal of Rehabilitation Medicine. 1975;7:13–31.
    1. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy. 1987;67(2):206–207.
    1. Bohannon RW, Horton MG, Wikholm JB. Importance of four variables of walking to patients with stroke. International Journal of Rehabilitation Research. 1991;14(3):246–250.
    1. Flansbjer UB, Holmbäck AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine. 2005;37(2):75–82.
    1. Hagberg K, Tranberg R, Zugner R, Danielsson A. Reproducibility of the physiological cost index among individuals with a lower-limb amputation and healthy adults. Physiotherapy Research International. 2010;00:1–9.
    1. Fredrickson E, Ruff RL, Daly JJ. Physiological Cost Index as a proxy measure for the oxygen cost of gait in stroke patients. Neurorehabilitation and Neural Repair. 2007;21(5):429–434.
    1. Danielsson A, Willén C, Sunnerhagen KS. Measurement of Energy Cost by the Physiological Cost Index in Walking After Stroke. Archives of Physical Medicine and Rehabilitation. 2007;88(10):1298–1303.
    1. Dogan A, Mengüllüoglu M, Özgirgin N. Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients. Disability and Rehabilitation. 2011;33:1433–1439.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する