Comparative study of anterior support ankle foot orthosis and posterior ankle foot orthosis in foot drop patients

Background: Anterior Support Ankle Foot Orthosis (A-AFO) is a fairly recent approach. There is dearth of studies relating to comparison of metabolic efficiency of A-AFO and P-AFO. Objective was to study the efficacy of A-AFO compared to P-AFO in foot drop patients, using gait and metabolic analysis.Methods: It was a cross over study, included foot drop patients who could walk with/ without orthosis. Patients having spasticity more than grade 2 (Modified Ashworth Scale) were excluded. The metabolic parameters measured were volume of Oxygen consumed at Standard Temperature and Pressure in l/min (VO2), Dry in l/min, Rate of Oxygen consumption (MET), Volume of Carbon dioxide produced in litre/min (VCO2). Along with various gait parameters, questionnaire about patient’s preference after 4 weeks was also incorporated.Results: A-AFO was significantly better than P-AFO in terms of VO2 and VCO2 (p value = 0.02 and 0.009 respectively) as well as in terms of subjective preference.Conclusions: A-AFO is comparable to P-AFO in terms of energy efficiency, gait parameters and subjective preference, hence should also be prescribed.

Morgagni Stewart Morel syndrome--additional features.

A case of Morgagni Stewart Morel syndrome with progressive depression in frontal bone, headache, transient monoparesis, obesity; imbalance, neuropsychiatric symptoms and recurrent disc prolapse with absent right radial pulse is discussed. This syndrome was first mentioned 235 years back, but till now exact pathology is not known. Balance assessment using dynamic posturography was done, which revealed abnormal vestibular function. To our knowledge this is the first case examined for Dynamic Posturography.

Phenol block in the management of spastic cerebral palsy.

In the present series 116 cases of spastic cerebral palsy were selected; in whom perineal care and ambulation was affected. These cases were given peripheral nerve block (obturator 110, posterior tibial 134 and median nerve 2) with 6% aqueous phenol solution. The block relieved the spastic condition, allowed better nursing care, freed the patient from the embarrassment of a contorted limb, allowed voluntary movement to take place and eased in fitment of caliper to aid further ambulation. The period of effectiveness ranged from 3 months to 18 months, with an average of 13 months. Paraesthesia occurred following 5 nerve blocks. Eleven nerve blocks had to be repeated. Ease, simplicity, safety, therapeutic benefits and economic advantages of peripheral nerve block using phenol in cerebral palsy warrant its more widespread use.