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Objective:To compare the effect of a knee-ankle-foot orthosis (KAFO) and a paraplegic walking orthosis (WO) on the walking ability and the physiological cost index (PCI) of persons suffering from AIS A-B spinal cord injury (SCI) at the L 2 level. Methods:Thirty subjects with AIS A-B SCI at L 2, aged 20 to 45, were assigned randomly into a KAFO group ( n=15) or a WO group ( n=15). All received muscle strength, range of motion, standing, balance and weight shifting training and training in the activities of daily life. Electrotherapy and acupuncture were also administered. Both groups underwent 60 minutes of walking training 6 times per week for 12 weeks, wearing either a KAFO or a WO. Step length, gait speed, step frequency, 10-metre walk time, 6-minute walk distance and PCI were compared after 2 and 12 weeks. Results:The average step length, gait speed, step frequency, 10-metre walk time, 6-minute walk distance and PCI of both groups had improved significantly between the 2-week and 12-week evaluations, with significantly greater average improvement among the WO group at both time points.Conclusion:A WO or KAFO facilitates better walking after an AIS A-B spinal cord injury at L 2. Wearing a WO is more effective than wearing a KAFO, on average.
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Aim: To compare the immediate effect of functional electrical stimulation (FES) to solid ankle foot orthosis (SAFO) concerning spatiotemporal parameters and ankle kinematics during gait in hemiplegic cerebral palsy (CP). Methodology: Thirty spastic hemiplegic cerebral palsied children were randomly distributed into two equal groups; group A, who used the functional electrical stimulation (FES) and group B, who worn the solid ankle foot orthosis (SAFO). Vicon 3D motion analysis system was used to measure the spatiotemporal parameters of gait and ankle dorsiflexion angle at initial contact and mid-swing before intervention and with application of either FES or SAFO. Spasticity was ranged between 2 and 1+ and determined by Modified Ashworth Scale score. Results: Following the application of solid AFO, stride length and walking speed significantly increased than next to FES (p=0.0001, p=0.001) respectively. Whereas, number of steps/minute significantly decreased (p=0.001). Further, Solid AFO increased ankle dorsiflexion at initial contact (6.2±4.7º) and mid-swing (3.4±0.6º) more than FES at initial contact (1.86±3.9º) and mid-swing (-4.6± 5º). Conclusion: FES, unlikely found to evoke an immediate effect of spatiotemporal parameters while solid AFO improved the gait efficiency by enhancing spatiotemporal parameters. Both treatment interventions increased ankle dorsiflexion at initial contact and mid-swing but solid AFO was more effective immediately than FES.
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Objective To investigate the application effect of the ankle foot orthoses (AFO)in the rehabilitation of patients with hemiplegia and abnormal gait after stroke Methods Sixty consecutive stroked patients with hemiplegia admitted to Meizhou People′s Hospital,Guagdong Province from January in 2013 to June in 2015 were enrolled retrospectively,and they were divided into either an AFO group or a non-AFO group (n = 30 in each group)according to the odd or even admission numbers. The patients in the non-AFO group were treated with conventional rehabilitation training and those in the AFO group were treated with AFO. Before and after treatment,the Berg balance scale (BBS)was used to assess the balance ability of the patients,10 m maximum walking speed (MWS)was used to assess the walking speed of the patients,and the physiological cost index (PCI)was used to assess the walking efficiency of the patients. Results After treatment,there was significant difference in Brunnstrom grade between the AFO group and the non-AFO group (P < 0. 05). The BBS score and MWS of the patients in the AFO group were 39 ± 5 and 0. 97 ± 0. 38 m/ s respectively after treatment,and they were higher than those before treatment (33 ± 4 and 0. 28 ± 0. 07 m/ s)and those of non-AFO group (36 ± 4 and 0. 54 ± 0. 31 m/ s)after treatment. There were significant differences (all P <0. 05). The PCI was 0. 84 ± 0. 30 in the AFO group after treatment was 0. 84 ± 0. 30. It was lower than that before treatment (1. 32 ± 0. 31)and that of non-AFO after treatment (0. 96 ±0. 33). There was significant difference (all P < 0. 05). Conclusion The application of APO in stroked patients with hemiplegia and abnormal gait has better clinical efficacy. It can significantly im-prove the balance state of patients and improve the walking speed and efficiency.
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Objective To explore the effects of wearing ankle-foot orthoses (AFOs) on motor function in children with spastic cerebral palsy (SCP). Methods Fifty-two children with SCP were randomly divided into a wearing-for-training group (n = 16, group 1 ), a day-wearing group (n = 19, group 2) and a day-night-wearing group (n = 17, group 3). In addition to the conventional rehabilitative treatment given to all participants, the children in group 1 wore AFOs during movement training, and children in group 2 wore AFOs in the daytime for 6-8 h per day, while AFOs were applied to the children in group 3 for 24 hours a day except for cleaning and during certain training routines. All the treatments were continued for 2 months. Clinical assessments included the range of passive ankle dorsi-and plantarflexion (APROM) , modified Ashworth scale (MAS) ratings, and the D and E dimensions of the Gross Motor Function Measure (GMFM). All were performed before and after treatment. Results Before treat-ment, no statistically significant differences were found among the three groups in terms of APROM, MAS, or GM-FM. There were significant subsequent improvements in groups 2 and 3 when compared with group 1 in terms of APROM, MAS and GMFM results. Group 2's improvements in APROM and MAS results were not significantly better than those of group 3, but their average GMFM score improvements were significantly better. Conclusion Wearing AFOs in the daytime 6-8 hours per day is more effective in reducing spasticity and improving functional performance in children with SCP.
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OBJECTIVE: This study was designed to analyse quantitatively the change in rigidity of plastic ankle foot orthoses (AFOs) corresponding with regulated ankle width and to find the appropriate ankle width for spastic ankles. METHOD: Five different plastic AFOs were fabricated according to the regulated ankle width. The resistance to dorsiflexion and plantar flexion movements was measured by bending the plastic AFOs at intervals of 2 degrees with the measuring device. Plantar flexion moments of hemiplegic spastic ankles were also measured. RESULTS: The rigidity of plastic AFOs increased nearly in proportion to the increase of the ankle width. The plantar flexion moments of hemiplegic spastic ankles increased in proportion to the severity of the spasticity. If the plastic AFOs would be used only for the prevention of toe dragging in swing phase, the ankle width of plastic AFOs could be reduced up to 60% which was enough to support the ankle in swing phase. CONCLUSION: These findings suggested that the degree of rigidity of plastic AFOs could be adjusted by trimming about the ankle to meet the individual patient's requirement. And this study could be helpful to quantify empirical approach of the prescription of plastic AFOs.
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Ankle , Foot Orthoses , Muscle Spasticity , Orthotic Devices , Plastics , Prescriptions , ToesABSTRACT
@#ObjectiveTo study the effect of Rehabilitative Ankle-Foot Orthoses training program on walking function of hemiplegic patients after stroke .Methods95 patients were randomly divided into two groups: observed group (49 cases) and control group (46 cases). The patients of control group were trained by routine rehabilitation training program, the patients of observed group were trained by Rehabilitative Ankle-Foot Orthoses and routine rehabilitation training program.ResultsAfter training, either observed group or control group showed significant improvement at walking function and ADL(P<0.01), but the improvement on observed group were more marked than coutrol group(P<0.01 and P<0.05). ConclusionsThe ability of walking in acute stroke patients were obviously improved, and the degree of the disability of them was decreased by Rehabilitative Ankle-Foot Orthoses.
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OBJECTIVE: To investigate the effects of dynamic (hinged) and solid ankle-foot orthoses (AFO) on the gait characteristics in spastic cerebral palsied children and to find out which AFO has a more beneficial effect on correcting the abnormal gait pattern in those children. METHOD: The subjects were 40 children with spastic cerebral palsy (CP) who were able to walk independently without walking aids. Their ages were ranging from 2 to 12 years. Children were randomly prescribed to dynamic or to solid AFO. Twenty-four children got solid AFO and 16 children got hinged AFO. Gait characteristics were evaluated by computer based kinematic gait analysis while they were walking with AFO and on barefoot. Gait characteristics on barefoot and with hinged AFO and with solid AFO respectively were compared. RESULTS: Temporospatial parameters while walking on barefoot were not significantly different from those while walking with AFOs. While walking with hinged AFO, the maximal knee extension angle during stance phase was decreased in comparison with that on barefoot (p<0.05). Ankle dorsiflexion angle on hinged AFO was increased throughout the gait cycle (p<0.05). While walking with solid AFO, ankle dorsiflexion angle at initial contact, at 98% of gait cycle and at maximal ankle dorsiflexion angle in stance phase were increased in comparison with that on barefoot (p<0.05). There was no significant difference of changes after wearing orthoses between hinged and solid AFO. CONCLUSION: Both types of AFOs exerted a positive effect on ankle motion, not in knee or hip joints in the children with spastic cerebral palsy. The gait characteristics during walking with both AFOs were not significantly different, even if the hinged type might be more effective in preventing knee hyperextension in stance phase and in improving maximal ankle dorsiflexion during the swing phase.
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Child , Humans , Ankle , Biomechanical Phenomena , Cerebral Palsy , Gait , Hip Joint , Knee , Muscle Spasticity , Orthotic Devices , WalkingABSTRACT
OBJECTIVE: To investigate the changes of gait patterns in subjects who use the ankle foot orthoses (AFOs) with a variable ankle joint stop. METHOD: Six young subjects without a known physical disability were involved in this study. Double upright AFOs with three kinds of ankle joint stops (eg. AFOs with 85o posterior stop, 90o posterior stop, and 95o posterior stop) were used for the right foot and a rigid shoe was used for the left foot. Gait patterns of the subjects using the AFOs with a variable ankle joint stop were evaluated with the three dimensional gait analysis system. RESULTS: The gait patterns of the subjects with a 85o posterior stop AFO showed a shorter duration of single support phase than the subjects with a 90o posterior stop or 95o posterior stop. They showed the increased maximal knee flexion angles, decreased knee extension angles and decreased ankle range of motions by the kinematics. These linear changes in parameters and kinematics were statistically significant. In kinetics, the gait patterns of the subjects using a AFO with 85o posterior stop had the largest maximal knee flexion moment and the gait patterns of the subjects using a AFO with 95o posterior stop had the largest maximal knee extension moment. However these results were not statistically significant. CONCLUSION: For the patients with uncontrolled ankle motion, the AFOs with 90o or 95o posterior stop would be more desirable than the AFOs with 85o posterior stop, for the clearance of foot and stability of knees but not for the correction of the knee hyperextension.
Subject(s)
Humans , Ankle Joint , Ankle , Biomechanical Phenomena , Foot Orthoses , Foot , Gait , Kinetics , Knee , ShoesABSTRACT
Hemiplegic gait is characterized by slow and poorly coordinated movements of the affected limb resulting from foot drop or equinus deformities. Ankle-foot orthoses(AFO) are frequently prescribed to improve the gait pattern of hemiplegics. Plastic AFO with different trimlines in controlling ankle motion can cause variable biomechanical effects. In this study, we analysed the biomechanical effect of donning AFO on hemiplegic gait and assessed whether any differences resulted when the AFO was modified. Gait events, plantar pressure, foot contact and centers of pressure(COP) parameters were measured with F-scan pressure sensitive insole system in 21 hemiplegic stroke patients with Brunnstrom's lower extremity stage 3. And those parameters were compaired in each of four different conditions: 1) before donning AFO, 2) donning AFO without any modification, 3) donning AFO with the dis tal part of metatarsal head trimmed off, 4) donning AFO with third condition and weaning a cushioned heel shoes. After donning AFO, total contact area and contact width were increased, and initial contact COP and mean COP were displaced medially. But contact length was not changed and initial contact COP and mean COP were not displaced anteroposteriorly. Anteroposterior displacement of COP, slope and velocity of COP were not also changed after donning AFO. Among various AFO adjustments, there were no significant changes of plantar pressure, foot contact and COP parameters. The results suggest that 1) AFO provides mediolateral stability, but does not provide additional functional rocker actions during stance phase and 2) There were no definite different biomechanical actions among various adjustments of plastic AFO in hemiplegic gait of Brunnstrom's lower extremity stage 3.