Investigating the effects of ankle foot orthoses on electromyography in impaired populations: a systematic review.

PURPOSE: Despite ample evidence supporting ankle foot orthoses (AFOs) for enhancing ambulation in those with neuromuscular impairment, a prevalent belief among rehabilitation professionals is that AFO use may lead to disuse and reduced muscle activity of the lower leg. To determine the effects of AFO intervention on electromyography (EMG) activity during walking in individuals with neuromuscular impairment. MATERIALS AND METHODS: Five databases were searched for studies that met the predefined inclusion criteria and were published any time through April 2024. AFO design characteristics, muscle groups measured, study design, experimental comparisons, and EMG parameters were extracted from each study. Methodological quality of the included studies was assessed using the modified PEDro scale. RESULTS: Twenty studies met the inclusion criteria. AFO interventions utilized, EMG outcomes utilized, and result interpretations varied widely. In situations of hypertonicity, reduced EMG activity was deemed a positive outcome, while other studies viewed it negatively. Seven longitudinal studies found no adverse long-term impact on EMG activity. CONCLUSION: The results of this review challenge the clinical belief that AFOs cause muscle disuse over time; however, the heterogeneity of AFO designs prevents broad statements related to which orthoses optimize muscle activity.

Ankle foot Orthosis (AFO) intervention demonstrates diverse effects on the timing and amplitude of electromyography (EMG) measures, with significant variability in direction, magnitude, and interpretation across studies, necessitating personalized approaches.Longitudinal studies refute concerns about adverse effects on EMG activity with prolonged AFO use, challenging the notion of decreased muscle activation and supporting the safety of extended AFO utilization.Clinicians are advised to differentiate between peripheral and central nervous system disorders when considering AFO intervention, emphasizing the need to align AFO goals with the patient's clinical presentation and carefully weigh the known advantages associated with AFO utilization.

Physical therapist's clinical reasoning in patients with gait impairments from hemiplegia.

Background: During stroke rehabilitation, physical therapists (PTs) perform gait analysis and design treatments based on this analysis. Objectives: To investigate the current trends in PTs clinical reasoning in assessing and managing gait in persons with hemiplegia. Design: A qualitative study using a phenomenological approach using a semi-structured interview protocol with FG. Methods: Participants consisted of expert and novice PTs working in a neurologic rehabilitation setting. FG were conducted in person and via web. Constant comparative qualitative analysis was used to analyze the qualitative data. Results: A total of 22 PTs participated in five FG (2 novice and 3 expert groups). From the analysis of qualitative data, five themes emerged. Novice and experienced clinicians: 1) take a systematic approach to examination and evaluation of persons with hemiplegia; 2) are in agreement in common gait deficits found in persons with hemiplegia; 3) may differ in their approach to treatment based on the amount of experience of the clinician; 4) generally agree on the manner in which orthotics are used in the management of persons with hemiplegia; and 5) demonstrate professional accountability to patients concerning the use of orthotic devices. Conclusions: This qualitative study provided insight into the variability in PTs' strategies for gait analysis, and their identification and interpretation of common deviations and impairments in persons with hemiplegia following stroke. Reluctance to utilize orthotics for patients with hemiplegia was a consistent theme across FG.

The free post-stroke clinic: a successful teaching and learning model.

Healthcare students are often challenged in understanding the complexities associated with the diagnosis of cerebrovascular accident (CVA, stroke). Due to the diversity of clinical presentations following stroke and the intractable nature of some stroke sequelae, learning to effectively manage persons with stroke cannot always be translated solely through didactic methods. This paper describes a free post-stroke clinic, organized as part of the occupational therapy (OT) and physical therapy (PT) curricula, that offered hands-on learning with actual patients with stroke, provided a needed service to the community, and established a pathway for university stroke research. Quantitative and qualitative data were collected from students, faculty supervisors, and patients. Seventy-eight persons with stroke, of diverse ages, ethnicities, and socioeconomic backgrounds, participated in our clinic over the course of a year. In post-clinic questionnaires, all students (n = 119, 100%) reported that the clinic enhanced learning of stroke diagnosis; 98% of PT students (n = 67) and 94% of OT students (n = 52) indicated that the clinic prepared them for future clinical rotations. An average of 93% of patients who participated reported that they made functional progress during the clinic, and 96% indicated they would recommend the clinic to others. Faculty supervisors reported the clinic was ideal for assessing professional and clinical behavior of students. The free post-stroke clinic can serve as an effective learning and teaching model for other educational programs by offering significant benefit to individuals, universities, and communities while simultaneously providing a mechanism for reliable assessment of student readiness for clinical practice.