Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia

Stefania Fatone, Steven A Gard, Bryan S Malas
Archives of Physical Medicine and Rehabilitation 2009, 90 (5): 810-8

OBJECTIVE: To investigate 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.

DESIGN: Repeated measures, quasi-experimental study.

SETTING: Motion analysis laboratory.

PARTICIPANTS: Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.

INTERVENTIONS: Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90 degrees 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 3/4 length foot-plate-3/4 AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.

MAIN OUTCOME MEASURES: Sagittal plane ankle and knee kinematics and kinetics.

RESULTS: In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). 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 control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.

CONCLUSIONS: These 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.

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