Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia
Presented to the International Society for Prosthetics and Orthotics, July 29–August 30, 2007, Vancouver, BC, Canada; the American Academy of Orthotists and Prosthetists, March 21–24, 2007, San Francisco, CA; the American Academy of Orthotists and Prosthetists, March 1–4, 2006, Chicago, IL; the American Academy of Orthotists and Prosthetists, March 16–19, 2005, Orlando, FL; International Society for Prosthetics and Orthotics, August 1–6, 2004, Wanchai, Hong Kong, China; the Gait and Clinical Movement Analysis Society, April 21–24, 2004, Lexington, KY; and the American Congress of Rehabilitation Medicine, October 23–26, 2003, Tucson, AZ.
Abstract
Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.
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° 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 ¾ length foot-plate–¾ 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.
aProsthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
bProsthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Biomedical Engineering, Northwestern University, Chicago, IL
cJesse Brown Veterans Affairs Medical Center, Chicago, IL
dMoira Tobin Wickes Orthotics Program, Children's Memorial Hospital, Chicago, IL
Reprint requests to Stefania Fatone, PhD, NUPRL & RERP, 345 E Superior St, Room 1441, Chicago, IL 60611
Supported by the Office of Research and Development (Rehabilitation R&D Service), Department of Veterans Affairs (merit review #A2676I) and administered by the Jesse Brown VA Medical Center.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT