Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 5 , Pages 810-818 , May 2009

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.

  • Stefania Fatone, PhD

      Affiliations

    • Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
    • Corresponding Author InformationReprint requests to Stefania Fatone, PhD, NUPRL & RERP, 345 E Superior St, Room 1441, Chicago, IL 60611
    • ,
  • Steven A. Gard, PhD

      Affiliations

    • Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
    • Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Biomedical Engineering, Northwestern University, Chicago, IL
    • Jesse Brown Veterans Affairs Medical Center, Chicago, IL
    • ,
  • Bryan S. Malas, MHPE, CO

      Affiliations

    • Moira Tobin Wickes Orthotics Program, Children's Memorial Hospital, Chicago, IL

  • Image Result

    Example of the custom-molded, polypropylene, articulated AFO with 90° plantar flexion stop, free dorsiflexion, and full-length foot-plate used in this study. Inset indicates attachment of the reflecti

    Example of the custom-molded, polypropylene, articulated AFO with 90° plantar flexion stop, free dorsiflexion, and full-length foot-plate used in this study. Inset indicates attachment of the reflective marker to the AFO ankle joint for gait analysis.

  • Image Result
    Self-selected normal and very slow median walking speeds shown for the control subjects (n=12). Normal self-selected walking speed shown for the subjects with hemiplegia for each condition tested (n=1

    Self-selected normal and very slow median walking speeds shown for the control subjects (n=12). Normal self-selected walking speed shown for the subjects with hemiplegia for each condition tested (n=16). Variance indicated by first and third quartiles.

  • Image Result
    Mean ankle angle (A), ankle moment (B), knee angle (C), and knee moment (D) for the involved limb of the subjects with hemiplegia at normal self-selected walking speed (n=16). Asterisks (*) indicate p

    Mean ankle angle (A), ankle moment (B), knee angle (C), and knee moment (D) for the involved limb of the subjects with hemiplegia at normal self-selected walking speed (n=16). Asterisks (*) indicate points in the gait cycle where the difference in peak angle or moment between conditions was significantly different. Vertical lines indicate mean toe-off for each condition. Internal moments are shown.

  • Image Result
    Median ankle and knee data for the involved limb: (A) ankle angle at initial contact (IC); (B) peak ankle dorsiflexion (DF) in stance; (C) ankle angle at mid-swing; (D) peak stance ankle plantar flexo

    Median ankle and knee data for the involved limb: (A) ankle angle at initial contact (IC); (B) peak ankle dorsiflexion (DF) in stance; (C) ankle angle at mid-swing; (D) peak stance ankle plantar flexor (PF) moment; (E) minimum (min) knee angle in stance; (F) maximum (max) knee angle in swing; (G) peak knee moment in first half of stance; and (H) peak knee moment in second half of stance. Variance indicated by first and third quartiles.

  • Image Result
    Mean knee angles and moments for the involved limb of (A, B) subjects who hyperextended at the knee (n=7) and (C, D) subjects who did not hyperextend at the knee (n=9). Vertical lines indicate mean to

    Mean knee angles and moments for the involved limb of (A, B) subjects who hyperextended at the knee (n=7) and (C, D) subjects who did not hyperextend at the knee (n=9). Vertical lines indicate mean toe-off for each condition. Internal moments are shown.

  • Image Result
    Median knee data for the involved limb comparing subjects who hyperextended (HE) to those who did not (No HE): (A) minimum (min) knee angle in stance; (B) maximum (max) knee angle in swing; (C) peak k

    Median knee data for the involved limb comparing subjects who hyperextended (HE) to those who did not (No HE): (A) minimum (min) knee angle in stance; (B) maximum (max) knee angle in swing; (C) peak knee moment in first half of stance; and (D) peak knee moment in second half of stance. Variance indicated by first and third quartiles.

  • Image Result
    Median excursion of the COP expressed as a fraction of foot length. Variance indicated by first and third quartiles.

    Median excursion of the COP expressed as a fraction of foot length. Variance indicated by first and third quartiles.

 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.

PII: S0003-9993(09)00122-1

doi: 10.1016/j.apmr.2008.11.012

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 5 , Pages 810-818 , May 2009

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