Dorsiflexion Assist Orthosis Reduces the Physiological Cost and Mitigates Deterioration in Strength and Balance Associated With Walking in People With Multiple Sclerosis

Published:September 25, 2014DOI:



      To evaluate the effect of wearing a dorsiflexion assist orthosis (DAO) on walking distance, physiological cost, fatigue, and strength and balance measures after a modified 6-minute walk test (6MWT) in people with multiple sclerosis (MS).


      Randomized crossover trial.


      Hospital Movement Laboratory.


      People with moderate MS and Expanded Disability Status Scale score of 3.7±0.7 (N=34; 26 women).


      Modified 6MWT with and without a DAO worn on the weaker leg.

      Main Outcome Measures

      Distance walked, perceived fatigue, and the physiological cost of walking were compared between walking conditions. Pre- and postwalk changes in knee extensor and ankle dorsiflexor isometric strength and standing postural sway with eyes open and closed were compared between walking conditions.


      There were no differences in distance walked or perceived fatigue between the 2 walking conditions. However, there was a reduced physiological cost of walking (P<.05), a smaller reduction in knee extensor strength (P<.05), and a smaller increase in standing postural sway with eyes open (P<.01) after walking while wearing the DAO compared with walking without wearing the DAO.


      Despite not increasing walking distance or reducing perceived fatigue, the DAO reduced the physiological cost of walking and maintained knee strength and standing balance, which may have important implications for physical rehabilitation in people with MS. Further trials are required to determine whether the beneficial effects of wearing a DAO found here are maintained for longer periods.


      List of abbreviations:

      6MWT (6-minute walk test), AFO (ankle foot orthosis), DAO (dorsiflexion assist orthosis), EDSS (Expanded Disability Status Scale), MS (multiple sclerosis), PCI (physiological cost index)
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