Do static or dynamic AFOs improve balance?

Cattaneo, Davide; Marazzini, F; Crippa, Alessandro; Cardini, Roldano

doi:10.1191/0269215502cr547oa

Cited by 54 publications

(29 citation statements)

References 9 publications

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“…These results suggest narrowing beam-walking has reduced learning effects relative to fixed-width beam-walking. This is consistent with previous studies that showed participants’ performance on a progressively narrowing path remained stable (22) while participants’ performance on a fixed-width narrow path improved trial-to-trial (16, 23). This implies that tests with offering progressively increasing challenge to balance (e.g.…”

Section: Discussionsupporting

confidence: 92%

Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users

Sawers¹,

Hafner²

2018

J Rehabil Med

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Objective: Challenging clinical balance tests are needed to expose balance deficits in lower-limb prosthesis users. This study examined whether narrowing beam-walking could overcome conceptual and practical limitations identified in fixed-width beam-walking. Design: Cross-sectional. Participants: Unilateral lower-limb prosthesis users. Methods: Participants walked 10 times along a low, narrowing beam. Performance was quantified using the normalized distance walked. Heuristic rules were applied to determine whether the narrowing beam task was “too easy,” “too hard,” or “appropriately challenging” for each participant. Linear regression and Bland-Altman plots were used to determine whether combinations of the first 5 trials could predict participants’ stable beam-walking performance. Results: Forty unilateral lower-limb prosthesis users participated. Narrowing beam-walking was appropriately challenging for 98% of participants. Performance stabilized for 93% of participants within 5 trials, while 62% were stable across all trials. The mean of trials 3–5 accurately predicted stable performance. Conclusion: A clinical narrowing beam-walking test is likely to challenge a range of lower-limb prosthesis users, have minimal administrative burden, and exhibit no floor or ceiling effects. Narrowing beamwalking is therefore a clinically viable method to evaluate lower-limb prosthesis users’ balance ability, but requires psychometric testing before it is used to assess fall risk.

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Section: Discussionsupporting

confidence: 92%

Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users

Sawers¹,

Hafner²

2018

J Rehabil Med

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“…Small uncontrolled studies in people with MS also suggest that exercise in standing [41], static and dynamic ankle foot orthoses [42], and physical therapy with a neurodevelopmental training approach [43] may improve balance in people with MS, but none of these approaches specifically addresses the postural control deficits unique to this population. Consistent with our expectations that interventions that specifically address proprioceptive or central processing deficits are likely to be particularly effective in people with MS, Cattaneo et al [44••] recently found that balance rehabilitation to improve sensory as well as motor strategies improved balance and reduced fall frequency more effectively than balance rehabilitation aimed only at improving motor strategies or than nonspecific rehabilitation treatments.…”

Section: Discussion and Recommendations For Fall Preventionmentioning

confidence: 99%

Postural Control in Multiple Sclerosis: Implications for Fall Prevention

Cameron

Lord

2010

Curr Neurol Neurosci Rep

250

176

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People with multiple sclerosis (MS) often have poor postural control, which likely underlies their increased risk of falls. Based on several studies of balance and gait in MS, it appears that the primary mechanisms underlying the observed changes are slowed somatosensory conduction and impaired central integration. This review of the published research on balance, gait, and falls in people with MS demonstrates that people with MS have balance impairments characterized by increased sway in quiet stance, delayed responses to postural perturbations, and a reduced ability to move toward their limits of stability. These impairments are likely causes of falls in people with MS and are consistent with the reduced gait speed, as well as decreased stride length, cadence, and joint movement, observed in most studies of gait in MS. Based on these findings, we identify several factors that may be amenable to intervention to prevent falls in people with MS.

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“…These abnormalities can be caused by multiple impairments, such as weakness, visual, vestibular and somatosensory loss, hypertonia and cerebellar dysfunction [2 Á/4]. In addition to physical therapy programmes [5], and walking aids [6], balance and gait may also be improved by orthotic devices [7]. The dynamic foot orthosis (DFO) is one such device currently being used for this purpose in ambulant people with MS.…”

Section: Introductionmentioning

confidence: 99%

De-stabilizing and training effects of foot orthoses in multiple sclerosis

et al. 2006

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This study evaluates the effects of dynamic foot orthoses (DFO) on walking and balance performance in people with multiple sclerosis (MS). Sixteen ambulant subjects with MS and ten age-matched healthy control subjects were studied on initial receipt of foot orthoses and after four weeks of daily wear. Walking speed, MS Walking Scale-12 (MSWS-12) and standing balance were assessed with and without orthoses at both these times. During standing, stance width and vision were varied, and performance was quantified using the velocity of the centre of pressure (COP), body sway velocity and the mean COP position relative to the shoe. People with MS walked slower (P <0.001) and showed increased sway when standing (P <0.001). At the first assessment, the foot orthoses caused an increase in sway and a medial and posterior shift of the COP position. At repeat measurement, the DFOs continued to increase sway compared to a shoe only condition. However, MS subjects reported an improvement in the MSWS-12 (P <0.05) and, compared to the initial session, showed decreased sway when eyes were closed both with and without DFOs. Dynamic foot orthoses may increase sway and change COP position by altering foot alignment and/or plantar afferent stimulation. Improvement in body sway over time may be an overall training effect of the DFOs, as MS subjects adapt to the initial de-stabilization.

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Do static or dynamic AFOs improve balance?

Abstract: Static and dynamic AFOs improved static balance, while dynamic balance was impaired especially by static AFOs; less negative influence on dynamic balance has been found while wearing dynamic AFOs.

Cited by 54 publications

References 9 publications

Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users

Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users

Postural Control in Multiple Sclerosis: Implications for Fall Prevention

De-stabilizing and training effects of foot orthoses in multiple sclerosis

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