Effects of Custom-Molded and Prefabricated Hinged Ankle-Foot Orthoses on Gait Parameters and Functional Mobility in Adults with Hemiplegia

Abstract

Introduction: Hinged ankle-foot orthoses (AFOs) have been shown to improve gait and functional mobility in both adult and pediatric populations with neurological disorders. Hinged AFOs provided to clients can either be prefabricated or custommade. To date, there have been no studies comparing a custom-made articulated AFO (C-AFO) with a prefabricated articulated AFO (P-AFO) and the effects that they have on gait and functional mobility in individuals with hemiplegia after a stroke. Materials and Methods: The purpose of this study was to determine if there were any differences in the gait and functional mobility parameters of patients with hemiplegia when wearing the C-AFO or the P-AFO and also to determine if there was a difference in the braced versus not-braced conditions. Fourteen participants with hemiplegia completed tests that assessed spatiotemporal gait parameters using the GAITRite walkway. In addition, participants completed tests to assess weight-bearing symmetry during sit-to-stand (using the Balance Master), stepping capabilities using the maximal step length (MSL) test, and functional mobility using the timed up and go test (TUG). Data were analyzed using a repeated measures analysis of variance with Bonferroni adjustments for multiple comparisons.Results: There were no significant differences (P 9 0.05) between the two braced conditions for the gait parameters, the TUG, the sit-to-stand symmetry, and the MSL. There were significant differences between the braced (C-AFO or P-AFO) and the shoes-only conditions for the gait parameters (gait speed, stride length, step length, and gait symmetry of the uninvolved leg) and for the functional mobility assessments (TUG and MSL-involved leg).Conclusions: This preliminary study has shown that there was no significant difference in any of the gait or functional mobility parameters when wearing the C-AFO or the P-AFO, provided that the P-AFO provides optimal support and fits the individual's anatomical dimensions well. Significant differences in both gait and functional mobility measures were observed between the shoes-only and braced conditions. The results of this study also demonstrated that wearing a hinged AFO does contribute to a better gait and functional mobility in people who have had a stroke. (J Prosthet Orthot. 2015;27:33Y38.) Values are presented as mean T SEM. Numbers in parentheses are the range of values. There were no significant differences between the C-AFO and P-AFO conditions (P 9 0.05) for all of the gait and functional mobility measures. *P G 0.05 for no-AFO condition versus C-AFO or P-AFO. AFO, ankle foot orthosis; STS, sit-to-stand; TUG, timed up and go; MSL, maximal step length.

The effect of anterior ankle-foot orthosis and posterior ankle-foot orthosis on functional ambulation in stroke patients

“…Moreover, AFOs significantly decreased the test completion time of the TUG test which showed mobility improvement in hemiplegic patients compared to the patients without AFO. 23 However, Zollo et al announced that PLS AFO was not significantly effective in improving the TUG test performance of patients compared to no AFO condition. However, it has been mentioned that presumably, the short-term use of the orthoses led to differences in the result of the study compared to other studies.…”

“…The sample size was calculated by using G*power software based on the mean and standard deviation of the TUG test with an estimated effect size of 0.5 and acceptable power ≥ 0.8 in a related study. 23 Additional baseline characteristics of participants can be seen in Table1 . The inclusion criteria were as follows: (1) A diagnosis of unilateral hemiparesis caused by a cerebrovascular accident with symptoms lasting more than 6 months.…”

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“…A non-randomized, one-group clinical design (quasiexperimental) was included in 10 papers in which functional tests without an AFO were defined as the control trials without a randomization for the order of tests [23][24][25][26][27][28][29][30][31][32]. A randomized, onegroup clinical design (quasi-experimental) was included in 13 papers in which functional tests without an AFO were the control trial with a randomization for the order of tests [33][34][35][36][37][38][39][40][41][42][43][44][45]. A randomized, parallel-group controlled design (RCT) was included in six papers in which one group of the patients used an AFO and the control group was evaluated with only shoes or other AFOs [46][47][48][49][50][51].…”

“…One study included a non-randomized parallel-group trial in which participants were not assigned randomly to two groups [52]. Seven papers evaluated the immediate effect of an AFO (without adaptation) [27,29,33,36,40,43,49], and other studies assessed the short-term (< 3 months) [24,26,28,30,31,35,37,38,[40][41][42]44,48,50,52] or long-time effects (> 3 months) [23,34,39,46,47,50,51] of an orthosis. Most studies had small sample sizes (4-61 subjects), and a sample size calculation (power) was reported in five studies [36,42,45,46,49].…”

“…Three studies evaluated the mixed group of subacute and chronic hemiparetic patients [26,35,38], and two of them recruited patients with rehabilitative care [26,35]. Most papers utilized a non-articulated AFO for all participants, while seven studies used an articulated AFO [24,25,27,35,40,42,50]. Five studies did not distinguish between articulated orthoses and nonarticulated orthoses (mixed group) [29,31,34,37,39].…”