Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users' opinions Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients. Ankle-foot orthoses in stroke: effects on functional balance, weight-bearing asymmetry and the contribution of each lower limb to balance control. Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients' opinion.
Objective : To examine the effects of an ankle-foot orthosis ( AFO ) on balance performance in patients with hemiparesis of short and long duration . Design : Within-subject r and om order of intervention , cross-sectional study design . Setting s : Medical centres and district hospitals . Subjects : Forty-two subjects with hemiparesis of short duration ( B = six months ) and 61 subjects of long duration ( = 12 months ) . Measurements : The balance and gait ability of subjects were evaluated both with an AFO and without . The static and dynamic balance activities were evaluated by the Balance Master System , whereas the functional balance was assessed with the Berg Balance Scale . The speed and cadence were also measured during a 10-metre walk . Paired t-test was used to determine the effect of the AFO . Results : In subjects with hemiparesis of short duration , we found that subjects wearing an AFO showed significant improvements in ( 1 ) weight-bearing distribution during quiet st and ing ( p / 0.042 , 95 % confidence interval ( CI ) 0.521 , 7.325 ) , ( 2 ) body sway during st and ing on foam surface with eyes open ( p / 0.020 , 95 % CI 0.020 , 0.680 ) and eyes closed ( p / 0.041 , 95 % CI 0.023 , 0.921 ) , ( 3 ) movement velocity during limit of stability test ( LOS ) / toward the affected side ( p / 0.037 , 95 % Cl / 0.978 , / 0.042 ) and nonaffected side ( p / 0.008 , 95 % CI / 2.223 , / 0.377 ) , ( 4 ) maximal excursion toward the affected side ( p / 0.042 , 95 % CI / 19.546,=0.071 ) , and ( 5 ) speed ( p / 0.028 , 95 % CI / 0.204 , / 0.017 ) and cadence ( p / 0.021 , 95 % CI / 22.983 , / 1.864 ) . Such effects were not observed in subjects with hemiparesis of long duration . Conclusions : For the subjects with hemiparesis of short duration , the AFO improves the symmetry in quiet and dynamic st and ing balances . It also increases speed and cadence . However , its effectiveness is minimal for patients of long duration Objective : To assess the effect of a hinged ankle foot orthosis ( AFO ) on functional mobility and gait impairments in people with a severe hemiplegia undergoing rehabilitation , and to investigate the patients ' views of the hinged AFO . Design : With/without group comparison , and face-to-face question naire . Subjects and setting : Twenty-five subjects over 18 years , with a hemiplegia following cerebrovascular accident ( CVA ) undergoing rehabilitation in a regional rehabilitation unit . Outcome measures : Functional Ambulation Categories as a measure of disability . Paper walkways to measure gait impairments – stride length , step length , symmetry , cadence and velocity . Face-to-face question naire to determine the users ' opinion of the hinged AFO . Results : Comparison of gait with and without the hinged AFO showed significant improvements in functional mobility ( p = 0.000 ) and in some gait impairments ; stride length of the weak ( p < 0.005 , 95 % CI –8.1 , –1.6 ) and sound legs ( p < 0.014 , 95 % CI –8 , –1 ) , velocity ( p = 0.00 , 95 % CI –0.1 , –0.03 ) and cadence ( p < 0.002 , 95 % CI –15.1 , –3.8 ) . No effect was found for step length in the weak or sound leg or symmetry . The subjects ' response was positive , 24 ( 96 % ) felt they walked better with the AFO and found it comfortable . Twenty-three ( 92 % ) were unbothered by the appearance and 16 ( 64 % ) could doff and don it . Conclusion : The hinged AFO improved objective measures of gait impairments and disability and patients were positive about it Objective : To evaluate the immediate effects of individually design ed functional in-shoe ankle-foot orthoses ( AFO ) made of soft and hard cast on balance , st and ing , and gait parameters in hemiparetic patients . Design : Crossover design with r and omized order of the intervention . Setting : A rehabilitation centre for adults with neurological disorders . Subjects : Twenty-eight patients with hemiparesis due to stroke or traumatic brain injury . Measures : Postural sway , st and ing and gait parameters based on ground reaction forces in two conditions : Patients were r and omly assigned to varying sequences of wearing AFO in footwear or wearing footwear alone . Results : AFO significantly improved weight-bearing on the affected leg ( affected/ unaffected side symmetry : 2.259 ± 1.5 with AFO versus 3.49 ± 2.5 without AFO , P B ± 0.05 ) and postural sway in stance ( 12.5 mm9 ± 5.2 with AFO versus 15.7 mm9 ± 6.7 without AFO , P < ± 0.05 ) , double stance duration ( 21.19 ± 14.4 % of gait cycle with AFO versus 25.99 ± 21.6 % of gait cycle without AFO , P < ± 0.05 ) , and symmetry ratios of gait parameters such as stance duration ( 2.09 ± 1.5 s with AFO versus 3.39 ± 3.6 s without AFO , P < ± 0.05 ) and deceleration forces ( 1.69 ± 0.5 with AFO versus 1.99 ± 0.6 without AFO , P < ± 0.05 ) during gait . No significant differences were observed in all other symmetry ratios of gait parameters . Conclusion : An individually design ed functional in-shoe AFO can improve stance and gait parameters , even in a single use , in patients with hemiparesis OBJECTIVES To evaluate the effects of an anterior ankle-foot orthosis ( AFO ) on static and dynamic postural stability in hemiplegic patients . DESIGN A cross-sectional assessment of hemiplegic subjects with and without an AFO . SETTING Outpatient department of a rehabilitation hospital . PATIENTS A convenience sample of 24 subjects who had been prescribed an anterior AFO .  OUTCOME MEASURES Postural sway index and postural symmetry ( body weight distribution through the affected leg ) when st and ing were measured as static postural stability . Maximal balance range in anterior-posterior and lateral directions and the affected leg 's weight bearing after weight shift to affected side were measured as dynamic postural stability . RESULTS When wearing the anterior AFO , there was no significant difference and small effect size ( r<0.3 ) in postural sway index ( p = .35 ) , postural symmetry ( p = .21 ) , and maximal balance range in anterior-posterior direction ( p = .46 ) . There was a significant improvement and large effect size ( r>0.5 ) in lateral weight shifting ( p<.01 ) and weight bearing through the affected leg after weight shifted to the affected side ( p<.01 ) . CONCLUSIONS The significant effects of the anterior AFO in long-term hemiplegic patients were on lateral weight shifting and weight bearing through affected leg after weight shifted to the affected side . Postural sway , postural symmetry , and anterior-posterior weight shifting were not significantly affected BACKGROUND Ankle-foot orthoses are often provided to improve walking in stroke patients , although the evidence of effects on walking and balance control is still inconsistent . This could be caused by a lack of insight into the influence of orthoses on the underlying impairments . These impairments can be assessed with dual plate posturography to determine the relative contribution of each lower limb to balance control and weight-bearing . This study examined the effects of ankle-foot orthoses on functional balance , static and dynamic weight-bearing asymmetry and dynamic balance control of the paretic and non-paretic lower limbs . METHODS Twenty stroke subjects ( time since stroke 5 - 127 months ) completed the study . Subjects were assessed with and without ankle-foot orthosis .  Functional balance was assessed using the Berg Balance Scale , Timed Up & Go test , Timed Balance Test , 10-m walking test and Functional Ambulation Categories . Weight-bearing asymmetry and dynamic balance control were assessed with force plates on a movable platform . FINDINGS No significant effects of ankle-foot orthoses were found for weight-bearing asymmetry and dynamic balance control , but significant differences in favour of ankle-foot orthosis use were found for most functional tests . INTERPRETATION Although ankle-foot orthoses had no effect on weight-bearing asymmetry or dynamic balance contribution of the paretic lower limb , functional tests were performed significantly better with orthoses . Apparently , improvements at functional level can not be readily attributed to a greater contribution of the paretic lower limb to weight-bearing or balance control . This finding suggests that ankle-foot orthoses influence compensatory mechanisms OBJECTIVE To assess the immediate effects of assistive walking devices on functional mobility , walking impairments , and patients ' opinions in nonambulant patients after stroke . DESIGN R and omized crossover trial . SETTING Inpatient rehabilitation units of 3 United Kingdom hospitals . PARTICIPANTS Twenty nonambulant patients with stroke undergoing rehabilitation to restore walking . INTERVENTIONS Five walking conditions : ( 1 ) Walking with no device ( the control condition ) , ( 2 ) walking with a walking cane , ( 3 ) ankle foot orthosis , ( 4 ) slider shoe , and ( 5 ) a combination of all 3 devices . MAIN OUTCOME MEASURES Functional mobility ( functional ambulation categories ) , walking impairments ( speed , step length of the weak leg ) , and patients ' opinions . RESULTS Functional mobility improved with all assistive devices ( P<.0001-.005 ; effect sizes 1.68 - 0.52 ; number needed to treat=2 - 5 ) . Walking impairments were unchanged ( P<.800-.988 ) . Participants were generally positive about the devices . They felt their walking , confidence , and safety improved and found the appearance and comfort of the devices acceptable . They would rather walk with the devices than delay walking until a normative gait pattern was achieved without them . CONCLUSIONS Assistive walking devices improved functional mobility in nonambulant rehabilitation patients with stroke . No changes in walking impairments were found . Participants were generally positive about using the devices . The results support the use of assistive walking devices to enable early mobilization after stroke ; 2 patients would need to be treated with a cane or combined devices for 1 to improve functional mobility
OBJECTIVE To determine the effectiveness of an ankle-foot orthosis ( AFO ) on mobility , walking , and balance in people with stroke .