Effects of ankle–foot orthoses on mediolateral foot-placement ability during post-stroke gait

2014 ◽  
Vol 39 (5) ◽  
pp. 372-379 ◽  
Author(s):  
Angelika Zissimopoulos ◽  
Stefania Fatone ◽  
Steven Gard
Keyword(s):  
Plantar Flexion ◽  
Foot And Ankle ◽  
Cognitive Mechanisms ◽  
Foot Placement ◽  
Ankle Foot Orthosis ◽  
Post Stroke ◽  
Accuracy And Precision ◽  
Hip Range Of Motion ◽  
Hip Kinematics ◽  
Foot Orthosis

Background: Accurate and precise mediolateral foot placement is important for balance during gait, but is impaired post stroke. Mediolateral foot placement may be improved with ankle–foot orthosis use. Objective: The purpose of this study was to determine whether an ankle–foot orthosis improves mediolateral foot-placement ability during post-stroke ambulation. Study design: Crossover trial with randomized order of conditions tested. Methods: The accuracy and precision of mediolateral foot placement was quantified while subjects targeted four different randomized step widths. Subjects were tested with and without their regular non-rigid ankle–foot orthosis in two separate visits (order randomized). Results: While ankle–foot orthosis use corrected foot and ankle alignment (i.e. significantly decreased mid-swing plantar flexion, p = 0.000), effects of ankle–foot orthosis use on hip hiking ( p = 0.545), circumduction ( p = 0.179), coronal plane hip range of motion ( p = 0.06), and mediolateral foot-placement ability ( p = 0.537) were not significant. Conclusion: While ankle–foot orthosis–mediated equinovarus correction of the affected foot and ankle was not associated with improved biomechanics of walking (i.e. proximal ipsilateral hip kinematics or mediolateral foot-placement ability), it may affect other aspects of balance that were not tested in this study (e.g. proprioception, cerebellar, vestibular, and cognitive mechanisms). Clinical relevance Studies that investigate the effect of ankle–foot orthosis on gait can help advance stroke rehabilitation by documenting the specific gait benefits of ankle–foot orthosis use. In this study, we investigated the effect of ankle–foot orthosis use on mediolateral foot-placement ability, an aspect of gait important for maintaining balance.

Kinematic and kinetic benefits of implantable peroneal nerve stimulation in people with post-stroke drop foot using an ankle-foot orthosis

2018 ◽  
Vol 36 (4) ◽  
pp. 547-558 ◽  
Author(s):  
Frank Berenpas ◽  
Sven Schiemanck ◽  
Anita Beelen ◽  
Frans Nollet ◽  
Vivian Weerdesteyn ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Peroneal Nerve ◽  
Drop Foot ◽  
Ankle Foot Orthosis ◽  
Post Stroke ◽  
Peroneal Nerve Stimulation ◽  
Foot Orthosis

scholarly journals Stiffness control in posterior-type plastic ankle-foot orthoses: Effect of ankle trimline Part 2: Orthosis characteristics and orthosis/patient matching

1996 ◽  
Vol 20 (2) ◽  
pp. 132-137 ◽  
Author(s):  
T. Sumiya ◽  
Y. Suzuki ◽  
T. Kasahara
Keyword(s):  
Plantar Flexion ◽  
Measuring Device ◽  
Ankle Foot Orthosis ◽  
Maximum Resistance ◽  
Severe Spasticity ◽  
Ankle Foot Orthoses ◽  
Final Adjustment ◽  
Flexion Strength ◽  
Foot Orthosis ◽  
Selection Of

The hingeless plastic ankle-foot orthosis (AFO) changes stiffness largely depending on how much plastic is trimmed around the ankle. To support proper selection of the orthosis and final adjustment of the orthotic stiffness, the correlation between the posterior upright width and the resistance to dorsi- and plantar flexion movements was measured in 30 posterior-type plastic AFOs. The posterior upright width was varied by regularly trimming around the ankle in nine stages. The resistance to dorsi- and plantar flexion movements was measured by bending the plastic AFOs 15d` with the measuring device described in Part 1. All the plastic AFOs decreased in their resistance to both movements in proportion to the reduction of the posterior upright width. The maximum resistance to plantar flexion movement was about 28 Nm, which was strong enough to assist dorsiflexion in patients with severe spasticity. On the other hand, the maximum resistance to dorsiflexion movement measured was about 10 Nm, which was insufficient to stabilise the ankle in patients who lacked in plantar flexion strength. These findings suggested that this type of plastic AFO should be prescribed for patients who predominantly require dorsiflexion assist, and that the orthotic stiffness could be finally adjusted by trimming to exactly meet individual requirements.

scholarly journals Clinical experiences with a convertible thermoplastic knee-ankle-foot orthosis for post-stroke hemiplegic patients

1996 ◽  
Vol 20 (3) ◽  
pp. 191-194 ◽  
Author(s):  
S. Kakurai ◽  
M. Akai
Keyword(s):  
Gait Training ◽  
Inhibitory Effect ◽  
Clinical Experiences ◽  
Recovery Stage ◽  
Physical Impairments ◽  
Ankle Foot Orthosis ◽  
Post Stroke ◽  
Walking Pattern ◽  
Accepted Practice ◽  
Foot Orthosis

As rehabilitation for post-stroke hemiplegic patients has become widely accepted practice, there has been an increase in patients who are more difficult to treat. In the prescription rationale of orthoses for hemiplegics, the knee-ankle-foot orthosis (KAFO) for the lower limb has generally been underestimated because of its inhibitory effect on the normal walking pattern and also its interference with gait training. The authors had an experience of 28 hemiplegics with severe physical impairments who were fitted with a convertible plastic KAFO. Among these patients, there were 11 cases in which the KAFO was replaced by an ankle-foot orthosis (AFO) within 1.5 to 8 months (average 4 months) following initial prescription when they were able to control their knee actively. Ambulatory capability in these patients was superior to that of the remaining KAFO group. The Barthel index of the AFO group patients was higher than the KAFO group (p<0.01). However neither age, sex, severity of hemiplegia, starting time of rehabilitation following onset of stroke, time of fitting with the orthosis, nor the functional recovery stage were critical factors between the two groups, only the incidence of major complications affected ambulatory capability.

A Soft Wearable Robotic Ankle-Foot-Orthosis for Post-Stroke Patients

2019 ◽  
Vol 4 (3) ◽  
pp. 2547-2552 ◽  
Author(s):  
Junghan Kwon ◽  
Ji-Hong Park ◽  
Subyeong Ku ◽  
YeongHyeon Jeong ◽  
Nam-Jong Paik ◽  
...  
Keyword(s):  
Stroke Patients ◽  
Ankle Foot Orthosis ◽  
Post Stroke ◽  
Foot Orthosis

836 Custom Fabricated Open Anterior Ankle Foot Orthosis to Promote Early Mobility with Lower Extremity Grafts

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S256-S257
Author(s):  
Lisa LePage
Keyword(s):  
Lower Extremity ◽  
Direct Contact ◽  
Weight Bearing ◽  
Heel Strike ◽  
Early Mobility ◽  
Foot Placement ◽  
Ankle Foot Orthosis ◽  
Plantar Surface ◽  
Distal Aspect ◽  
Foot Orthosis

Abstract Introduction Distal lower extremity STSG’s present a challenge with the balance of early mobility and immobilization of the ankle. Traditional commercially available ambulation boots or pre-fabricated orthotics may impose circumferential compression endangering graft integrity. Custom fabricated posterior AFO’s comprised of thermoplastic, scotch cast or fiberglass materials are not recommended for weight-bearing of the lower extremity during mobility/ambulation. What may also hinder promotion of early mobility is having a multitude of injuries or advanced age with decreased ability to adhere to a LE NWB status. An anterior approach to immobilization of the ankle was thought of to free the plantar surface of the foot for weight-bearing. The open concept of the orthosis itself minimizes direct contact with the involved LE graft. This promotes graft integrity during mobility with ankle immobilization. Methods Materials: Thermoplastic material, scissors, strapping, dense adhesive foam, adhesive Velcro and a heat gun. Fabrication: Measure the point of distance between where the desired proximal end of the orthosis would be to the patient’s metatarsal heads on the dorsal aspect of the foot; double it to calculate the amount of material needed. The width of the material should be approx. 3 to 4 inches. Warm material and tri-fold it together reducing width to approx. 1 ½ to 2 inches to increase stability. Shape the folded material into a continuous oval and place on the patient’s distal LE. As the material cools, shape the oval away from the medial/ lateral aspects of the distal LE restricting the points of contact to the anterior most proximal and distal aspect of the desired splint parameters. Remove once cooled and add dense adhesive foam to the 2 points of contact that will rest against the patient. This will allow for a slight area of “give” against the patient during weight-bearing of the LE/foot. Velcro and straps are added to the proximal/distal ends of the oval; heating the adhesive side will imbed the Velcro allowing increased durability with repeated donning/doffing. Results The open construction of this orthosis allows different degrees of weight-bearing eliminating contact with the distal LE STSG. The forefoot and heel are available to weight bear safely within the confines of the open anterior ankle foot orthosis. Conclusions Patients have been trialed with/without an AD with success in the achievement of ankle immobilization with mobility. Weight-bearing instructions that accompany this splint wear is foot placement rather than a normal heel strike cadence to avoid undue pressure at the proximal aspect of the splint on the lower extremity. Applicability of Research to Practice This splint has been successfully utilized for immobilization without compromise to STSG integrity due to the anterior open support it offers the ankle. Perhaps this concept could be applied to other joints to avoid direct contact of the splint with STSG during the initial stages of healing.

scholarly journals A Model to Predict the Effect of Ankle Joint Misalignment on Calf Band Movement in Ankle-Foot Orthoses

2007 ◽  
Vol 31 (1) ◽  
pp. 76-87 ◽  
Author(s):  
Stefania Fatone ◽  
Andrew H. Hansen
Keyword(s):  
Ankle Joint ◽  
Walking Speed ◽  
Sagittal Plane ◽  
Plantar Flexion ◽  
Dimensional Model ◽  
Ankle Foot Orthosis ◽  
Ankle Joints ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis ◽  
Anterior Posterior

Accurate alignment of anatomical and mechanical joint axes is one of the major biomechanical principles pertaining to articulated orthoses, yet knowledge of the potential effects of axis misalignment is limited. The purpose of this project was to model the effects of systematic linear (proximal-distal and anterior-posterior) misalignments of single axis mechanical ankle joints in an ankle-foot orthosis (AFO) in order to determine the degree and direction of calf band travel that would occur over a functional range of motion. Sagittal plane misalignments of the ankle joint centres of an AFO were simulated using a simple two-dimensional model for both a range of ankle angles and a typical able-bodied ankle kinematic curve for self-selected normal walking speed. The model assumed that no movement occurred between the foot and the foot-plate of the AFO. The model predicted that for anterior (positive horizontal) misalignments, dorsiflexion movements would cause the calf band to travel proximally (i.e., up the leg) and plantar flexion movements would cause the calf band to travel distally (i.e., down the leg). The opposite was predicted for posterior (negative horizontal) misalignments. Proximal (positive vertical) misalignments would cause only distal movements of the calf band while distal (negative vertical) misalignments would cause only proximal movements of the calf band. Anterior-posterior misalignments were found to have a much larger effect on the amount of calf band travel than proximal-distal misalignments.

scholarly journals The effect of changing plantarflexion resistive moment of an articulated ankle–foot orthosis on ankle and knee joint angles and moments while walking in patients post stroke

2015 ◽  
Vol 30 (8) ◽  
pp. 775-780 ◽  
Author(s):  
Toshiki Kobayashi ◽  
Madeline L. Singer ◽  
Michael S. Orendurff ◽  
Fan Gao ◽  
Wayne K. Daly ◽  
...  
Keyword(s):  
Knee Joint ◽  
Joint Angles ◽  
Ankle Foot Orthosis ◽  
Post Stroke ◽  
Foot Orthosis

scholarly journals Effects of plantar flexion resistive moment generated by an ankle-foot orthosis with an oil damper on the gait of stroke patients: a pilot study

2012 ◽  
Vol 37 (3) ◽  
pp. 212-221 ◽  
Author(s):  
Sumiko Yamamoto ◽  
Naoki Tomokiyo ◽  
Tadashi Yasui ◽  
Toshikazu Kawaguchi
Keyword(s):  
Plantar Flexion ◽  
Reaction Force ◽  
Three Dimensional ◽  
Chronic Phase ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Ankle Foot Orthosis ◽  
Paretic Limb ◽  
Gait Parameters ◽  
Foot Orthosis

Background: An ankle-foot orthosis with an oil damper was previously developed to assist the first rocker function during gait, but the effects of the amount of resistive moment generated on gait have not been clarified. Objectives: To measure the amount of resistive moment generated by the ankle-foot orthosis with an oil damper during gait and determine its effect on the gait of patients with stroke. Study Design: Preliminary cross-sectional study. Methods: The gait of four patients with stroke in the chronic phase was measured in four conditions: without an ankle-foot orthosis and with the ankle-foot orthosis with an oil damper generating three different amounts of resistive moment. Measurements were taken with a three-dimensional motion analysis system and a specially designed device to determine the resistive moment. Results: The resistive moment was observed in the former half in stance of the paretic limb, and its magnitude was less than 10 N m. Some gait parameters related to terminal stance and preswing were affected by the amount of resistive moment. The forward component of floor reaction force and the shank vertical angle showed peak values when the patients reported feeling most comfortable during gait. Conclusion: Although the resistive moment generated by the ankle-foot orthosis with an oil damper was small, it was sufficient to alter gait. Clinical relevance To maximize the effectiveness of ankle-foot orthoses, it is necessary to know the effects of resistive moment on the gait of patients with stroke. The ankle-foot orthosis with an oil damper assists the first rocker function in gait and also affects the gait in a later phase in stance. The peak values of some gait parameters coincided with patients reporting gait to be most comfortable. It is important to know that ankle-foot orthosis with an oil damper assistance in the first rocker alters the weight acceptance on the paretic limb and affects the gait parameters related to propulsion ability in stance.

scholarly journals Design and Physical Modelling Series Elastic Actuator for Ankle-Foot Orthosis

2020 ◽  
Vol 9 (5) ◽  
pp. 210-215
Keyword(s):  
Plantar Flexion ◽  
Physical Modelling ◽  
Walking Ability ◽  
Rehabilitation Process ◽  
Ankle Foot Orthosis ◽  
Series Elastic Actuator ◽  
Ankle Movement ◽  
Basic Movement ◽  
Foot Orthosis ◽  
Series Elastic

This paper describes the development of Physical Modelling of Series Elastic Actuator for Active Ankle-Foot Orthosis by using Simscape Multibody Link. Active Ankle-Foot Orthosis is essential that can be used for the rehabilitation process to the patient. It is useful in medicine to help a patient who loses their walking ability, due to ankle weakness, to regain the walking ability. This project focuses on the design, simulate and physical modelling for Ankle-Foot Orthosis. This project was used Solidworks as a platform to design the Active Ankle-Foot Orthosis and using MatLab/Simulink for simulation by using Simscape Multibody Link tools. The Active Ankle-Foot Orthosis moves in 2 basic movement of ankle that is dorsiflexion and plantar flexion for rehabilitation. So, this project focuses on the physical modelling for the Series Elastic Actuator that drives the ankle movement mimicking the normal gait cycle.

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