scholarly journals Use and usability of custom-made knee-ankle-foot orthoses in polio survivors with knee instability: A cross-sectional survey

2021 ◽  
Author(s):  
Bart Raijmakers ◽  
Roelofine A. Berendsen-de Gooijer ◽  
Hilde E. Ploeger ◽  
Fieke S. Koopman ◽  
Frans Nollet ◽  
...  
Keyword(s):  
Daily Life ◽  
Walking Ability ◽  
Foot Orthoses ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Ankle Foot Orthosis ◽  
Custom Made ◽  
Ankle Foot Orthoses ◽  
Polio Survivors ◽  
Foot Orthosis

Objective: To investigate the use of custom-made knee-ankle-foot-orthoses in daily life and differences in usability factors of knee-ankle-foot-orthoses between users and discontinued users. Design: Cross-sectional survey study. Subjects: A total of 163 polio survivors provided with a knee-ankle-foot-orthosis at an outpatient clinic of a university hospital. Methods: Use and usability of knee-ankle-foot-orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard. Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot-orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot-orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot-orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot-orthosis-related aspects (p < 0.001). Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot-orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot-orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot-orthosis in polio survivors. 

scholarly journals Gastrocnemius operating length with ankle foot orthoses in cerebral palsy

2016 ◽  
Vol 41 (3) ◽  
pp. 274-285 ◽  
Author(s):  
Hwan Choi ◽  
Tishya Anne Leong Wren ◽  
Katherine Muterspaugh Steele
Keyword(s):  
Cerebral Palsy ◽  
Classification System ◽  
Daily Life ◽  
System Level ◽  
Foot Orthoses ◽  
Functional Classification ◽  
Ankle Foot Orthosis ◽  
Ankle Foot Orthoses ◽  
Children With Cerebral Palsy ◽  
Foot Orthosis

Background:Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation.Objectives:This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy.Study design:Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses.Methods:We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis.Results:Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait.Conclusion:Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life.Clinical relevanceDetermining whether ankle foot orthoses stretch tight muscles can inform future orthotic design and potentially provide a platform for integrating therapy into daily life. However, stretching tight muscles must be balanced with other goals of orthoses such as improving gait and preventing bone deformities.

Ankle foot orthosis–footwear combination tuning: An investigation into common clinical practice in the United Kingdom

2014 ◽  
Vol 39 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Nicola Eddison ◽  
Nachiappan Chockalingam ◽  
Stephen Osborne
Keyword(s):  
United Kingdom ◽  
Clinical Practice ◽  
Foot Orthoses ◽  
Cross Sectional Survey ◽  
Ankle Foot Orthosis ◽  
The United Kingdom ◽  
Standard Clinical Practice ◽  
Ankle Foot Orthoses ◽  
Common Clinical Practice ◽  
Foot Orthosis

Background:Ankle foot orthoses are used to treat a wide variety of gait pathologies. Ankle foot orthosis–footwear combination tuning should be routine clinical practice when prescribing an ankle foot orthosis. Current research suggests that failure to tune ankle foot orthosis–footwear combinations can lead to immediate detrimental effect on function, and in the longer term, it may actually contribute to deterioration.Objectives:The purpose of this preliminary study was to identify the current level of knowledge clinicians have in the United Kingdom regarding ankle foot orthosis–footwear combination tuning and to investigate common clinical practice regarding ankle foot orthosis–footwear combination tuning among UK orthotists.Study design:Cross-sectional survey.Methods:A prospective study employing a multi-item questionnaire was sent out to registered orthotists and uploaded on to the official website of British Association of Prosthetists and Orthotists to be accessed by their members.Results:A total of 41 completed questionnaires were received. The results demonstrate that only 50% of participants use ankle foot orthosis–footwear combination tuning as standard clinical practice. The most prevalent factors preventing participants from carrying out ankle foot orthosis–footwear combination tuning are a lack of access to three-dimensional gait analysis equipment (37%) and a lack of time available in their clinics (27%).Clinical relevanceAlthough, ankle foot orthosis–footwear combination tuning has been identified as an essential aspect of the prescription of ankle foot orthoses, the results of this study show a lack of understanding of the key principles behind ankle foot orthosis–footwear combination tuning.

scholarly journals The immediate effects of fitting and tuning solid ankle–foot orthoses in early stroke rehabilitation

2014 ◽  
Vol 39 (6) ◽  
pp. 454-462 ◽  
Author(s):  
Bruce Carse ◽  
Roy Bowers ◽  
Barry C Meadows ◽  
Philip Rowe
Keyword(s):  
Stroke Rehabilitation ◽  
Step Length ◽  
Foot Orthoses ◽  
Post Intervention ◽  
Kinematic Effect ◽  
Ankle Foot Orthosis ◽  
Custom Made ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis ◽  
Early Stroke

Background: Ankle-foot orthoses are known to have a generally positive effect on gait in stroke, however the specifc type of AFO and the time point at which it is provided are highly variable in the currently available literature. Objective: The objective was to determine the immediate spatiotemporal and kinematic effect of custom-made solid ankle–foot orthoses in early stroke rehabilitation, compared to shod walking. Methods: Five male and three female participants were recruited to the study ( n = 8), with a mean age of 57 (16) years who were 3.5 (3) weeks post-stroke. Each received a custom-made solid ankle–foot orthosis to a predefined set of design criteria and tuned using heel wedges to control the shank inclination angle during shod walking. Repeated spatiotemporal and three-dimensional gait measures were taken pre- and immediately post-intervention. Study design: A pre–post-test experimental study. Results: With the solid ankle–foot orthosis, walking velocity increased from 0.22 (0.2) to 0.36 (0.3) m/s ( p < 0.05), overall average step length increased from 0.28 (0.1) to 0.37 (0.1) m ( p < 0.05), cadence increased from 45 (19) to 56 (19) steps/min ( p < 0.05) and step length symmetry ratio increased from 0.65 (0.2) to 0.74 (0.2) (not significant). No clear changes were observed in the joint kinematics of the hip and knee. Conclusion: In our small group of early stroke patients who were fitted with a solid ankle–foot orthosis, immediate significant improvements occurred in walking speed, step length and cadence, when compared to walking with shoes only. Clinical relevance This study provides evidence about the immediate effects of custom solid ankle–foot orthoses on gait of early stroke survivors. Ankle–foot orthosis design specifications are fully described for replication. This study suggests that observing global segment orientation may be more useful than joint angles when fitting and tuning ankle–foot orthoses for optimal ankle–foot orthosis/footwear alignment.

Content analysis of child user and carer perspectives of ankle–foot orthoses

2020 ◽  
pp. 030936462095290
Author(s):  
David Lahoud ◽  
Christine HE Teng ◽  
Erez Nusem ◽  
Joshua Burns ◽  
Cara Wrigley ◽  
...  
Keyword(s):  
Content Analysis ◽  
User Experience ◽  
Secondary Data ◽  
Foot Orthoses ◽  
Ankle Foot Orthosis ◽  
Online Platforms ◽  
Ankle Foot Orthoses ◽  
Data Points ◽  
Negative Feelings ◽  
Foot Orthosis

Background: The evaluation of ankle–foot orthoses is primarily focused on biomechanical performance, with comparatively less studies pertaining to users’ quality of life and experiential factors. Objectives: To investigate how child users regard acquisition and use of ankle–foot orthoses through the perspectives of child users, parents/carers and practitioners. Study design: Inductive content analysis of secondary data. Methods: Child user and parent/carer perspectives, as communicated by them and by practitioners, were collected from online platforms and formal publications. Data and themes were analysed through an inductive approach. Investigator triangulation was used to increase trustworthiness and reduce bias. Results: We found and analysed 223 data points from 30 informal online platforms and 15 formal publications. These data clustered into five key themes relating to user experience with ankle–foot orthoses, including materials, structure, aesthetics, service and impact. Child users had mixed opinions about ankle–foot orthoses, reporting satisfaction with the functional improvements resulting from ankle–foot orthosis wear, while noting negative feelings from the experience of acquiring and using the device. Conclusion: This research suggests that considering the five themes in ankle–foot orthosis provision could improve the child user experience, inform future ankle–foot orthosis design, and improve clinical outcomes.

The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy

2012 ◽  
Vol 37 (2) ◽  
pp. 95-107 ◽  
Author(s):  
Nicola Eddison ◽  
Nachiappan Chockalingam
Keyword(s):  
Cerebral Palsy ◽  
Foot Orthoses ◽  
Ankle Foot Orthosis ◽  
Gait Parameters ◽  
Ankle Foot Orthoses ◽  
Children With Cerebral Palsy ◽  
Within Subjects ◽  
Kinetics Of ◽  
Kinematics And Kinetics ◽  
Foot Orthosis

Background:There are a wide variety of ankle foot orthoses used in clinical practice which are characterised by their design, the material used and the stiffness of that material. Changing any of these three components will alter the effect of the ankle foot orthosis on gait.Objectives:The purpose of this article is to provide an overview on the available research on ankle foot orthosis–footwear combination tuning on the gait characteristics of children with cerebral palsy through a structured review.Study Design:Literature review.Methods:A thorough search of previous studies published in English was conducted within all major databases using relevant phrases without any limits for the dates. These searches were then supplemented by tracking all key references from the appropriate articles identified including hand searching of published books where relevant.Results:To date, there are 947 papers in the literature pertaining to the study of ankle foot orthosis. Of these, 153 investigated the use of ankle foot orthosis for children with cerebral palsy. All the studies included in this review were of a within-subjects design and the evidence levels were generally low.Conclusions:The overall results suggested that ankle foot orthosis–footwear combination tuning has the potential to improve the kinematics and kinetics of gait in children with cerebral palsy. However, the review highlights a lack of well-designed and adequately powered studies.Clinical relevanceWhile the research described in this article indicates an improvement in the gait of children with cerebral palsy following tuning of their ankle foot orthosis–footwear combination, there is still a paucity of research with quantitative data on the effects of kinematics and kinetics of ankle foot orthosis–footwear combination tuning, comparing untuned ankle foot orthosis–footwear combinations with tuned ankle foot orthosis–footwear combination. Furthermore, current research does not identify the effect of tuning on energy efficiency.

scholarly journals A new structural concept in moulded fixed ankle foot orthoses and comparison of the bending stiffness of four constructions

2004 ◽  
Vol 28 (1) ◽  
pp. 44-48 ◽  
Author(s):  
R. E. Major ◽  
P. J. Hewart ◽  
A. M. Macdonald
Keyword(s):  
Carbon Fibre ◽  
Gait Cycle ◽  
Test Procedure ◽  
The Other ◽  
Foot Orthoses ◽  
Mechanical Stiffness ◽  
Ankle Foot Orthosis ◽  
Ankle Foot Orthoses ◽  
Structural Concept ◽  
Foot Orthosis

There are many reasons why a rigid ankle foot orthosis (AFO) may be prescribed. In some cases it is desirable that the rigidity is sufficient to maintain a constant ankle position throughout the gait cycle. There is a need to determine a design of cosmetic, lightweight AFO that provides the necessary stiffness whilst being acceptable to the patient, encouraging continued wear with the resultant benefits. This paper describes an investigation of AFO resistance to dorsiflexion, comparing the stiffness of an AFO with forward trim lines, two designs of reinforced AFOs and an AFO with forward trim lines and an external ankle strap. One reinforced AFO had corrugations moulded in the polypropylene around the ankle, the other had carbon fibre inserts attached to the inside of the polypropylene. The emphasis was on testing the mechanical stiffness of the four AFO designs: the test procedure did not mimic the patterns of AFO loading during gait. Each design was tested in the same manner by the same examiner. The AFO with forward trimlines and an ankle strap displayed similar stiffness to the carbon fibre reinforced AFO and both were stiffer than the other two designs.

scholarly journals Manufacturing and analysis of carbon fiber knee ankle foot orthosis

2018 ◽  
Vol 7 (4) ◽  
pp. 2236 ◽  
Author(s):  
Ayad M. Takhakh ◽  
Saif M. Abbas
Keyword(s):  
Mechanical Properties ◽  
Spinal Cord ◽  
Carbon Fiber ◽  
Tensile Tests ◽  
Foot Orthoses ◽  
Well Control ◽  
Ankle Foot Orthosis ◽  
Cord Injury ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis

Knee ankle foot orthoses (KAFOs) are used by paraplegia patients with low level spinal cord injury and having well control of the stem muscles. Four layers of carbon fiber with C- orthocryl lamination resin are used for manufacturing the knee ankle foot orthoses in this work. The mechanical properties of most of the components materials were estimated with the aid of fatigue and tensile test machines. Results of the tensile tests showed that the mechanical properties: yield stress, ultimate strength and modulus of elasticity were 92MPa, 105.7MPa and 2GPa respectively. The value of amidst pressure between the patient limb and the manufactured KAFO was measured using (F-socket) Mat scan sensor and these values of pressure were (663kPa) and (316kPa) for the thigh and calf regions respectively. 

Comparison of ankle–foot orthoses with plantar flexion stop and plantar flexion resistance in the gait of stroke patients: A randomized controlled trial

2018 ◽  
Vol 42 (5) ◽  
pp. 544-553 ◽  
Author(s):  
Sumiko Yamamoto ◽  
Souji Tanaka ◽  
Naoyuki Motojima
Keyword(s):  
Controlled Trial ◽  
Plantar Flexion ◽  
Upper Body ◽  
Foot Orthoses ◽  
Stroke Patients ◽  
Subacute Phase ◽  
Ankle Foot Orthosis ◽  
Randomized Controlled ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis

Background: The effect of plantar flexion resistance of ankle–foot orthoses on the ankle and knee joints is well known, but its effect on the hip joint and upper body movement during the gait of stroke patients remains unclear. Objectives: To compare the effect of an ankle–foot orthosis with plantar flexion stop and an ankle–foot orthosis with plantar flexion resistance on the gait of stroke patients in the subacute phase. Study design: Randomized controlled trial. Methods: A total of 42 stroke patients (mean age = 59.9 ± 10.9 years, 36 men and 4 women) in the subacute phase were randomized to each ankle–foot orthosis group in a parallel controlled trial with no blinding. Patients received gait training from physiotherapists using the specified ankle–foot orthosis for 2 weeks. Shod gait without an ankle–foot orthosis before training and gait with an ankle–foot orthosis after training were measured by three-dimensional motion analysis. Results: A total of 20 patients were analyzed in each group. Significant differences were found in pelvic and thoracic tilt angles between the two groups. Compared with the gait without an ankle–foot orthosis, the pelvis showed forward tilt when patients walked with an ankle–foot orthosis with plantar flexion stop, and the thorax showed decreased forward tilt when the patients walked with an ankle–foot orthosis with plantar flexion resistance. Conclusion: The difference in ankle–foot orthosis function in sagittal plantar flexion resistance affected the alignment of the upper body and the pelvis during the gait of stroke patients in the subacute phase. Clinical relevance Maintaining upright posture is important in gait rehabilitation. The findings of this study suggest that the ankle–foot orthosis with plantar flexion resistance facilitated better alignment of the upper body and pelvis during the gait of stroke patients in subacute phase. This type of ankle–foot orthosis could be beneficial for patients with malalignment of the upper body and pelvis.

scholarly journals The effect of ankle–foot orthoses on self-reported balance confidence in persons with chronic poststroke hemiplegia

2013 ◽  
Vol 38 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Angelika Zissimopoulos ◽  
Stefania Fatone ◽  
Steven Gard
Keyword(s):  
Study Design ◽  
Self Efficacy ◽  
Foot Orthoses ◽  
Ankle Foot Orthosis ◽  
Balance Confidence ◽  
Post Stroke ◽  
Study Results ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis ◽  
Confidence Scale

Background: One intervention often used to address physical impairments post stroke is an ankle–foot orthosis. Ankle–foot orthoses may improve walking speed, stride length, and gait pattern. However, effects on balance, crucial for safe ambulation, are thus far inconclusive. One aspect of balance shown to contribute to functional ability is self-efficacy. Self-efficacy, defined as the belief in one’s ability to succeed in particular situations, has been shown to be more strongly associated with activity and participation (as defined by the International Classification of Functioning, Disability, and Health) than physical performance measures of gait or balance. Objectives: We investigated whether self-efficacy, or balance confidence when referred to in the context of balance capabilities, is improved with ankle–foot orthosis use. Study design: Repeated measures study design. Methods: Balance confidence was measured using the Activities-specific Balance Confidence Scale in 15 persons with chronic poststroke hemiplegia, with and without their regular ankle–foot orthosis. Results: Activities-specific Balance Confidence Scale scores were significantly higher ( p ≤ 0.01) for the ankle–foot orthosis condition compared to no ankle–foot orthosis. Conclusions: One mechanism by which ankle–foot orthosis use may influence balance is improved balance confidence. Future work should explore the specific mechanisms underlying this improvement in self-efficacy. Clinical relevance Self-efficacy may be an important factor to consider when evaluating functioning post stroke. Rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations, particularly in the fall-prone poststroke population. Study results provide evidence for improvements in balance confidence with ankle–foot orthosis use.

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