scholarly journals The Comparison of the Effects of Flexible vs Rigid Ankle-foot orthoses on Balance and Walking Performance in Individuals With Multiple Sclerosis: A Crossover Study

2021 ◽  
Vol 19 (2) ◽  
pp. 199-206
Author(s):  
Sama-Sadat Parian ◽  
◽  
Niloufar Fereshtenejad ◽  
Susan Hillier ◽  
Ebrahim Sadeghi-Demneh ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Crossover Study ◽  
Postural Stability ◽  
Walking Speed ◽  
Foot Orthoses ◽  
Timed Up And Go ◽  
Walking Test ◽  
Ankle Foot Orthosis ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis

Objectives: Ankle-Foot orthoses are used to minimize the impact of weakness in ankle dorsiflexion muscles. The study on different orthotic types defines the optimal design, which effectively improves the users’ mobility. This study investigated the potential benefits and risks of a Dictus-band (flexible orthotic), compared with a thermoplastic (fixed) ankle-foot orthosis on the mobility of individuals with Multiple Sclerosis (MS). Methods: Fifteen subjects with MS and dorsiflexion ankle weakness volunteered in this randomized crossover study. The study participants received either a Dictus-band or a thermoplastic ankle-foot orthosis worn on the weaker leg, compared to barefoot as the control condition. Postural stability during standing, forward reach test, timed up and go test, and walking speed in the 10-meter walking test were compared between the study conditions. Results: There were no significant differences in the postural stability and forward reach tests between study conditions (P>0.5). When the research participants used a Dictus-band, compared to the fixed ankle-foot orthosis, the time required to complete the timed up and go was significantly reduced [P<0.01; Mean±SD difference: 6.4±1.4; 95% Confidence Interval (CI): 2.7-10.2], and walking speed was increased in the 10-meter walking test (P<0.01; Mean±SD difference: 0.46±0.8; 95%CI: 0.23-0.69). There was no difference in the timed up and go and 10-meter walking test data between the barefoot and Dictus-band conditions (P>0.5). No adverse or safety events were sustained in this research. Discussion: The present study data provided initial evidence for the lack of detrimental effects of using the Dictus-band in subjects with MS and ankle dorsiflexion deficiencies.

scholarly journals The effect of different shoes on functional mobility and energy expenditure in post-stroke hemiplegic patients using ankle–foot orthosis

2016 ◽  
Vol 40 (5) ◽  
pp. 591-597 ◽  
Author(s):  
Farzad Farmani ◽  
Mohammad Ali Mohseni Bandpei ◽  
Mahmood Bahramizadeh ◽  
Gholamreza Aminian ◽  
Mohammad Reza Nikoo ◽  
...  
Keyword(s):  
Energy Expenditure ◽  
Walking Speed ◽  
Functional Mobility ◽  
Timed Up And Go ◽  
Ankle Foot Orthosis ◽  
Post Stroke ◽  
Group I ◽  
Ankle Foot Orthoses ◽  
Rocker Shoes ◽  
Foot Orthosis

Background:Ankle–foot orthoses could be utilized both with and without shoes. While several studies have shown that ankle–foot orthoses improve gait abilities in hemiplegic patients, it remains unclear whether they should be used with shoes or without.Objectives:The study purpose was to compare the effect of standard shoes and rocker shoes on functional mobility in post-stroke hemiplegic patients utilizing ankle–foot orthosis.Study design:Randomized clinical study.Methods:Thirty post-stroke hemiplegic patients participated in this study randomly assigned to two groups. Group I received standard shoes + ankle–foot orthosis and group II were provided with rocker shoes + ankle–foot orthosis. Their functional mobility and energy expenditure parameters including timed up and go, timed up stairs, timed down stairs, preferred walking speed, and oxygen (O2) cost (mL/kg/m) were measured.Results:In group I, no significant changes were seen in outcome measures after wearing standard shoes. While in group II, O2cost and timed up and go time significantly decreased, and preferred walking speed increased when patients wore rocker shoes. Also, there was a significant difference between rocker shoes and standard shoes in improvement of timed up and go, preferred walking speed, and O2cost.Conclusion:When patients using ankle–foot orthosis wore rocker shoes, their functional mobility improved and oxygen cost diminished. Also, rocker shoes was significantly more effective than standard shoes in improving functional mobility parameters.Clinical relevanceThis study suggests that in post-stroke hemiplegic patients using ankle–foot orthosis, wearing rocker shoes can lead to much more improved functional mobility and decreased energy expenditure compared to ankle–foot orthosis only. Thus, in stroke patients, the combination of ankle–foot orthosis-rocker shoes is recommended for both rehabilitation programs and ankle–foot orthosis efficacy investigations.

The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

2019 ◽  
Vol 34 (2) ◽  
pp. 145-159 ◽  
Author(s):  
Saeed Shahabi ◽  
Hosein Shabaninejad ◽  
Mohammad Kamali ◽  
Maryam Jalali ◽  
Ahmad Ahmadi Teymourlouy
Keyword(s):  
Confidence Interval ◽  
Publication Bias ◽  
Walking Speed ◽  
Risk Of Bias ◽  
Foot Orthoses ◽  
Quality Of Evidence ◽  
Ankle Foot Orthosis ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis

Objective: The aim of this study was to evaluate the effects of ankle-foot orthoses on speed walking in patients with stroke. Data sources: PubMed, Embase, Web of Science, Scopus, CENTRAL, PEDro, RehabData, RECAL, and ProQuest were searched from inception until 30 September 2019. Review methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Risk of bias assessment was performed using the Cochrane Risk of Bias Tool. Begg’s test and Egger’s regression method were used to assess the publication bias. Trim and fill analysis was also used to adjust any potential publication bias. Sensitivity analysis was performed to evaluate the effect of individual studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Overall, 14 studies were included with a total of 1186 participants. A small-to-moderate and non-significant improvement in favor of the ankle-foot orthosis versus without ankle-foot orthosis (standardized mean difference (SMD) = 0.41, 95% confidence interval = −0.15 to 0.96), similar effects of ankle-foot orthosis and functional electrical stimulation (SMD = 0.00, 95% confidence interval = −0.16 to 0.16), and a small and non-significant improvement in favor of ankle-foot orthosis versus another type of ankle-foot orthosis (SMD = 0.22, 95% confidence interval = −0.05 to 0.49) in walking speed were found. However, the quality of evidence for all comparisons was low or very low. Conclusion: Despite reported positive effects in some studies, there is no firm evidence of any benefit of ankle-foot orthoses on walking speed.

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.

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.

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.

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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