ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2022 June;58(3):352-62

DOI: 10.23736/S1973-9087.21.07048-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Effects of ankle-foot orthoses on the stability of post-stroke hemiparetic gait

Kazuhiro TSUCHIYAMA ¹, Masahiko MUKAINO ² ✉, Kei OHTSUKA ¹, Fumihiro MATSUDA ¹, Hiroki TANIKAWA ¹, Junya YAMADA ³, Kannit PONGPIPATPAIBOON ⁴, Yoshikiyo KANADA ¹, Eiichi SAITOH ², Yohei OTAKA ²

¹ School of Health Sciences, Faculty of Rehabilitation, Fujita Health University, Toyoake, Japan; ² School of Medicine, Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan; ³ Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan; ⁴ Rehabilitation Medicine Center, Samitivej Srinakarin Hospital, Bangkok, Thailand

BACKGROUND: Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on gait stability.
AIM: To investigate the effects of ankle-foot orthoses on post-stroke gait stability.
DESIGN: An experimental study with repeated measurements of gait parameters with and without orthosis.
SETTING: Inpatients and outpatients in the Fujita Health University Hospital, Toyoake, Japan.
POPULATION: Thirty-two patients (22 males; mean age 48.3±20.0 years) with post-stroke hemiparesis participated in the study.
METHODS: Three-dimensional treadmill gait analysis was performed with and without ankle-foot orthosis for each participant. Spatiotemporal parameters, their coefficient of variation, and margin of stability were evaluated. Toe clearance, another major target of orthosis, was also examined. The effect of orthosis in the patients with severe (not able to move within the full range of motion, defying gravity) and mild ankle impairment (able to move within the full range but have problem with speed and/or smoothness of the ankle movement) was compared.
RESULTS: In the total group comparison, the decrease in the coefficient of variation of step width (P=0.012), and margin of stability on the paretic side (P=0.023) were observed. In the severe ankle impairment groups, the decreased in the coefficient of variation of the non-paretic step length (P=0.007), stride length (P=0.037), and step width (P=0.033) and margin of stability on the paretic side (P=0.006) were observed. No significant effects were observed in the mild ankle impairment group; rather, the coefficient of variation of non-paretic step length increased with the use of orthosis in this group (P=0.043); however, toe clearance increased with the use of ankle-foot orthosis (P=0.041).
CONCLUSIONS: Ankle-foot orthoses improved gait stability indices; however, the effect was either not significant or showed possible worsening in the patients with mild ankle impairment, while the effect on toe clearance was significant. These results suggest that the effects of using orthoses in patients with mild impairment should be carefully evaluated.
CLINICAL REHABILITATION IMPACT: Understanding the effects of ankle-foot orthoses on the stability of post-stroke gait and their relationship with ankle impairment severity may support clinical decision-making while prescribing orthosis for post-stroke hemiparesis.

KEY WORDS: Hemiplegia; Stroke; Gait; Rehabilitation