Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.
OBJECTIVE
To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.


METHODS
Repeated measures, quasi-experimental study.


METHODS
Motion analysis laboratory.


METHODS
Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.


METHODS
Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90 degrees plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with 3/4 length foot-plate-3/4 AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.


METHODS
Sagittal plane ankle and knee kinematics and kinetics.


RESULTS
In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.


CONCLUSIONS
These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.
Fatone
Stefania
S
Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA. s-fatone@northwestern.edu
Gard
Steven A
SA
Malas
Bryan S
BS
D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000502:physiology*; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation*; D006429:Hemiplegia / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D011336:Probability; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome