title: Effects of ankle foot orthosis in stiff knee gait in adults with hemiplegia.
abstract: Stroke survivors present a less efficient gait compared to healthy subjects due to abnormal knee flexion during the swing phase of gait, associated with spasticity of the rectus femoris muscle and overactivity of the ankle plantarflexors. It is relevant to understand the effect of the ankle foot orthosis (AFO) on gait in individuals with plantarflexor spasticity. The aim of this study was to compare the knee kinematics with an AFO/footwear combination and barefoot in post-stroke subjects with plantarflexor spasticity. Ten subjects with chronic hemiplegia were measured. Two kinematic variables were assessed during the swing phase of the paretic limb: knee flexion angle at toeoff and peak knee flexion angle. We also analyzed gait speed and step length of the non-paretic limb. All variables were obtained with and without the orthosis. Kinematic data were acquired using a motion capture system (ELITE). Subjects wearing an AFO showed significant improvements in gait speed (0.62 m/s (0.08 SD) vs. 0.47 m/s (0.13 SD) (p=0.007)), step length of the non-paretic limb (42 cm (5.9 SD) vs. 33.5 cm (6.6 SD) (p=0.005)) and peak knee flexion angle during the swing phase: 30.7° (14.1° SD) vs. 26.3° (11.7° SD) p=0.005. No significant differences were obtained in the knee flexion angle at toeoff between no AFO and AFO conditions. We described benefits with AFO/footwear use in the kinematics of the knee, the step length of the non-paretic limb, and the gait velocity in hemiplegic subjects after mild to moderate stroke. We conclude that the use of an AFO can improve the gait pattern and increase velocity in these subjects.
authors.affiliation: Physical Therapy Unit, FLENI Rehabilitation Institute, Ruta 9 Km 52.5 Colectora Este, Escobar Buenos Aires, Argentina. marcelogatti@hotmail.com
authors.forename: Marcelo Andrés
authors.initials: MA
authors.lastname: Gatti
authors.forename: Orestes
authors.initials: O
authors.lastname: Freixes
authors.forename: Sergio Anibal
authors.initials: SA
authors.lastname: Fernández
authors.forename: Maria Elisa
authors.initials: ME
authors.lastname: Rivas
authors.forename: Marcos
authors.initials: M
authors.lastname: Crespo
authors.forename: Silvina V
authors.initials: SV
authors.lastname: Waldman
authors.forename: Lisandro Emilio
authors.initials: LE
authors.lastname: Olmos
mesh_terms: D000328:Adult; D000842:Ankle; D001696:Biomechanical Phenomena; D005260:Female; D005528:Foot; D005684:Gait / Q000502:physiology*; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology / Q000534:rehabilitation*; D009989:Orthotic Devices; D016138:Walking / Q000502:physiology; D055815:Young Adult