To evaluate the effects of heel-opened ankle foot orthosis (HOAFO) on hemiparetic gait after stroke, especially on external foot rotation, and to compare the effects of HOAFO with conventional plastic-AFO (pAFO) and barefoot during gait.
This cross-over observational study involved 15 hemiparetic patients with external rotation of the affected foot. All subjects were able to walk independently, regardless of their usual use of a single cane, and had a less than fair-grade in ankle dorsiflexion power. Each patient was asked to walk in three conditions with randomized sequences: 1) barefoot, 2) with a pAFO, and 3) with an HOAFO. Their gait patterns were analyzed using a motion analysis system.
Fifteen patients consisted of nine males and six females. On gait analysis, hip and foot external rotation were significantly greater in pAFO (-3.35° and -23.68°) than in barefoot and HOAFO conditions (p<0.05). Wearing an HOAFO resulted in significant decreases in hip (0.78°, p=0.04) and foot (-17.99°, p<0.01) external rotation compared with pAFO; although there was no significant difference between HOAFO and barefoot walking. Walking speed and percentage of single limb support were significantly greater for HOAFO than in barefoot walking.
HOAFO was superior to pAFO in reducing hip and foot external rotation during the stance phase in patients with post-stroke hemiparesis. HOAFO may, therefore, be useful in patients with excessive external rotation of the foot during conventional pAFO.
Citations
Objective: The purpose of this study were to investigate the temporospatial, kinematic data and energy consumption in hemiplegic patients according to the types of ankle-foot orthosis (AFO), and to determine the most effective type of AFO for gait training.
Method: A prospective study was performed for 10 patients with hemiplegia who was able to walk independently at indoor level. The temporospatial, kinematic data and energy consumption were compared in each five different conditions: 1) barefoot, 2) donning AFO with posterior leaf spring (PLS), 3) donning PLS with the distal part of metatarsal head trimmed off (PLS-C), 4) donning hinged PLS (HPLS), 5) donning hinged PLS with the distal part of metatarsal head trimmed off (HPLS-C).
Results: With four types of PLS, maximal ankle plantar flexion was significantly decreased, however we didn't find any difference in kinematic data of the pelvis and hip as compared with barefoot and with PLS, HPLS, HPLS-C and maximal knee extension angle was significantly decreased compared with barefoot. With HPLS-C, cadence and walking speed significantly increased and double support time and oxygen cost significantly decreased as compared with barefoot.
Conclusion: This study showed increased walking speed, decreased energy cost and improved
Method: We retrospectively reviewed the medical records and radiographs of all patients with idiopathic scoliosis seen in our institution from March, 1997 to February, 2002. Inclusion criteria in this study included a diagnosis of adolescent idopathic scoliosis, with no history of back pain before brace prescription, with Cobb's angle 15-degree or more. All subjects were educated to do scoliosis correction exercise, educated for correct posture, and to wear the orthosis over 22 hours per day, even during sleeping.
Results: Forty-nine subjects were reviewed, treated with the orthosis. We found that pain regions occurring after institution of modified Boston orthosis were chest wall (contacting with pad), lower back, neck and pelvis orderly. We also found that aggravation of Cobb's angle in patients with pain more than without pain, but any disease was not found in the former.
Conclusion: There were no serious conditions with the patients who had the pain after institution of the modified Boston orthosis, but the pain was often associated with curve progression in adolescent idiopathic scoliosis patients. (J Korean Acad Rehab Med 2003; 27: 941-945)
Objective: To develop and evaluate newly designed orthosis to control contracture of the shoulder and the forearm in the spastic upper limb.
Method: Subjects were 6 hemiplegic patients and 1 tetraplegic patient who showed the features of spasticity. Volar wrist hand orthosis was modified to attach a plastic stick which can be easily separated. The orthosis was applied in supinated position for 8 weeks. The shoulder and elbow range of motion was measured every 2 weeks for 8 weeks.
Results: The subjects with spasticity showed significant improvement in the shoulder abduction (p＜0.05), adduction (p＜0.05) and external rotation (p＜0.05) after applying modified volar wrist hand orthosis for 8 weeks. The forearm supination was well maintained for 8 weeks.
Conclusion: The newly designed orthosis showed significant effects in the improvement of the shoulder abduction, adduction and external rotation and the forearm supination of spastic upper limbs.
Objective: Excessive external rotation of the hemiplegic foot is a common problem of hemiplegic gait. There has been a few report on etiological investigation and corrective measurement of an excessive external rotation of hemiplegic foot. Thus we present a newly designed Torque heelⰒ to correct the external rotation of hemiplegic foot.
Method: Ten hemiparetic patients with an excessive external rotation of affected foot participated in this study. All of the participants were able to walk at least 10 meters with metal a ankle foot orthosis (AFO) using a single cane. Each of these patients was placed on four tries of walk: (1) on a bare foot; (2) with an AFO; (3) with an AFO and a quarter inch of lateral wedge; and (4) with an AFO and the Torque heelⰒ. Gait patterns were analysed by the Vicon 370, three dimensional motion analyser.
Results: The speed and stride length increased in all tries except for the bare foot walk. Those who walked with the assistive devices showed no difference in the speed and stride length. All the participants showed an increased in external rotation of pelvis and ankle. Those who walked with an AFO and Torque heelⰒ presented a decrease in the external rotation of foot and pelvis. The hip and ankle motions of the hemiplegic limbs were not affected with the AFO and Torque heelⰒ. A significant degree of correction in pelvic rotation with an AFO and Torque heelⰒ was noted.
Conclusions: This study indicates that an AFO with Torque heelⰒ is beneficial to the correction of external rotation of a hemiplegic foot. And the excessive external rotation of hemiplegic foot may be due possibly to the external rotation of pelvis.
Objective: This study was performed to investigate the energy expenditure at self-selected comfortable and fast walking speeds with or without plastic ankle-foot orthosis in hemiplegic patients.
Method: Objects of this study were 10 ambulatory hemiplegic patients. To estimate oxygen consumption, we used K2 machine and measured gait speed, stride length, stride frequency, and heart rate energy expenditure index (EEI) with or without plastic ankle-foot orthosis.
Results: Stride length and gait speed of the hemiplegic patients with plastic ankle-foot orthosis significantly increased at their comfortable walking speed pattern. Oxygen consumption, oxygen cost and EEI significantly decreased in hemiplegic patients with plastic ankle-foot orthosis whether their gait speed pattern.
Conclusion: The plastic ankle-foot orthosis is useful for the hemiplegic patients to increase walking speed and to reduce energy expenditure.
Objective: To describe the inappropriate application of spinal orthosis and the frequency of the noncompliance and to identify the relating factors for compliance of spinal orthosis in patients with spinal metastasis.
Method: Twenty patients diagnosed as spinal instability due to spinal metastasis and applied with Knight-Taylor thoracolumbosacral orthosis or Knight lumbosacral orthosis were interviewed about the mobility and pain. Visual analogue scale (VAS) about severity of back pain and discomfort was also applied to each patient.
Results: Nine of the twenty patients were considered as being in poor compliance group. Six of eleven patients with good compliance had inappropriate application method or fitting problems. Inability to walk, poor walking endurance, greater degree of discomfort were related to the poor compliance of the spinal orthosis in patients with spinal metastasis.
Conclusion: Even with intensive education about the need for spinal orthosis and the method for application, there is high probability that the patients did not use the orthosis or use the orthosis incorrectly especially when patients cannot walk (or cannot walk enough time) and complain severe discomfort.
Objective: Lower extremity orthoses are important in the rehabilitation of the patients with stroke and traumatic brain injury. But it is unknown how much they are used in the social activity after the discharge from the hospital. This study was carried out to investigate the status of using orthosis in social activity and complaints about orthosis.
Method: The questionnaires were given to 42 cases with stroke and 17 cases with traumatic brain injury.
Results: The user of lower extremity orthosis in social activity were 55.9%, and the causes of disuse were patient's poor condition, improved gait pattern, inappropriate design and defect of orthosis, and patient's refusal. The degree of satisfaction with orthosis for comfort, external appearance and weight were 79.3%, 86.2%, and 72.4%, respectively.
Conclusion: Physiatrists should give more attention in orthosis at follow-up of patients with stroke and traumatic brain injury and make efforts to improve function and external appearance of orthosis.
Objective: To investigate the changes of gait patterns in hemiplegic patients with ankle foot orthosis (AFO) and with functional electrical stimulation (FES).
Method: Fifteen hemiplegic patients who can walk independently with cane participated in this study. Kinematic gait analysis was performed for all subjects using three-dimensional gait analysis system in barefoot, wearing AFO, and applying FES. The mean values of each gait trials were taken and statistically analysed by repeated measures of ANOVA.
Results: Genu recurvatum at stance phase and excessive ankle plantar flexion at stance and swing phase were decreased after wearing AFO. Excessive ankle plantar flexion at swing phase were decreased after applying FES.
Conclusion: The results showed that the FES is useful for the correction of hemiplegic gait as mush as of wearing AFO.
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