Cross-over Study Yields Substantial Effect on Gait, Walking Speeds information_schema Adults with Post-stroke Hemiplegia

CHICAGO – Most hemiplegia patients are prescribed AFOs which rely
on differing degrees of resistance to restore function. Despite the large
numbers of people prescribed AFOs, research is limited, said one investigator.

Stefania Fatone, PhD, BPO (Hons), conducted a
randomized study to evaluate a baseline shoe-only condition and three AFO
conditions with varying degrees of plantar flexion to assess the affect of
ankle components on this population. Fatone presented the research during her
Thranhardt Lecture, here, at the American Academy of Orthotists and
Prosthetists Annual Meeting and Scientific Symposium.

The first AFO condition included 90° of plantar
flexion stop with free dorsiflexion. With the second AFO condition, Fatone
tried “to create a more compliant planter flexion stop rather than having
a rigid plantar flexion stop.” For the third AFO condition, Fatone said
that instead of limiting plantar flexion, she resisted it with a dorsiflexion
assist joint.

Through the randomized crossover trial, she found
increased walking speed and effected step side length with all AFO conditions.

“There was no difference in those two variables
between AFO conditions,” Fatone said. “The baseline, compared to any
AFO, improved those two variables.”

Fatone recognized the limitations of the study including
a small sample size and that clinical judgment was used in selecting the
durometers for the different conditions.

“We didn’t go through mechanical testing or
try to match that in an objective fashion,” she said.


It really has everyday relevance … The odds are
that one of these patients is going to be in your office in the next day or two
so you’re talking about a huge bulk of our clinical practice that ask the
same questions – that she asked – of themselves every day. Should I
do this design? What was eluded with a lot of the answers is that it’s an
individualized question and you can not standardize it across a large scope.

— JoAnne L. Kanas, DPT, CPO
— Assistant Director of Rehabilitation, Shriners Hospitals

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