PM&R
Volume 1, Issue 6 , Pages 524-529, June 2009

Objective Assessment of Functional Ambulation in Adults with Hemiplegia using Ankle Foot Orthotics after Stroke

  • Karen J. Nolan, PhD

      Affiliations

    • Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ 07052; Department of Physical Medicine and Rehabilitation, UMDNJ - New Jersey Medical School, Newark, NJ†
    • Corresponding Author InformationAddress correspondence to: K.J.N.
    • ,
  • Krupa K. Savalia, BS

      Affiliations

    • Kessler Foundation Research Center, West Orange, NJ‡
    • ,
  • Anthony H. Lequerica, PhD

      Affiliations

    • Kessler Foundation Research Center, West Orange, NJ; Department of Physical Medicine and Rehabilitation, UMDNJ - New Jersey Medical School, Newark, NJ§
    • ,
  • Elie P. Elovic, MD

      Affiliations

    • Division of Physical Medicine and Rehabilitation, School of Medicine, University of Utah, Salt Lake City, UT. Formerly: Kessler Foundation Research Center, West Orange, NJ; Department of Physical Medicine and Rehabilitation, UMDNJ - New Jersey Medical School, Newark, NJ

Received 21 January 2009; accepted 28 April 2009.

Objective

To objectively evaluate the effect of ankle foot orthotics (AFOs) on functional ambulation in individuals with hemiplegia secondary to stroke using quantifiable outcome measures.

Design

With-without repeated measures design.

Setting

Rehabilitation research center.

Participants

Eighteen adults with stroke-related hemiplegia 6 months using a prescribed AFO.

Interventions

Not applicable.

Main Outcome Measurements

The distance (m) and velocity (m/s) during the 6-Minute Walk Test (6MWT) and total time (s) and velocity (m/s) during the 25-ft walk (25ftW). Secondary analysis evaluated the 6MWT and 25ftW grouped by the time component of the Ambulatory Index (AI).

Results

Distance walked during the 6MWT was significantly greater with AFO (228.54 ± 103.93) than without AFO (197.49 ± 104.13), P = .002. Time to complete the 25ftW was significantly greater without AFO (21.22 ± 20.57) than with AFO (15.49 ± 14.65), P = .010. There was a significant difference in average velocity between the 25ftW and 6MWT during the with AFO condition, P = .010. Secondary analysis grouped by the AI time showed that as level of function decreases, brace effect on functional ambulation increases (Group 3: 25ftW with AFO, P = .040).

Conclusions

AFO usage in hemiplegic stroke patients improves functional ambulation, particularly in individuals with a slower gait velocity. The 25ftW, with and without AFO, may be useful to the patient and clinician when determining the importance of brace utilization. Speed modulation was improved when the AFO was added to the paretic limb, and AI grouping indicated that the AFO was more beneficial in people with a slower gait velocity (>20 seconds for the 25ftW). A more definitive study is needed to more completely address this issue. As an exploratory study, the feasibility of different walking assessments was determined so that future studies can validate which objective measures can be used and easily implemented in clinical settings.

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  • † Disclosure: 7A, Innovative Neurotronics; 8A, NIDRR Switzer Grant and NIDRR TBI Model Systems
  • ‡ Disclosure: nothing to disclose
  • § Disclosure: 8A, NIDRR TBI Model Systems
  •  Disclosure: 2A, Allergan; 7A, Allergan; 8A, NIDRR TBI Model Systems

 The contents of this publication were developed under a grant from the Department of Education, NIDRR grant number H133P020012. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.

 Supported by the Department of Education National Institute on Disability and Rehabilitation Research (grant no. H133P020012), New Balance Athletic Shoe, Inc, and Kessler Foundation.

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(09)00439-0

doi:10.1016/j.pmrj.2009.04.011

PM&R
Volume 1, Issue 6 , Pages 524-529, June 2009

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