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Kinematic features of rear-foot motion using anterior and posterior ankle-foot orthoses in stroke patients with hemiplegic gait
Chen C, Hong W, Wang C, Wu KP, Kang C, Tang SF
Archives of Physical Medicine and Rehabilitation 2010 Dec;91(12):1862-1868
clinical trial
3/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the kinematic features of rear-foot motion during gait in hemiplegic stroke patients, using anterior ankle-foot orthoses (AFOs), posterior AFOs, and no orthotic assistance. DESIGN: Crossover design with randomization for the interventions. SETTING: A rehabilitation center for adults with neurologic disorders. PARTICIPANTS: Patients with hemiplegia due to stroke (n = 14) and able-bodied subjects (n = 11). INTERVENTIONS: Subjects with hemiplegia were measured walking under 3 conditions with randomized sequences: (1) with an anterior AFO, (2) with a posterior AFO, and (3) without an AFO. Control subjects were measured walking without an AFO to provide a normative reference. MAIN OUTCOME MEASURES: Rear-foot kinematic change in the sagittal, coronal, and transverse planes. RESULTS: In the sagittal plane, compared with walking with an anterior AFO or without an AFO, the posterior AFO significantly decreased plantar flexion to neutral at initial heel contact (p = 0.001) and the swing phase (p < 0.001), and increased dorsiflexion at the stance phase (p = 0.002). In the coronal plane, the anterior AFO significantly increased maximal eversion to neutral (less inversion) at the stance phase (p = 0.025), and decreased the maximal inversion angle at the swing phase when compared with using no AFO (p = 0.005). The posterior AFO also decreased the maximal inversion angle at the swing phase as compared with no AFO (p = 0.005). In the transverse plane, when compared with walking without an AFO, the anterior AFO and posterior AFO decreased the adduction angle significantly at initial heel contact (p = 0.004). CONCLUSIONS: For poststroke hemiplegic gait, the posterior AFO is better than the anterior AFO in enhancing rear-foot dorsiflexion during a whole gait cycle. The anterior AFO decreases rear-foot inversion in both the stance and swing phases, and the posterior AFO decreases the rear-foot inversion in the swing phase when compared with using no AFO.

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