Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients

OBJECTIVE: To evaluate the immediate effects of individually designed functional in-shoe ankle-foot orthoses (AFO) made of soft and hard cast on balance, standing, and gait parameters in hemiparetic patients. DESIGN: Crossover design with randomized order of the intervention. SETTING: A rehabilitation centre for adults with neurological disorders. SUBJECTS: Twenty-eight patients with hemiparesis due to stroke or traumatic brain injury. MEASURES: Postural sway, standing and gait parameters based on ground reaction forces in two conditions: Patients were randomly assigned to varying sequences of wearing AFO in footwear or wearing footwear alone. RESULTS: AFO significantly improved weight-bearing on the affected leg (affected/ unaffected side symmetry: 2.25 +/- 1.5 with AFO versus 3.4 +/- 2.5 without AFO, P<0.05) and postural sway in stance (12.5 mm +/- 5.2 with AFO versus 15.7 mm +/- 6.7 without AFO, P < 0.05), double stance duration (21.1 +/-14.4% of gait cycle with AFO versus 25.9 +/- 21.6% of gait cycle without AFO, P < 0.05), and symmetry ratios of gait parameters such as stance duration (2.0 +/- 1.5 s with AFO versus 3.3 +/- 3.6 s without AFO, P < 0.05) and deceleration forces (1.6 +/- 0.5 with AFO versus 1.9 +/- 0.6 without AFO, P < 0.05) during gait. No significant differences were observed in all other symmetry ratios of gait parameters. CONCLUSION: An individually designed functional in-shoe AFO can improve stance and gait parameters, even in a single use, in patients with hemiparesis.