A thematic framework of illness narratives produced by stroke patients

Abstract

Purpose: The present study aims at elucidating the impact of stroke on psychosocial functioning of stroke survivors. Methods: Data were investigated using interpretative thematic analysis of illness stories produced by 29 patients. Results: Eight themes emerged from the data: Medical Information; Interpersonal Changes; Cognitive, Physical and Emotional Functioning; Strategies of Coping; Social Support; and Information Irrelevant to the Question. The most frequent organization of the themes followed the course of medical intervention and rehabilitation. Narrations of individual patients varied in terms of the presence of particular themes, the amount of information on each topic and organization. Conclusions: The results suggest that the analysis of non-guided illness narratives can be effectively used to identify the thematic areas important to individual stroke patients. The thematic content analysis of stroke stories can allow health professionals to better understand the patient’s state of knowledge related to illness as well as his or her socio-psychological functioning which may be useful in the course of planning further assessment and rehabilitation of patients with stroke.

• Implications for Rehabilitation

• Experience of illness and life changes following stroke should be recognized as central to the provision of targeted rehabilitation.

• To understand the subjective perspective a content analysis of the content narrative is recommended.

• Our study highlights seven general thematic categories that may be regarded as key.

• The categories may be useful for clinicians to help individuals to clarify their main concerns following a stroke.

     

Rehabilitation and education are underutilized for mild stroke and TIA sufferers

Purpose: Transient ischemic attack (TIA) and mild stroke represent a large proportion of cerebrovascular events, at high risk of being followed by recurrent, serious events. The importance of early education addressing risk management, secondary prevention and lifestyle modifications is the centerpiece of further stroke prevention. However, delivering education and rehabilitation to this population can be complex and challenging.

Methods: Via synthesis of a narrative review and clinical experience, we explore the unique and inherent complexities of rehabilitation management and education provision for patients following mild stroke and TIA.

Results: A considerable proportion of TIA/mild stroke survivors have ongoing rehabilitation needs that are poorly addressed. The need for rehabilitation in these patients is often overlooked, and available assessment tools lack the sensitivity to identify common subtle impairments in cognition, mood, language and fatigue. Active and accessible education interventions need to be initiated early after the event, and integrated with ongoing rehabilitation management. Priority areas in need of future development in this field are highlighted and discussed.

• Implications for rehabilitation

• Survivors of mild stroke and TIA have ongoing unmet rehabilitation needs and require a unique approach to rehabilitation and education.

• Rehabilitation needs are difficult to assess and poorly addressed in this cohort, where available assessment tools lack the sensitivity required to identify subtle impairments.

• Education needs to be initiated early after the event and involve active engagement of the patient in order to improve stroke knowledge, mood and motivate adherence to lifestyle modifications and secondary prevention.

• Rehabilitation physicians are currently an underutilized resource, who should be more involved in the management of all patients following TIA or mild stroke.

     

Recovery of walking ability using a robotic device in subacute stroke patients: a randomized controlled study

Purpose: This study investigates the effectiveness of Lokomat + conventional therapy in recovering walking ability in non-ambulatory subacute stroke subjects involved in inpatient rehabilitation. Method: Thirty first-ever stroke patients completed 8 weeks of intervention. One group (n?=?16) received Lokomat therapy twice a week, combined with three times 30?min a week of conventional overground therapy. The second group (n?=?14) received conventional assisted overground therapy only, during a similar amount of time (3.5?h a week). The intervention was part of the normal rehabilitation program. Primary outcome measure was walking speed. Secondary outcome measures assessed other walking- and mobility-related tests, lower-limb strength and quality of life measures. All outcome measures were assessed before and after the intervention and at wk 24 and wk 36 after start of the intervention. Results: Patients showed significant (p?Conclusion: These results indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as conventional therapy alone.

• Implications for Rehabilitation

• Recovery of walking after stroke is important.

• Robot-assisted therapy is currently receiving much attention in research and rehabilitation practice as devices such as the Lokomat seem to be promising assistive devices.

• Technical developments, sub-optimal study designs in literature and new therapy insights warrant new effectiveness studies.

• Results of a financially and practically feasible study indicate that substituting Lokomat therapy for some of conventional therapy is as effective in recovering walking ability in non-ambulatory stroke patients as compared to conventional overground therapy alone.

     

Effectiveness of 7-day versus weekday-only rehabilitation for stroke patients in an acute-care hospital: a retrospective cohort study

Abstract

Purpose: Early rehabilitation is widely recommended for acute-stroke patients. We tested the hypothesis that the functional prognosis of stroke patients receiving daily early rehabilitation in a clinical practice setting is generally better than that of patients receiving rehabilitation only on weekdays.

Materials and methods: We analyzed hospitalized patients who experienced either cerebral infarctions or cerebral hemorrhages and subsequently underwent rehabilitation at our hospital between October 2010 and September 2014. We examined the association between training frequency and activities of daily living improvements, as indicated by the Barthel Index (BI) effectiveness.

Results: In total, 661 patients with cerebral infarctions and 245 with intracerebral hemorrhages (ICHs) were analyzed. The BI effectiveness was highest for patients receiving high-frequency therapy following cerebral infarction. In addition, multiple linear regression analysis indicated that BI effectiveness was significantly and positively correlated with high-frequency therapy (coefficient, 0.072; 95% confidence interval, 0.019–0.126; p?<?0.01) in patients with cerebral infarctions. There was no significant difference in BI effectiveness between therapeutic protocols for patients with ICHs.

Conclusion: This retrospective cohort study demonstrated that extensive therapy can result in functional recovery in patients with cerebral infarctions.

• Implications for Rehabilitation

• Early intervention with intensive rehabilitation therapy is important for improving the functional recovery of patients during acute-care hospitalization.

• Few acute hospitals provide more than 2?h of daily rehabilitation for patients with acute stroke.

• In a daily clinical practice setting, this clinical study demonstrates a direct relationship between early intervention with intensive rehabilitation therapy and good functional recovery of stroke patients in an acute ward.

     

The impact of patient's weight on post-stroke rehabilitation

Purpose To evaluate the influence of patient’s weight on rehabilitation outcomes in first-event stroke patients. Design Retrospective, observational comparative study. 102 first-time stroke male and female patients admitted to the 52-bed neurology rehabilitation department in a rehabilitation hospital were included in the study. Body mass index (BMI), Functional Independence Measure (FIM) on admission and at discharge, as well as the delta-FIM (FIM on admission – FIM at discharge) were evaluated. The Kruskal–Wallis test was used to compare the FIM and the NIHSS scores between BMI groups (normal, overweight, moderate and severe obesity). Results A statistically significant negative correlation (rho?=??0.20, p?=?0.049) was found between FIM change and BMI, that remained significant after adjustments for age, sex and hospitalisation days. No difference was found between groups in FIM or NIHSS change between BMI groups. Conclusions In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients’ BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. Further investigations are needed to identify the functional parameters affected by the patients’ BMI.

• Implications for Rehabilitation

• In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters.

• Patients’ BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients.

• New rehabilitation strategies should be designed to improve the functional outcomes of rehabilitation of obese patients.

     

A comprehensive assessment of family caregivers of stroke survivors during inpatient rehabilitation

Abstract

Purpose: Stroke caregivers have been identified as a group at high risk for poor outcomes as a result of the suddenness of stroke and a potentially high level of care needed due to significant functional limitations of the patient. However, there is little research on the assessment of family members who will assume the caregiving role prior to patient discharge from rehabilitation. The purpose of this article is to delineate critical assessment domains identified by a subset of spousal stroke caregivers. Methods: Semi-structured interviews were conducted pre- and post-discharge from rehabilitation as part of a larger study that focused on identifying caregiver and stroke survivor needs as they transitioned home from inpatient rehabilitation. For this study, two semi-structured interviews with 14 spousal caregivers were analyzed using grounded theory methods. Results: Long-term stroke survivor outcomes were dependent upon the commitment, capacity and preparedness of the family caregiver. Twelve domains of assessment were identified and presented. Conclusions: A comprehensive, systematic caregiver assessment to understand the caregiver’s concerns about stroke should be conducted during rehabilitation to help the team to develop a plan to address unmet needs and better prepare family caregivers to take on the caregiving role.

• Implications for Rehabilitation

• Stroke is a sudden event that often leaves stroke survivors and their families in crisis.

• The needs of stroke family caregivers are not often systematically assessed as part of inpatient rehabilitation.

• Long-term stroke survivor outcomes are dependent upon the commitment, capacity and preparedness of the family caregiver.

• Stroke caregiver assessment should include the commitment, capacity and preparedness to provide care, and the overall impact of stroke in order to develop discharge plans that will adequately address the needs of the stroke survivor/caregiver dyad.

     

Exploring patient and public involvement in stroke research: a qualitative study

Abstract

Purpose: To explore the experiences of patients and carers involved in patient and public involvement (PPI) activities for stroke research. Methods: Semi-structured interviews conducted with stroke survivors and carers (n?=?11) were analysed using thematic analysis. Results: Four key themes emerged: impact of PPI on the individual and the research process, credibility and expertise, level of involvement and barriers and facilitators to PPI for stroke survivors and carers. The perceived benefits to the research process included: asking questions, keeping researchers grounded and directing the research agenda. All participants drew upon their experiential expertise in their PPI role, but some also drew upon their professional expertise to provide additional credibility. Stroke survivors and carers can be involved in PPI at different levels of involvement simultaneously and the majority of participants wanted to be more involved. Barriers to involvement included: location, transport and stroke survivors capacity to concentrate and comprehend complex information. Facilitators included: reimbursement for travel and time and professionals effort to facilitate involvement. Conclusions: PPI in stroke research benefits stroke survivors and carers and is perceived to benefit the research process. The barriers and facilitators should be considered by professionals intending to engage stroke survivors and carers collaboratively in research.

• Implications for Rehabilitation

• This study has implications for PPI in stroke rehabilitation research, which could also be extrapolated to stroke rehabilitation service development and evaluation.

• Professionals facilitating PPI need to invest in developing supportive relationships in order to maintain ongoing involvement.

• Professionals need to be aware of how the varied consequences of stroke might impede participation and strategies to facilitate involvement for all who wish to be involved.

• For each rehabilitation issue being considered professionals need to decide: (1) how representative of the specific rehabilitation population the PPI members need to be, (2) whether experience alone is sufficient or whether additional professional skills are required and (3) whether training is likely to assist involvement or potentially reduce the lay representation.

     

Relaxation training after stroke: potential to reduce anxiety

Abstract

Objective: To consider the feasibility of setting up a relaxation group to treat symptoms of post stroke anxiety in an in-patient post-acute setting; and to explore the effectiveness of relaxation training in reducing self-reported tension. Method: A relaxation group protocol was developed in consultation with a multidisciplinary team and a user group. Over a period of 24 months, 55 stroke patients attended group autogenic relaxation training on a rehabilitation ward. Attendance ranged between one and eleven sessions. Self-reported tension was assessed pre and post relaxation training using the Tension Rating Circles (TRCs). Results: The TRCs identified a significant reduction in self-reported tension from pre to post training, irrespective of the number of sessions attended; z?=??3.656, p?<?0.001, r?=??0.67, for those who attended multiple sessions, z?=??2.758, p?<?0.01, r?=??0.6 for those who attended a single session. Discussion: The routine use of relaxation techniques in treating anxiety in patients undergoing post-stroke rehabilitation shows potential. Self-reported tension decreased after attendance at relaxation training. The TRCs proved acceptable to group members, but should be validated against standard anxiety measures. Further exploration of the application of relaxation techniques in clinical practice is desirable.

• Implications for Rehabilitation

• Anxiety is prevalent after stroke and likely affects rehabilitation outcomes.

• Relaxation training is a well proven treatment for anxiety in the non-stroke population.

• A significant within session reduction in tension, a hallmark symptom of anxiety, was evidenced via group relaxation training delivered in a post-acute, in-patient stroke unit setting.

• Relaxation training a shows promise as a treatment for anxiety after stroke.

     

Rehabilitation professionals’ perceptions of the use of new visualisation software tools with people with stroke

Purpose: The envisage programme of research was funded to explore and evaluate the use of visualisation software tools using biomechanical data within rehabilitation. Three work packages were developed to evaluate the impact of the tools within stroke rehabilitation. The research presented here aimed at exploring the perceptions of rehabilitation therapists about the use of the visualisation software tools in the context of future randomised controlled trials and stroke rehabilitation practice. Methods: Sixteen therapists working in a range of stroke rehabilitation contexts participated in semi-structured interviews. Interview questions explored their current practice, and the perceived impact of the new visualisation technologies on their workplace environment and practice. Framework analysis was used to analyse the textual data. Results: In general, the stroke therapists were enthusiastic about the potential application of the visualisation software tools. Three themes were identified through qualitative framework analysis: potential uses of the visualisation tools; integration within current service provision; and trial involvement. Conclusions: The study highlights important contextual considerations which may impact significantly on the success of novel technologies in stroke rehabilitation. Normalisation process theory was proposed as a useful process evaluation methodology to optimise both trial evaluation and future service implementation.

• Implications for Rehabilitation

• There is limited research exploring the use of visual software technologies featuring biomechanical data within stroke rehabilitation.

• The perspectives of stroke rehabilitation therapists about the potential of such tools are useful both in terms of planning trial evaluations, and implementation.

• Therapists were generally positive about the contribution of visual software tools in stroke rehabilitation, but highlighted a number of practical constraints which required addressing.

• Normalisation process theory provides a useful process evaluation methodology which can support both trial evaluation and implementation of such novel technologies within stroke rehabilitation.

     

What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services

Abstract

Introduction: Multi-disciplinary team members predict each patient’s rehabilitation potential to maximise best use of resources. A lack of underpinning theory about rehabilitation potential makes it difficult to apply this concept in clinical practice. This study theorises about rehabilitation potential drawing on everyday decision-making by Health Care Professionals (HCPs) working in stroke rehabilitation services. Methods: A clinical scenario, checked for face validity, was used in two focus groups to explore meaning and practice around rehabilitation potential. Participants were 12 HCPs working across the stroke pathway. Groups were co-facilitated, audio-recorded and fully transcribed. Analysis paid attention to data grounded in first-hand experience, convergence within and across groups and constructed a conceptual overview of HCPs’ judgements about rehabilitation potential. Results: Rehabilitation potential is predicted by observations of “carry-over” and functional gain and managed differently across recovery trajectories. HCPs’ responses to rehabilitation potential judgements include prioritising workload, working around the system and balancing optimism and realism. Impacts for patients are streaming of rehabilitation intensity, rationing access to rehabilitation and a shifting emphasis between management and active rehabilitation. For staff, the emotional burden of judging rehabilitation potential is significant. Current service organisation restricts opportunities for feedback on the accuracy of previous judgements. Conclusion: Patients should have the opportunity to demonstrate rehabilitation potential by participation in therapy. As therapy resources are limited and responses to therapy may be context-dependent, early decisions about a lack of potential should not limit longer-term opportunities for rehabilitation. Services should develop strategies to enhance the quality of judgements through feedback to HCPs of longer-term patient outcomes.

• Implications for Rehabilitation

• Rehabilitation potential is judged at the level of individual patients (rather than population-based predictive models of rehabilitation outcome), draws on different sources of often experiential knowledge, and may be less than reliable.

• Decisions about rehabilitation potential may have far reaching consequences for individual patients, including the withdrawal of active rehabilitation in hospital or in the community and eventual care placement.

• A better understanding of what people mean by rehabilitation potential by all team members, and by patients and carers, may improve the quality of joint decision making and communication.

     

Effectiveness of commercial video gaming on fine motor control in chronic stroke within community-level rehabilitation

Abstract

Purpose: The purpose of this study was to investigate the effectiveness of commercial gaming as an intervention for fine motor recovery in chronic stroke. Methods: Ten chronic phase post-stroke participants (mean time since CVA?=?39 mos; mean age?=?72 yrs) completed a 16-session program using the Nintendo Wii for 15?min two times per week with their more affected hand (10 right handed). Functional recovery (Jebsen Hand Function Test (JHFT), Box and Block Test (BBT), Nine Hole Peg Test (NHPT)), and quality of life (QOL; Stroke Impact Scale (SIS)) were measured at baseline (pre-testing), after 8 sessions (mid-testing) and after 16 sessions (post-testing). Results: Significant improvements were found with the JHFT, BBT and NHPT from pre-testing to post-testing (p?=?0.03, p?=?0.03, p?=?0.01, respectively). As well, there was an increase in perceived QOL from pre-testing to post-testing, as determined by the SIS (p?=?0.009). Conclusion: Commercial gaming may be a viable resource for those with chronic stroke. Future research should examine the feasibility of this as a rehabilitation tool for this population.

• Implications for Rehabilitation

• Stroke survivors often live with lasting effects from their injury, however, those with chronic stroke generally receive little to no rehabilitation due to a perceived motor recovery plateau.

• Virtual reality in the form of commercial gaming is a novel and motivating way for clients to complete rehabilitation.

• The Nintendo Wii may be a feasible device to improve both functional ability and perceived quality of life in chronic stroke survivors.

     

How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions

Purpose: We investigated stroke rehabilitation clinician’s perceptions of the patient as an active partner in setting goals within stroke rehabilitation and factors that influence patient engagement.

Methods: Semi-structured interviews, subject to general inductive analysis with 20 Clinicians’ working in three UK based stroke rehabilitation teams (one in-patient ward and two community based rehabilitation teams).

Results: There were three key themes that impacted on the patients active involvement in setting goals for rehabilitation after stroke: Patient barriers to goal setting (knowledge of the patient and family, who is the patient and the stroke’s impact); How we work as a team (the role of the patient in setting goals, the effect of clinician attributes on goal setting); and How systems impact goal setting (goal-setting practice, home versus hospital, and professional/funder expectations of clinicians’).

Conclusions: Goal setting served a range of different, sometimes conflicting, functions within rehabilitation. Clinicians’ identified the integral nature of goals to engage and motivate patients and to provide direction and purpose for rehabilitation. Further, there was an identified need to consider the impact of prioritizing clinician-derived goals at the expense of patient-identified goals. Lastly the reliance on the SMART goal format requires further consideration, both in terms of the proposed benefits and whether they disempower the patient during rehabilitation.

• Implications for rehabilitation

• Goal setting is often promoted as a relatively simple, straightforward way to structure interactions with patients

• Patient-related factors together with resourcing constraints are significant barriers to patient-centered goal setting, particularly during inpatient rehabilitation

• Clinicians need to have pragmatic tools that can be integrated into practice to ensure that goal-setting practice can be maximized for patients with different intrinsic characteristics

     

Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy

Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists’ practice of stroke rehabilitation. Method The frame of reference is Fairclough’s critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012–2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient’s independence than to enabling the regaining of meaningful activities and participation.

• Implications for Rehabilitation

• Individualized rehabilitation must be organized with flexibility as it is a complex process

• Critical reflectiveness among health professionals is needed to provide individualized rehabilitation of high quality

• A broader range of stake holders, including patient organizations, are in demand within health policy making

• The discourses that construct rehabilitation policy and practices are sometimes in conflict, which may impact on, and impede, the rehabilitation for the individual patient

     

Understanding nursing practice in stroke units: a Q-methodological study

Abstract

Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses’ involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses’ practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills.

• Implications for Rehabilitation

• Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care.

• Views of stroke unit team members on nurses’ involvement in rehabilitation have not been reported previously.

• Nurses can routinely incorporate rehabilitation principles in their care.

• Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

     

Developing a personalised self-management system for post stroke rehabilitation; utilising a user-centred design methodology

Abstract

Purpose: To develop and evaluate an information and communication technology (ICT) solution for a post-stroke Personalised Self-Managed Rehabilitation System (PSMrS). The PSMrS translates current models of stroke rehabilitation and theories underpinning self-management and self-efficacy into an ICT-based system for home-based post-stroke rehabilitation. Methods: The interdisciplinary research team applied a hybrid of health and social sciences research methods and user-centred design methods. This included a series of home visits, focus groups, in-depth interviews, cultural probes and technology biographies. Results: The iterative development of both the content of the PSMrS and the interactive interfaces between the system and the user incorporates current models of post-stroke rehabilitation and addresses the factors that promote self-managed behaviour and self-efficacy such as mastery, verbal persuasion and physiological feedback. Conclusion: The methodological approach has ensured that the interactive technology has been driven by the needs of the stroke survivors and their carers in the context of their journey to both recovery and adaptation. Underpinned by theories of motor relearning, neuroplasticity, self-management and behaviour change, the PSMrS developed in this study has resulted in a personalised system for self-managed rehabilitation, which has the potential to change motor behaviour and promote the achievement of life goals for stroke survivors.

• Implications for Rehabilitation

• Radical innovation and the adoption of a self-management paradigm need to be considered as a way of delivering home-based post-stroke rehabilitation.

• A hybrid of health and social sciences research and user-centred design methods are required to ensure that technology for post-stroke rehabilitation has been driven by the needs of the stroke survivors and their carers.

• Personalised technology systems for self-managed post-stroke rehabilitation have the potential to change motor behaviour and promote the achievement of life goals for stroke survivors.

     

Role of ankle foot orthoses in functional stability of individuals with stroke

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke. Methods: Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO. Results: When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p?<?0.05). Conclusions: The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke.

• Implications for Rehabilitation

• Functional stability is impaired in individuals with stroke.

• Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control.

• Individuals with stroke improved their functional stability while they were provided with AFOs.

• Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.