Balance, balance confidence, and health-related quality of life in persons with chronic stroke after body weight-supported treadmill training

Combs SA, Dugan EL, Passmore M, Riesner C, Whipker D, Yingling E, Curtis AB. Balance, balance confidence, and health-related quality of life in persons with chronic stroke after body weight–supported treadmill training.ObjectivesTo examine changes in balance, balance confidence, and health-related quality of life immediately and 6 months after body weight–supported treadmill training (BWSTT) for persons with chronic stroke (primary objective) and to determine whether changes in gait speed after BWSTT were associated with changes in these dimensions of health (secondary objective).DesignProspective pre-/posttest pilot study with 6 months retention.SettingUniversity research laboratory settings.ParticipantsA convenience sample of participants (N=19; at least 6mo poststroke; able to ambulate 0.4–0.8m/s) were recruited.InterventionBWSTT was provided for 24 sessions over 8 weeks with 20 minutes of total walking each session.Main Outcome MeasuresBerg Balance Scale (BBS), Activities-Specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), comfortable 10-m walk test (CWT), and fast 10-m walk test (FWT). Proportions of participants who achieved minimal detectable changes (MDCs) were examined for all measures.ResultsStatistically significant improvements were found from pre- to posttest for BBS, ABC, SIS mobility, SIS stroke recovery, and CWT scores (P<.05) and from pretest to retention on BBS, ABC, CWT, and FWT scores (P<.05). For most participants, improvements did not exceed MDCs. Changes in gait speed and BBS, ABC, and SIS scores were not associated.ConclusionsThe findings of this study suggest that effects of BWSTT may transfer beyond gait to positively influence balance, balance confidence, and health-related quality of life. However, for most participants, BWSTT was not sufficient to induce improvements in balance and balance confidence beyond measurement error or long-term retention of enhanced perceptions of quality of life.     

Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study

Badke MB, Sherman J, Boyne P, Page S, Dunning K. Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study.

Objective

To assess balance recovery and quality of life after tongue-placed electrotactile biofeedback training in patients with stroke.

Design

Prospective multicenter research design.

Setting

Outpatient rehabilitation clinics.

Participants

Patients (N=29) with chronic stroke.

Interventions

Patients were administered 1 week of therapy plus 7 weeks of home exercise using a novel tongue based biofeedback balance device.

Main Outcome Measures

The Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-Specific Balance Confidence (ABC) Scale, Dynamic Gait Index (DGI), and Stroke Impact Scale (SIS) were performed before and after the intervention on all subjects.

Results

There were statistically and clinically significant improvements from baseline to posttest in results for the BBS, DGI, TUG, ABC Scale, and some SIS domains (Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, Social, Physical, Recovery domains). Average BBS score increased from 35.9 to 41.6 (P<.001), and DGI score, from 11.1 to 13.7 (P<.001). Time to complete the TUG decreased from 24.7 to 20.7 seconds (P=.002). Including the BBS, DGI, TUG, and ABC Scale, 27 subjects improved beyond the minimal detectable change with 95% certainty (MDC-95) or minimal clinically important difference (MCID) in at least 1 outcome and 3 subjects improved beyond the MDC-95 or MCID in all outcomes.

Conclusions

Electrotactile biofeedback seems to be a promising integrative method to balance training. A future randomized controlled study is needed.     

Effect of space balance 3D training using visual feedback on balance and mobility in acute stroke patients

[Purpose] The purpose of the study was to determine the effects of balance training with Space Balance 3D, which is a computerized measurement and visual feedback balance assessment system, on balance and mobility in acute stroke patients. [Subjects and Methods] This was a randomized controlled trial in which 52 subjects were assigned randomly into either an experimental group or a control group. The experimental group, which contained 26 subjects, received balance training with a Space Balance 3D exercise program and conventional physical therapy interventions 5 times per week during 3 weeks. Outcome measures were examined before and after the 3-week interventions using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Postural Assessment Scale for Stroke Patients (PASS). The data were analyzed by a two-way repeated measures ANOVA using SPSS 19.0. [Results] The results revealed a nonsignificant interaction effect between group and time period for both groups before and after the interventions in the BBS score, TUG score, and PASS score. In addition, the experimental group showed more improvement than the control group in the BBS, TUG and PASS scores, but the differences were not significant. In the comparisons within the groups by time, both groups showed significant improvement in BBS, TUG, and PASS scores. [Conclusion] The Space Balance 3D training with conventional physical therapy intervention is recommended for improvement of balance and mobility in acute stroke patients.Key words: Balance training, Visual feedback, Acute stroke patients     

Validity of the Community Balance and Mobility Scale in Community-Dwelling Persons After Stroke

Knorr S, Brouwer B, Garland SJ. Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke.

Objectives

To examine the convergent validity, sensitivity to change, floor and ceiling effects of the Community Balance and Mobility Scale (CB&M) in community-dwelling stroke survivors. The secondary objective was to determine the correlations between the CB&M and lower-limb motor recovery and strength.

Design

Validity study.

Setting

Two university-based research centers.

Participants

Community-dwelling persons after stroke (N=44; 24 men, 20 women; mean age, 62.6±12.6y). Baseline measures were taken 3 months after the onset of stroke (98.6±52.6d); participants were reassessed 8 months poststroke (246.8±57.2d).

Interventions

Not applicable.

Main Outcome Measures

CB&M, Berg Balance Scale (BBS), Timed Up & Go (TUG), Chedoke McMaster Stroke Assessment (CMSA) Impairment Inventory for leg and foot, concentric bilateral isokinetic strength of the lower-limb flexor and extensor muscle groups using a dynamometer. The magnitude of the associations and the standardized response means (SRMs) among the CB&M, BBS, and TUG were used to examine the convergent validity and sensitivity to change, respectively.

Results

Moderate to high convergent validities (ρ=.70 to .83, P<.001) were observed among the CB&M, BBS, and TUG. The CB&M was moderately correlated with the CMSA leg and foot scores (ρ=.61 and .63, respectively, P<.001) and the paretic limb strength (ρ=.67, P<.001). The CB&M demonstrated the greatest ability to detect change between the baseline and follow-up assessments (SRM=.83).

Conclusions

The CB&M is valid and sensitive to change in assessing functional balance and mobility in ambulatory stroke survivors with moderate to mild neurologic impairments.     

Visual and haptic verticality misperception and trunk control within 72 h after stroke

IntroductionStroke patients often exhibit an altered perception of verticality, but there are no studies evaluating verticality perception in the first 72 h after stroke and its relationship with trunk control. Therefore, this study aimed to analyze visual and haptic verticality in the acute phase of stroke.MethodsThis was a cross-sectional study conducted with two groups: (a) 13 individuals with stroke and (b) 12 healthy participants. We assessed verticality via the subjective visual vertical (SVV) and the subjective haptic vertical (SHV); and we measured trunk control with the Trunk Impairment Scale (TIS). We performed t-tests to compare the SVV and SHV between groups. Pearson correlation was performed between verticality tests with National Institutes of Health Stroke Scale (NIHSS) and the TIS.ResultsParticipants with recent stroke presented higher true and absolute SVV deviation values than did the control group. There was significant negative correlation between absolute (r = −0.57; p = 0.02) and true SVV (r = −0.54; p = 0.01) with TIS scores There was also significant positive correlation between absolute (r = 0.63; p = 0.009) and true SVV (r = 0.61; p = 0.003) with NIHSS. A significant negative correlation between NIHSS and TIS scores also was found (r = −0.80; p = 0.005).ConclusionIndividuals with acute stroke presented larger variability in their perceptions of visual verticality than did healthy controls, and verticality perceptions were positively correlated with trunk impairment.     

Apathy and Health-Related Quality of Life in Stroke

Objective

To examine differences in health-related quality of life (HRQOL) in stroke survivors with and without apathy.

Design

Cross-sectional study.

Setting

Acute stroke unit in a regional hospital.

Participants

Stroke survivors (N=391) recruited from the acute stroke unit.

Interventions

Not applicable.

Main Outcome Measures

Participants were divided into apathy and nonapathy groups. Participants who scored ≥36 on the Apathy Evaluation Scale, clinician's version formed the apathy group. HRQOL was measured with the 2 component scores, mental component summary (MCS) and physical component summary (PCS), of the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12). Demographic and clinical information were obtained with the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS).

Results

Thirty-six (9%) participants had apathy. The apathy group had significantly lower MCS and PCS scores. After adjusting for sex, education, diabetes mellitus, and NIHSS, MMSE, GDS, and BI scores, the MCS score in the apathy group remained significantly lower.

Conclusions

Apathy has a significant negative effect on HRQOL in stroke survivors, particularly on their mental health. Interventions for apathy could improve the HRQOL of stroke survivors.     

聚焦解决模式在脑卒中出院患者随访管理中的应用

目的：探讨对脑卒中患者进行聚焦解决模式随访管理的效果。方法选取我院神经内科2015年2~6月收治的脑卒中患者,分为对照组37例,干预组35例。对照组实施常规随访模式管理,干预组在此基础上应用聚焦解决模式随访管理。两组患者在随访前、随访后3个月末以及随访后6个月末均采用脑卒中影响量表、脑卒中患者出院随访依从性问题和脑卒中健康知识试卷进行测评,并进行比较。结果随访后3个月末干预组SIS评分中力气、记忆与思维、交流、ADL/IADL、移动能力、参与,出院随访依从性中的康复训练、生活作息、按时服药、按时复诊的条目评分以及脑卒中健康知识得分与对照组比较差异有统计学意义(P<0.05),随访后6个月末干预组SIS、出院随访依从性各维度及脑卒中健康知识得分与对照组比较差异有统计学意义( P<0.05)。结论应用聚焦解决模式随访管理能改善脑卒中患者的生存质量,同时对提高健康认知水平及出院随访依从性有积极影响。     

Perceived recovery as a predictor of physical activity participation after mild stroke

Purpose: The purpose of this study was to identify what acute care variables and/or perceived recovery factors could predict decreased participation in physical activities post-mild stroke. Methods: Secondary analysis of persons with mild stroke. Participants were split into two groups based on the percentage of high-demand leisure (HDL) activities retained on the Activity Card Sort (ACS) at 6 months post-stroke. Demographic variables, measures from the acute care setting (National Institutes of Health Stroke Scale (NIHSS), premorbid Barthel Index, and Modified Rankin Scale), and a perceived recovery measure collected at 6 months post-stroke (Stroke Impact Scale (SIS)) were analyzed between groups using independent samples t-tests and logistic regression. Results: There were no significant differences between groups on any of the demographic or acute care setting measures. Logistic regression indicated that only the overall perceived recovery (p = 0.05) and strength domain scores (p = 0.01) of the SIS were statistically significant factors for determining the percent of retained HDL activities following mild stroke. Conclusions: Clinicians must consider the clients’ own perceived recovery level and other more subjective factors in determining what barriers are limiting their physical activity participation after stroke.

Implications for Rehabilitation

• Persons with mild stroke are significantly decreasing their participation in physical activities post-stroke.

• Common stroke measures from the acute care setting that are currently used in practice are not sensitive enough to predict the changes in physical activity after mild stroke.

• Perceived level of recovery/limitations should be considered by clinicians in determining what barriers are affecting clients’ physical activity participation after stroke.

     

Do Changes in Mental Energy and Fatigue Impact Functional Assessments Associated with Fall Risks? An Exploratory Study Using Machine Learning

Abstract

Using a crossover-design, we assessed changes in 30-second chair stand test (30?s-CST), Timed Up-and-Go (TUG) and Berg Balance Scale (BBS) and energy and fatigue in older adults (N?=?11) after performance of mental tasks. A Wilcoxon Sign Rank Test and a Friedman’s rank test were used to assess changes in 30?s-CST, TUG, BBS and energy and fatigue respectively. A linear mixed model was used to assess joint variance and random forest classifier and support vector machine (SVM) algorithms were used to verify results. Statistically significant declines in feelings of energy (p=.003), specifically mental energy (p=.015), and BBS (p<.001), specifically during the “standing with eyes closed” (SEC), was noted for participants on days when they completed mental tasks compared to days they did not. The random-forest and SVM algorithms predicted with 79% and 80% accuracy respectively whether the SEC item of the BBS was performed after a decline a mental energy.     

中青年出血性脑卒中患者功能锻炼依从性的影响因素及路径分析

目的 了解中青年出血性脑卒中患者功能锻炼依从性现状,影响因素及其作用路径,以期为医护人员做好中青年出血性脑卒中的运动康复管理提供理论依据。方法 2021年7月—2022年5月,采用便利抽样法选取我国北、东、中部3所三级甲等医院神经外科369名中青年出血性脑卒中患者为研究对象。应用一般资料调查表、脑卒中健康信念量表、运动自我效能量表、锻炼计划量表及脑卒中功能锻炼依从性量表进行调查。结果 369例患者功能锻炼依从性总分为（43.18±9.57）分,患者功能锻炼依从性与健康信念、运动自我效能、计划分别呈显著正相关（r=0.529,0.717,0.686;均P<0.01）;健康信念对运动自我效能、计划和功能锻炼依从性均有直接正向预测作用（β=0.393,0.371,0.155;均P<0.01）;运动自我效能和计划在健康信念与功能锻炼依从性间呈部分中介作用（β=0.375,P<0.01）,中介效应占总效应值的70.75%。结论 运动自我效能、计划在患者健康信念和功能锻炼依从性间起中介作用,医护人员应加强对中青年出血性脑卒中患者的健康教育,提升内在驱动力,促使其形成运动计划,进而提高患者的功能锻炼依从性。     

Stroke Quick Score: a visual aid in scoring neurologic deficits for acute stroke with National Institutes of Health Stroke Scale

The 15-item National Institutes of Health Stroke Scale is depicted here as a single diagram with major categories of deficits placed into 3 separate functional groups with 7 points assigned to each, in addition to 4 points for motor deficits in each of 4 extremities. This simple composite visual aid, known as the Stroke Quick Score, may help in training stroke team members in the use of the National Institutes of Health Stroke Scale.     

Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone

Hiengkaew V, Jitaree K, Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up &; Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone.ObjectiveTo determine test-retest reliability and absolute and relative minimal detectable changes at the 95% confidence level (MDC₉₅) of measures to detect postural balance and lower limb movements in individuals with chronic stroke who were able to walk and had differences in ankle plantarflexor tone.DesignTest-retest study. Data were collected on 2 occasions, about 6 days apart.SettingOutpatient physical therapy clinics.ParticipantsVolunteers (N=61) with chronic stroke who were able to walk and had differences in ankle plantarflexor tone: no increase in ankle plantarflexor tone (n=12), a slight increase in ankle plantarflexor tone (n=32), and a marked increase in ankle plantarflexor tone (n=17).InterventionNot applicable.Main Outcome MeasuresReliability and absolute and relative MDC₉₅ of the Berg Balance Scale (BBS), the lower limb subscale of Fugl-Meyer Assessment (FMA-LE), the Timed “Up &; Go” test (TUG), the comfortable gait speed (CGS), the fast gait speed (FGS), and the 2-minute walk test (2MWT).ResultsExcellent reliability of the BBS, FMA-LE, TUG, CGS, FGS, and 2MWT for all the participants combined and for the subgroups was shown. All the participants combined showed the absolute and relative MDC₉₅ in the BBS of 5 points and 10%, FMA-LE of 4 points and 16%, TUG of 8 seconds and 28%, CGS of 0.2m/s and 34%, FGS of 0.1m/s and 21%, and 2MWT of 13m and 23%. The absolute and relative MDC₉₅ of the subgroups were varied based on ankle plantarflexor tone.ConclusionsThe BBS, FMA-LE, TUG, CGS, FGS, and 2MWT are reliable measures to detect postural balance and lower limb movements in individuals with chronic stroke who have differences in ankle plantarflexor tone. The absolute and relative MDC₉₅ of each measure are dissimilar in those with differences in ankle plantarflexor tone. The relative MDC₉₅ seems more useful than the absolute MDC₉₅ because the relative value can be used for a single individual.     

Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-analysis

ObjectiveTo consolidate the evidence from randomized trials for the use of endovascular therapy (ET) in patients with acute ischemic stroke.MethodsWe searched major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus) from their inception to February 12, 2013, for randomized trials evaluating the efficacy of ET compared with standard of care for acute ischemic stroke. Pooled absolute and relative risk estimates were synthesized by using a random-effects model. Heterogeneity was assessed by using Q statistic and I² statistic. Subset analysis was performed for patients with severe stroke (National Institutes of Health Stroke Scale score ≥20). The study was conducted from January 15, 2013 to April 30, 2013.ResultsOf the 1252 retrieved articles, 5 randomized trials enrolling 1197 patients with acute ischemic stroke were included. Seven hundred eleven patients received ET, and 486 received intravenous (IV) tissue plasminogen activator. There was no significant improvement in any of the outcomes in patients receiving ET compared with those receiving IV thrombolysis. On subgroup analysis, ET was found to have better outcomes in patients with severe stroke (National Institutes of Health Stroke Scale score ≥20), showing a dose-response gradient and improving excellent, good, and fair outcomes by an additional 4%, 7%, and 13%, respectively, compared with IV thrombolysis.ConclusionOverall, ET is not superior to IV thrombolysis for acute ischemic strokes (level B recommendation). However, ET showed promise and improved outcomes in patients with severe strokes, but the evidence is limited due to sample size. There is a need for further trials evaluating the role of ET in this high-risk group.     

Group- and Individual-Level Responsiveness of the 3-Point Berg Balance Scale and 3-Point Postural Assessment Scale for Stroke Patients

Objectives

To examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (Berg Balance Scale [BBS] and Postural Assessment Scale for Stroke Patients [PASS]) and their short forms (short-form Berg Balance Scale [SFBBS] and short-form Postural Assessment Scale for Stroke Patients [SFPASS]) and between the BBS-3P and PASS-3P.

脑卒中患者血浆Lp-PLA2水平及临床意义探讨

目的研究脑卒中患者血浆脂蛋白相关磷脂酶A2(Lp-PLA2)的变化,探讨其与缺血性脑卒中梗死灶大小和神经功能缺损程度的关系。方法采用酶联免疫吸附试验(ELISA)测定180例缺血性脑卒中患者、165例出血性脑卒中患者及105名健康对照者(正常对照组)血浆Lp-PLA2水平,同时测定血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、葡萄糖(Glu)及纤维蛋白原(FIB)。采用受试者工作特征(ROC)曲线评价Lp-PLA2对缺血性脑卒中和出血性脑卒中的诊断效能;采用头颅核磁共振检查脑梗死体积大小,按照美国国立卫生研究所中风量表进行神经功能缺损程度评估;对缺血性脑卒中患者血浆Lp-PLA2与神经功能缺损程度评分进行相关性分析。结果缺血性脑卒中组、出血性脑卒中组和正常对照组之间Lp-PLA2、TC、HDL-C、LDL-C、FIB水平差异均有统计学意义(P均0.05);缺血性脑卒中组与出血性脑卒中组之间TG和Glu水平差异无统计学意义(P值分别为0.133、0.067),但与正常对照组比较差异有统计学意义(P均0.05)。血浆Lp-PLA2诊断缺血性脑卒中的ROC曲线下面积为(AUC)为0.905、最佳临界点为42.35μg/L、敏感性为81.5%、特异性为80.0%。血浆Lp-PLA2水平随脑梗死体积增加而呈递增趋势,但差异无统计学意义(H=0.372,P=0.719)。Spearman相关分析显示缺血性脑卒中患者血浆Lp-PLA2水平与神经功能缺损程度评分密切相关(P均0.05)。结论缺血性脑卒中患者血浆Lp-PLA2水平明显升高,与神经功能缺损程度评分密切相关。Lp-PLA2是缺血性脑卒中发病的独立危险因子,可成为缺血性脑卒中的预测指标和评价病情严重程度的重要指标。     

The effects of stair gait training using proprioceptive neuromuscular facilitation on stroke patients’ dynamic balance ability

[Purpose] This study aims to examine stroke patients’ changes in dynamic balance ability through stair gait training where in proprioceptive neuromuscular facilitation (PNF) was applied. [Subjects and Methods] In total 30 stroke patients participated in this experiment and were randomly and equally allocated to an experimental group and a control group. The experimental group received exercise treatment for 30 min and stair gait training where in PNF was applied for 30 min and the control group received exercise treatment for 30 min and ground gait training where in PNF was applied for 30 min. For the four weeks of the experiment, each group received training three times per week, for 30 min each time. Berg Balance Scale (BBS) values were measured and a time up and go (TUG) test and a functional reach test (FRT) were performed for a comparison before and after the experiment. [Results] According to the result of the stroke patients’ balance performance through stair gait training, the BBS and FRT results significantly increased and the TUG test result significantly decreased in the experimental group. On the contrary, BBS and FRT results did not significantly increase and the TUG test result did not significantly decrease in the control group. According to the result of comparing differences between before and after training in each group, there was a significant change in the BBS result of the experimental group only. [Conclusions] In conclusion, the gait training group to which PNF was applied saw improvements in their balance ability, and a good result is expected when neurological disease patients receive stair gait training applying PNF.Key words: Proprioceptive neuromuscular facilitation, Stroke, Balance ability     

The Effect of Statins on Acute and Long-Term Outcome After Ischemic Stroke in the Elderly

BackgroundAlthough treatment with statins has produced beneficial effects when used as secondary prevention, its primary protective role is still somewhat controversial. Moreover, few studies have evaluated the effect of statins in older patients with stroke.ObjectiveThe aim was to investigate whether treatment with statins decreases stroke severity and/or improves survival and outcome after stroke in an older population.MethodsWe investigated the association between previous statin use and stroke severity (National Institutes of Health Stroke Scale [NIHSS]), as well as the effect of poststroke statin treatment on 12-month functional outcome (modified Rankin Scale [mRS] score) in 799 patients (mean age, 78 years), with acute ischemic stroke. The effect of statin treatment on survival was examined using the Cox proportional hazard model, after adjusting for relevant covariates.ResultsStatins did not decrease stroke severity and did not improve 30-day survival. However, both the 12-month survival (hazard ratio = 0.33; 95% CI, 0.20–to 0.54; P < 0.001) and the 12-month functional outcome (odds ratio = 2.09; 95% CI, 1.25–3.52; P = 0.005) were significantly better in the group treated with statins.ConclusionsSignificantly better survival and functional outcome were noted with poststroke statins at the end of the 12-month follow-up period. Statins seem to provide beneficial effects for the long-term functional outcome and survival in the elderly.     

Role of the newly designed Ankle Foot Orthosis on balance related parametersin drop foot post stroke patients

BackgroundPassive and hybrid passive ankle foot orthoses (AFOs) are often prescribed in post stroke drop foot; however, the effects of these AFOs on balance related parameters in these patients seem unclear. Accordingly, the aim of current study was to evaluate the role of the newly designed hybrid passive and Posterior Leaf Spring (PLS) AFOs on balance related parameters including: self-reported balance confidence (ABC), Timed Up and Go Test (TUG) and Berg Balance Scale (BBS) in post stroke drop foot patients.MethodsFifteen post stroke drop foot patients were recruited in current study. Then, ABC, TUG and BBS were assessed with newly designed AFO and PLS AFO.ResultsThe results of this study were shown a significant improvement in ABC, TUG and BBS scores with the newly designed AFO than PLS AFO (p < 0.05).ConclusionThis study suggested that the newly designed AFO was improved the balance related parameters than PLS AFO.