| Author: | Wong, Shu-ming Denis |
| Title: | The effect of hinged ankle-foot orthoses with plantarflexion stop vs plantarflexion-resistant control on the gait pattern of patients with stroke |
| Degree: | M.Sc. |
| Year: | 2008 |
| Subject: | Hong Kong Polytechnic University -- Dissertations. Foot -- Abnormalities -- Treatment. Orthopedic apparatus. Cerebrovascular disease -- Patients -- Rehabilitation. |
| Department: | Department of Health Technology and Informatics |
| Pages: | xxii, 138 leaves : ill. (chiefly col.) ; 30 cm. |
| Language: | English |
| Abstract: | The aims of this study are to critically evaluate the effects of Ankle Foot Orthoses (AFO) on the walking gait of hemiplegic patients using three-dimensional quantitative gait analysis. The kinematic, kinetic and temporal-spatial parameters were identified during ambulation, and subjects were divided into two groups - one group with simple hinged AFO with plantarflexion stop (PFS) while the other group with AFO with plantarflexion-resistant control (PFR). Quantitative gait analysis and patients' opinion on the use of AFOs were assessed. All data were collected under 3 walking conditions: (1) with shoes only as control, (2) hinged AFO with PFS joint together with shoes and (3) AFO with PFR joint together with shoes. Repeated measures design with subjects serving as their own controls was used in this study. The subjects were tested with no orthoses for a baseline measurement, then with two different hinged AFOs. The order of wearing either AFO with PFS or PFR joint was randomly assigned. A subject's feedback form focused on two main issues: the effect of the AFO on gait and the subjective view of two different AFOs, was modified from Tyson (2001). Subjects were questioned about the key aspects of functional outcomes; including the ability to lift their toes, swing their leg forwards, take weight through their leg and the effect on their confidence, perceived safety, speed, and distance they can walk. Then they were asked the effect of the hinged AFO on these aspects of walking. They also commented on the comfort and weight of the hinged AFO, ease of donning & doffing, and their opinions on its appearance. At the end of evaluation, patients would be invited to choose their preferred AFO if they need it for long-term application. Total eight subjects, five males and three females, were recruited in this study (with mean age = 57.5 years; SD = 10.39; range = 38-74). Subjects wearing either AFO (PFS) or AFO (PFR) showed significant improvement in reducing abnormal ankle plantarflexion in the stance and swing phase. There were also significantly reduced in peak knee extension moment in mid-stance found on patients wearing both AFOs. Moreover, there were slight reductions/improvements in peak knee extension in stance, pelvic obliquity, velocity, cadence, step width as well as single & double support, but the differences were not significant. The plantarflexion angle at initial contact on both AFO (PFS) and AFO (PFR) conditions were significantly smaller than control (Shod) condition (p<0.001). The mean ankle range in stance on control (Shod) conditions was significantly larger than that of AFO (PFS) condition (p=0.002). Moreover, the mean peak ankle plantarflexion in stance on control (Shod) conditions was significantly larger than AFO (PFS) and AFO (PFR) conditions (p=0.001 & 0.002) and the mean peak ankle plantarflexion in swing on control (Shod) conditions was significantly larger than AFO (PFS) and AFO (PFR) conditions (p=0.001 & 0.002). A significant difference was also found between AFO (PFS) and AFO (PFR), with the ankle range of AFO (PFR) condition significantly larger than AFO (PFS) condition in stance (p<0.001) as well as ankle plantarflexion in stance and swing conditions (p=0.042 & 0.002). For the kinetic result, the peak knee extension moment in mid-stance was significantly reduced in both AFO (PFS) and AFO (PFR) conditions (p<0.001 and p=0.004). The subjects were very positive about the use of AFOs. All subjects chose "improved" or "a little improved" in all question items with AFO (PFS) and nobody felt it made worse on walking. Most of the subjects (n=6, 75%) found the weight of AFO (PFS) was acceptable, seven of them felt that it was easy to put on and take off, while six subjects accepted the appearance of AFO. The result of patient's feedback in the AFO (PFR) group was similar to that of AFO (PFS). However, subjects found that their gait pattern were better in AFO (PFR) group. Nobody commented on the weight of AFO, ease of donning and doffing together with its appearance as not acceptable. Most of the subjects (87.5%) preferred AFO (PFR) as their long-term prescribed orthoses because of its wider range of controlled ankle motion that was similar to normal gait pattern. It was concluded that both AFOs changed talipes equines gait pattern into normal heel-toe gait pattern in all subjects. However, subjects wearing AFO (PFR) showed better improvement in gait pattern due to presence of dorsiflexion and controlled plantarflexion motion by the PER joint resulting in smooth progression of the body during stance phase. |
| Rights: | All rights reserved |
| Access: | restricted access |
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|---|---|---|---|---|
| b22404570.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 6.99 MB | Adobe PDF | View/Open |
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