Skip to main content

A novel hinged ankle foot orthosis for gait performance in chronic hemiplegic stroke survivors: a feasibility study

Abstract

Stroke survivors with gait disturbances may use ankle foot orthoses (AFOs). However, most AFOs come in one-piece styles, which make it difficult for spasticity-affected stroke survivors to don. AFOs are also limited since they do not properly prevent ankle joint for foot drop by itself. Therefore, the present study developed a novel hinged AFO by adding a locking device to a hinged joint. We then tested its feasibility in 9 hemiplegic stroke survivors by investigating temporal–spatial gait parameters using the GAITRite in the following 3 conditions: no AFO, traditional AFO, and novel hinged AFO. There was no significant difference in spatiotemporal gait parameters among the different conditions. There were greater decreases in gait velocity, cadence, step length, and stride length in the novel hinged AFO group than in the no AFO and traditional AFO groups. This novel hinged AFO was developed to prevent foot drop. However, the AFO did not show significant differences in gait parameters because it consists of metal with extra weight and volume. Functionally, it prevented foot drop. It also improved convenience by its releasable design. Thus, further studies are needed to develop an AFO that improves gait and is convenient to use for hemiplegic stroke survivors.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. de Wit DC, Buurke JH, Nijlant JM, Ijzerman MJ, Hermens HJ. The effect of an ankle–foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial. Clin Rehab. 2004;18:550–7.

    Article  Google Scholar 

  2. Awad LN, Palmer JA, Pohlig RT, Binder-Macleod SA, Reisman DS. Walking speed and step length asymmetry modify the energy cost of walking after stroke. Neurorehab Neural Rep. 2015;29:416–23.

    Article  Google Scholar 

  3. Lewek MD, Bradley CE, Wutzke CJ, Zinder SM. The relationship between spatiotemporal gait asymmetry and balance in individuals with chronic stroke. J Appl Biomech. 2014;30:31–6.

    Article  Google Scholar 

  4. Abe H, Michimata A, Sugawara K, Sugaya N, Izumi S. Improving gait stability in stroke hemiplegic patients with a plastic ankle–foot orthosis. Tohoku J Exper Med. 2009;218:193–9.

    Article  Google Scholar 

  5. Cho KH, Lee JY, Lee KJ, Kang EK. Factors related to gait function in post-stroke patients. J Phys Ther Sci. 2014;26:1941–4.

    Article  Google Scholar 

  6. van Bloemendaal M, Bus SA, de Boer CE, Nollet F, Geurts AC, Beelen A. Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial. Trials. 2016;17:477.

    Article  Google Scholar 

  7. Roth EJ, Harvey RL. Rehabilitation of stroke syndromes. Physical medicine and rehabilitation. 2nd ed. Philadelphia: WB Saunders; 2000. p. 1117–63.

    Google Scholar 

  8. Jeong YG, Jeong YJ, Myong JP, Koo JW. Which type of cane is the most efficient, based on oxygen consumption and balance capacity, in chronic stroke patients? Gait Posture. 2015;41:493–8.

    Article  Google Scholar 

  9. Richards CL, Malouin F, Dean C. Gait in stroke: assessment and rehabilitation. Clin Geriatr Med. 1999;15:833–55.

    Article  Google Scholar 

  10. Tyson SF, Rogerson L. Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients’ opinion. Arch Phys Med Rehabil. 2009;90:475–9.

    Article  Google Scholar 

  11. Raine S. The current theoretical assumptions of the Bobath concept as determined by the members of BBTA. Physiother Theory Pract. 2007;23:137–52.

    Article  Google Scholar 

  12. Mauritz KH. Gait training in hemiparetic stroke patients. Eur Medicophys. 2004;40:165–78.

    Google Scholar 

  13. Gök H, Küçükdeveci A, Altinkaynak H, Yavuzer G, Ergin S. Effects of ankle–foot orthoses on hemiparetic gait. Clin Rehab. 2003;17:137–9.

    Article  Google Scholar 

  14. Geboers JF, Drost MR, Spaans F, Kuipers H, Seelen HA. Immediate and long-term effects of ankle–foot orthosis on muscle activity during walking: a randomized study of patients with unilateral foot drop. Arch Phys Med Rehabil. 2002;83:240–5.

    Article  Google Scholar 

  15. Ryerson SD. Hemiplegia. In: Umphred DA, editor. Neurological rehabilitation. New York: Elseiver; 2001.

    Google Scholar 

  16. Leung J, Moseley A. Impact of ankle–foot orthoses on gait and leg muscle activity in adults with hemiplegia: systematic literature review. Physiotherapy. 2003;89:39–55.

    Article  Google Scholar 

  17. Wang RY, Yen LL, Lee CC, Lin PY, Wang MF, Yang YR. Effects of an ankle–foot orthosis on balance performance in patients with hemiparesis of different durations. Clin Rehab. 2005;19:37–44.

    Article  Google Scholar 

  18. Whiteside S, Allen MJ, Beiswenger WD. Practice analysis of certified practitioners in the disciplines of orthotics and prosthetics. Alexandria: American Board for Certification in Orthotics and Prosthetics Inc; 2007.

    Google Scholar 

  19. Kim JH, Sim WS, Won BH. Effectiveness of elastic band-type ankle–foot orthoses on postural control in poststroke elderly patients as determined using combined measurement of the stability index and body weight-bearing ratio. Clin Interv Aging. 2015;10:1839–47.

    Article  Google Scholar 

  20. Ring H, Treger I, Gruendlinger L, Hausdorff JM. Neuroprosthesis for footdrop compared with an ankle–foot orthosis: effects on postural control during walking. J Stroke Cerebrovasc Dis. 2009;18:41–7.

    Article  Google Scholar 

  21. Sankaranarayan H, Gupta A, Khanna M, Taly AB, Thennarasu K. Role of ankle foot orthosis in improving locomotion and functional recovery in patients with stroke: a prospective rehabilitation study. J Neurosci Rural Pract. 2016;7:544–9.

    Article  Google Scholar 

  22. Bouchalová V, Houben E, Tancsik D, Schaekers L, Meuws L, Feys P. The influence of an ankle–foot orthosis on the spatiotemporal gait parameters and functional balance in chronic stroke patients. J Phys Ther Sci. 2016;28:1621–8.

    Article  Google Scholar 

  23. Simons CD, van Asseldonk EH, van der Kooij H, Geurts AC, Buurke JH. Ankle–foot orthoses in stroke: effects on functional balance, weight-bearing asymmetry and the contribution of each lower limb to balance control. Clin Biomech. 2009;24:769–75.

    Article  Google Scholar 

  24. Telfer S, Pallari J, Munguia J, Dalgarno K, McGeough M, Woodburn J. Embracing additive manufacture: implications for foot and ankle orthosis design. BMC Musculoskelet Disord. 2012;13:84.

    Article  Google Scholar 

  25. Kobayashi T, Leung AK, Hutchins SW. Techniques to measure rigidity of ankle–foot orthoses: a review. J Rehabil Res Dev. 2011;48:565–76.

    Article  Google Scholar 

  26. Chen CH, Yeung KT, Wu SH, Chiang PY. Effects of an anterior ankle–foot orthosis on hemiplegic gait. J Rehabil Med Assoc ROC. 1998;26:119–27.

    Google Scholar 

  27. Balmaseda MT Jr, Koozekanani SH, Fatehi MT, Gordon C, Dreyfuss PH, Tanbonliong EC. Ground reaction forces, center of pressure, and duration of stance with and without an ankle–foot orthosis. Arch Phys Med Rehab. 1988;69:1009–12.

    Google Scholar 

  28. Thijssen DH, Paulus R, van Uden CJ, Kooloos JG, Hopman MT. Decreased energy cost and improved gait pattern using a new orthosis in persons with long-term stroke. Arch Phys Med Rehab. 2007;88:181–6.

    Article  Google Scholar 

Download references

Funding

No financial or grant support was received for this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to GyuChang Lee.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This study was conducted after the approval of the Institutional Review Board of Kyungnam University.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, SH., Choi, C., Lee, D. et al. A novel hinged ankle foot orthosis for gait performance in chronic hemiplegic stroke survivors: a feasibility study. Biomed. Eng. Lett. 8, 301–308 (2018). https://doi.org/10.1007/s13534-018-0074-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13534-018-0074-3

Keywords

  • Ankle foot orthosis
  • Hemiplegic stroke survivors
  • Gait