Among patients who have had an acute cerebrovascular accident, use of either an off-the-shelf carbon ankle-foot orthosis or a custom plastic ankle-foot orthosis significantly improved gait velocity, cadence and step and stride length compared with no ankle-foot orthosis, according to study results.
“For years custom [ankle-foot orthoses] have been the standard, but there has been a big push in marketing and development of prefabricated carbon fiber devices that seem like they can be appropriate in an acute rehabilitation environment,” Daniel Hasso, CPO, LPO, of Scheck and Siress, told O&P Business News. “The purpose behind the study was to determine which type of bracing would be more appropriate for the cerebrovascular accident population.”
C-AFO vs. P-AFO
In random order, 30 patients with acute hemiparetic cerebrovascular accidents (CVA) were trialed and tested with an off-the-shelf carbon ankle-foot orthosis (C-AFO), a custom plastic AFO (P-AFO) or no AFO. Researchers collected temporal and spatial gait parameters using a GAITRite electronic walkway (CIR Systems Inc, Havertown, Pa.) and all participants completed the Subject Perception of Functional Benefit Survey.
Compared to no AFO use, when patients used a P-AFO or C-AFO study results showed they walked significantly faster with a higher cadence and longer stride and step lengths. While researchers found no significant difference in gait parameters between the P-AFO and C-AFO, patients preferred using the P-AFO significantly in relation to balance, confidence and sense of safety during ambulation. Overall, 50.87% of patients preferred the P-AFO and 23.56% preferred the C-AFO. Researchers also found 18.1% of patients preferred using both types of AFOs and 3.1% preferred not using either type of AFO.
“With the acute stroke population, [patients] need to get up and move and walk. Walking is a positive sign in terms of [a patient’s] ability to recover and function back in society. If the person is comfortable, I think they are going to be more apt to want to walk or at the very least it is one less barrier to walking,” Hasso said. “[These results] underline that what we do is important [and] that custom made devices still have a role in today’s environment. Even though it may not have an increased performance value, it does have a preference value among this patient population.”
Future research
While the results of this study were generally in line with the literature, according to the researchers, future studies should focus on the effect of different types of AFOs on gait velocity and cadence, and also should examine the longer term effects, as well as the cost-effectiveness of prescribing a C-AFO or P-AFO to patients with CVA.
“[This study] is just another little piece of information that helps us make good clinical decisions,” Hasso said. “It is not going to change too drastically the way anybody goes about doing what they do, but it is one more little piece of evidence that says what we do is significant and it is an important part of the rehabilitation process.”
“I think our profession in general needs a lot more research that underlines and says what we do and supports its relevance,” Hasso continued. “Hopefully [this study] sparks someone’s interest and they will do more. Maybe look at it with a different population, maybe a multiple sclerosis population or an orthopedic injury type population to see if there are similar results.” — by Casey Tingle
Rao N. Rehabil Res Pract. 2014;doi: 10.1155/2014/301469.
Disclosure: Hasso has no relevant financial disclosures.
