Background: Ankle-foot orthoses (AFO) have been used to improve the gait of individuals post stroke, but their use has come into question secondary to increased understanding of motor re-learning. Objectives: The purpose of this study was to determine if there is a change in tibialis anterior muscle electromyography, ankle angle, or gait velocity when individuals post stroke walk with a posterior leaf-spring AFO (PLAFO) or a dynamic ankle orthosis (DAO). Study Design: Repeated measures. Methods: Fifteen participants post stroke walked without an orthosis, with a PLAFO, and with a DAO. Data were gathered using electromyography, force plates, and three-dimensional motion analysis cameras. A repeated measures ANOVA was used to test for statistical significance (p 0.05). Results: Participants exhibited significantly less tibialis anterior muscle electromyography during the swing phase of gait with use of a DAO (p < 0.001). No change in velocity or ankle angle was exhibited with use of either orthosis. Conclusions:The results support therapists' notions that bracing can lead to a decline in tibialis anterior muscle activity during the swing phase of gait. The results also showed no improvement in gait velocity when either orthosis was used by participants who could walk without an orthosis. Clinical relevanceFirst, the use of relatively flexible orthoses can cause a decline in tibialis anterior muscle activity during the swing phase of gait. Secondly, neither the posterior leaf-spring ankle-foot orthosis nor the dynamic ankle orthosis should be prescribed to improve gait velocity in individuals who are able to walk without bracing.

The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0-9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. During phase A, the children received their usual physical therapy treatment. During phase B, children received the prolonged standing program three times per week, in addition to their usual physical therapy treatment. During phase A2, children received their usual physical therapy treatment. Gait analysis and clinical assessment of spasticity were performed before and after each phase. Analysis of variance (ANOVA) for repeated measurements was used to test for changes in gait measures across the four measurement sessions. Friedman's was used to test for changes in muscle tone (Modified Ashworth Scale) across the four measurement sessions. Stride length (p <.001), gait speed (p <.001), stride time (p <.001), stance phase time (p <.001), double support time (p <.003), muscle tone (p <.02), and peak dorsiflexion angle during midstance (p <.004) improved significantly following the intervention phase. The results of this study demonstrate that the gait pattern of children with cerebral palsy classified as level II or III on the Gross Motor Functional Classification System (GMFCS) improved by a prolonged standing program. However, these improvements were not maintained at 3 weeks. Further research is necessary with larger sample sizes to replicate these findings and determine specific "dosing" for standing programs to create long-lasting functional effects on gait.

The use of an assistive ambulatory device (AAD) such as a cane or walker may potentially be linked to a greater risk of falling. This study examined the test and re-test reliability of an instrument developed by the authors: the Ambulatory Device Dependence Efficacy Scale (ADDES), which assesses older institutionalized adults’ level of dependence on an AAD, with the aim of determining the relationship (if any) between AAD dependence and falling. Thirty-five AAD users from two assistive living facilities qualified to participate in this study. The validity of the ADDES was evaluated by three experienced physical therapists working in geriatric settings. The test reliability of the ADDES and how it related to history of falling were also assessed and analysed. This study found the ADDES scale to be highly reliable in testing how dependent an AAD user is on his/her AAD during walking. Findings showed that dependence on an AAD is positively correlated with the length of time it has been used. ADDES scores may indicate the level of falls risk, although a follow-up study is suggested to explore this relationship further.

Aims Fear of falling is considered a risk factor for falls. Walkers are commonly used by older adults for enhancing mobility. This study aimed to investigate the level of fear of falling in terms of the Falls Efficacy Scale, how that level is associated with fall frequency, and how walkers were used among older walker users. Methods Forty two qualified older adults completed the Falls Efficacy Scale and a questionnaire concerning walker use and history of falls in the last 12 months. Their walkers were assessed for appropriate use and maintenance. Findings Fifteen subjects (36%) fell at least once after beginning to use a walker, but the number of falls did not correlate to the duration of walker use. A moderate positive correlation existed between Falls Efficacy Scale scores and the number of falls. Assessments of the walkers showed that the most common misuse was lack of medical consultation in obtaining a walker, followed by incorrect walker height, forward-leaning posture during ambulation. However, the most significant difference (P<0.05) between the fallers and the non-fallers was only identified in poor posture problems. Conclusions Inappropriate use of a walker, especially the forward-leaning posture, may be associated with the falls. Falls may increase the fear of falling in older walker users. Clinicians including physicians, therapists, and nurses should possess knowledge to instruct older adults on appropriate walker use.

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