Early or delayed provision of an ankle-foot orthosis in patients with acute and subacute stroke: a randomized controlled trial

Nikamp, Corien; Buurke, Jaap H.; Palen, Job van der; Hermens, Hermie; Rietman, Johan Swanik

doi:10.1177/0269215516658337

Cited by 24 publications

(60 citation statements)

References 31 publications

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“…We already reported positive effects of AFO provision on ankle kinematics early after stroke (17), while no effects of early vs delayed AFO provision on pelvis, hip and knee kinematics were found after 26 weeks (18). At the same time, beneficial effects of AFO provision were found on functional levels (12). After 26 weeks no differences with respect to balance and mobility were found between early and delayed provision, but early provision showed favourable outcomes in the first 11-13 weeks, possibly resulting in earlier independent and safe walking (19).…”

Section: Discussionmentioning

confidence: 80%

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Effect of long-term use of ankle-foot orthoses on tibialis anterior muscle electromyography in patients with sub-acute stroke: A randomized controlled trial

Nikamp¹,

Buurke²,

Schaake³

et al. 2019

J Rehabil Med

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LAY ABSTRACTAnkle-foot orthoses (AFOs) are often used to improve walking after stroke. However, it is unknown whether early or later provision of AFOs affects muscle activity, and what are the effects of long-term AFO use after stroke. Some clinicians fear that early use of AFO after stroke has negative effects on muscles around the ankle. Therefore, we studied the effect of AFO use on the tibialis anterior muscle in 26 subjects after stroke. Subjects were prescribed an AFO in week 1 of the study, or 8 weeks later. Muscle activity was measured 4 times over a period of 26 weeks. We found that AFO use reduced muscle activity levels compared with walking without an AFO within 1 measurement. However, longterm use of an AFO for a period of 26 weeks did not affect muscle activity. These effects were the same for the subjects provided with the AFO in week 1 or 8 weeks later. This study did not find any negative effects on activity of the tibialis anterior muscle with long-term use of an AFO early after stroke.Objective: To determine: (i) whether the use of ankle-foot orthoses over a period of 26 weeks affects tibialis anterior muscle activity; (ii) whether the timing of provision of ankle-foot orthoses (early or delayed) affects the results; (iii) whether the provision of ankle-foot orthoses affects tibialis anterior muscle activity within a single measurement. Design: Randomized controlled trial. Subjects: Unilateral hemiparetic subjects, a maximum of 6 weeks post-stroke. Methods: Subjects were assigned randomly to early (at inclusion; week 1) or delayed provision of anklefoot orthoses (8 weeks later; week 9). Tibialis anterior electromyography was measured with and without ankle-foot orthoses, in study weeks 1, 9, 17 and 26. Results: A total of 26 subjects were analysed. In a single measurement, use of an ankle-foot orthosis significantly reduced the activity levels of the tibialis anterior muscle during the swing phase (p = 0.041) compared with walking without an ankle-foot orthosis. During the 26-week follow-up, no changes were found in tibialis anterior muscle activity in the swing phase without an ankle-foot orthosis, both within-groups (p = 0.420 early; p = 0.282 delayed), and between-groups (p = 0.987). After 26 weeks, no differences were found in tibialis anterior muscle activity between both groups in the swing phase, with (p = 0.207) or without ankle-foot orthoses (p = 0.310). Conclusion: Use of ankle-foot orthoses post-stroke reduced tibialis anterior muscle activity in the swing phase within one measurement; however, long-term use of ankle-foot orthoses for 26 weeks did not affect such activity. Early or delayed provision of ankle-foot orthoses did not affect the findings. The results indicate that there is no need to fear negative consequences on tibialis anterior-activity because of long-term AFO-use (early) after stroke.

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Section: Discussionmentioning

confidence: 80%

“…AFO-fitting was performed by a licensed orthotist. AFO type was chosen according to a custom-developed protocol (12). Besides the AFO-intervention, all subjects received usual care from experienced physiotherapists according to the Dutch guidelines for physiotherapy after stroke (13,14).…”

Section: Provision Of Ankle-foot Orthosesmentioning

confidence: 99%

Effect of long-term use of ankle-foot orthoses on tibialis anterior muscle electromyography in patients with sub-acute stroke: A randomized controlled trial

Nikamp¹,

Buurke²,

Schaake³

et al. 2019

J Rehabil Med

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“…Momosaki et al [21] suggested that stroke survivors had better functional recovery if they were prescribed an AFO than if they were not prescribed an AFO. Nikamp et al [22] also described positive effects of providing AFO in subacute stroke patients who had not used these orthosis before from a randomized control trial. Furthermore, walking training is possible with KAFOs for patients with severe paralysis.KAFOs for hemiplegia in stroke patients have been used since the prewar time in our country [23], but orthotic therapy for gait training has only been performed in the recent 30 years [17].…”

Section: Discussionmentioning

confidence: 99%

Lower Limb Orthotic Therapy for Stroke Patients in a Rehabilitation Hospital and Walking Ability at Discharge

Maeshima¹,

Okamoto²,

Okazaki³

et al. 2017

Int J Phys Ther Rehabil

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“…A detailed description of our study design and patient inclusion can be found in our previous paper. 65 In summary, we recruited unilateral ischemic or hemorrhagic stroke subjects from the Roessingh, Centre for Rehabilitation in Enschede, the Netherlands. Subjects were maximal six weeks post-stroke and had an indication for use of an AFO.…”

Section: Methodsmentioning

confidence: 99%

“…58 We previously reported the short-term results of an explorative randomised controlled trial to study the effects of providing off-the-shelf AFOs on two different moments poststroke. 65 We included patients within six weeks post-stroke and provided them with an AFO in week 1 (early) or 9 (delayed) of the study. The effects of provision were studied after two weeks.…”

Section: Introductionmentioning

confidence: 99%

The sooner the better?! Providing ankle-foot orthoses in the rehabilitation after stroke

Nikamp-Simons¹

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Objective 1) To study the effects of providing ankle-foot orthoses (AFOs) in subjects with (sub)acute stroke; and 2) to study whether the point in time at which an AFO is provided post-stroke (early or delayed), influences these effects. Design Randomized controlled trial. Setting Rehabilitation centre. Subjects Unilateral hemiparetic stroke subjects with indication for use of an AFO and maximal six weeks post-stroke. Interventions Subjects were randomly assigned to: early provision (at inclusion; week 1) or delayed provision (eight weeks later; week 9). Outcome measures 10-meter walk test, 6-minute walk test, Timed Up and Go Test, stairs test, Functional Ambulation Categories, Berg Balance Scale, Rivermead Mobility Index and Barthel Index; assessed in week 1, 3, 9 and 11. Results A total of 33 subjects were randomized (16 early, 17 delayed). Positive effects of AFOs were found two weeks after provision, both when provided early (significant effects on all outcomes) or delayed (Berg Balance Scale p =0.011, Functional Ambulation Categories p =0.008, 6-minute walk test p =0.005, Timed Up and Go Test p =0.028). Comparing effects after early and delayed provision showed that early provision resulted in increased levels of improvement on Berg Balance Scale (+5.1 points, p =0.002), Barthel Index (+1.9 points, p =0.002) and non-significant improvements on 10-Meter walk test (+0.14m/s, p =0.093) and Timed Up and Go Test (-5.4 sec, p =0.087), compared to delayed provision. Conclusions We found positive effects of providing AFOs in (sub)acute stroke subjects that had not used these orthoses before.

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Early or delayed provision of an ankle-foot orthosis in patients with acute and subacute stroke: a randomized controlled trial

Abstract: We found positive effects of providing ankle-foot orthoses in (sub)acute stroke subjects that had not used these orthoses before.

Cited by 24 publications

References 31 publications

Effect of long-term use of ankle-foot orthoses on tibialis anterior muscle electromyography in patients with sub-acute stroke: A randomized controlled trial

Effect of long-term use of ankle-foot orthoses on tibialis anterior muscle electromyography in patients with sub-acute stroke: A randomized controlled trial

Lower Limb Orthotic Therapy for Stroke Patients in a Rehabilitation Hospital and Walking Ability at Discharge

The sooner the better?! Providing ankle-foot orthoses in the rehabilitation after stroke

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