The Effects of Tuning an Ankle-Foot Orthosis Footwear Combination on Kinematics and Kinetics of the Knee Joint of an Adult with Hemiplegia

Abstract

The effects of tuning the AFO footwear combination (AFOFC) for an adult with post-stroke hemiplegia were investigated. Gait analysis and tuning were carried out using a Vicon 3D motion analysis system and two force plates. Tuning of the AFOFC was accomplished by gradually modifying its design over a number of gait trials, to achieve optimal (i.e., as close as possible to normal, within the capability of the patient) knee kinematics and alignment of the Ground Reaction Force vector (GRF) relative to the knee joint. Heel wedges and a stiff rocker were used to tune mid-stance and terminal stance, respectively. Temporal-spatial parameters and selected kinetic and kinematic variables were compared between the non-tuned AFOFC, the tuned AFOFC immediately after tuning, and the tuned AFOFC after three months. There were several changes after three months compared to the non-tuned AFOFC, including improvement in stride length and a reduction in knee hyperextension. A subjective reduction in knee pain and improvement in function were also reported. The feasibility and the lack of objective evidence of tuning AFOFCs as a part of a clinical service need to be addressed in future research.

The effect of tuning ankle foot orthoses–footwear combination on the gait parameters of children with cerebral palsy

“…Twenty-seven papers implemented some form of AFO-FC tuning within the study, and 9 were rejected because they did not include research on both AFOs and children with CP. [87][88][89][90][91][92][93][94][95] Research by Meadows 96 was rejected because it was not published in a peer-reviewed journal.…”

The Shank-to-Vertical-Angle as a parameter to evaluate tuning of Ankle-Foot Orthoses

“…Accordingly, the SVA at midstance may be an important and relatively simple parameter to evaluate the effects of adjustments to the AFO-FC during its tuning process [8,13], also because information on the ground reaction force and calculations of joint moments are not always available in clinical practice. Several studies in patients with neurological disorders report the SVA, and describe a normalization of gait parameters following changes of the heel-sole differential [11,12,14,15]. However, in all available studies, the SVA was measured while the patient was in a static position, whereas there is no evidence showing that the SVA in this position represents the SVA at midstance [8].…”

Use of the ICF to investigate impairment, activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities

“…In this study, people using AFOs as recommended did not report lower pain levels compared to the other 2 groups. In contrast, reduction in pain following use of AFOs has been reported in other studies [49][50][51] with Jagadamma [49] reporting the importance of appropriate tuning of the AFO-footwear combination in reducing knee pain. However, due to the research design, we were not able to ascertain if the AFOs had been appropriately tuned.…”