The impact of ankle-foot orthosis stiffness on gait: A systematic literature review

Totah, Deema; Menon, Meghna; Jones-Hershinow, Carlie; Barton, Kira; Gates, Deanna H.

doi:10.1016/j.gaitpost.2019.01.020

Cited by 81 publications

(69 citation statements)

References 42 publications

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“…Positive influences on the ankle, knee, and hip are known especially in the sagittal plane. Conclusively, positive changes in the gait indices Gillette Gait Index, Gait Profile Score, and Gait Deviation Index were described [5–8]. Additional positive effects after multilevel surgery have been reported recently [9].…”

Section: Introductionmentioning

confidence: 99%

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Schwarze

Horoba

Block

et al. 2019

Rehabilitation Research and Practice

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Objective. To date there is only limited knowledge about the wearing time of orthoses. Ankle-foot orthoses (AFOs) have not been studied with this research question. Additional influences of the orthotic design as well as weekdays and the weekend are also unknown. Design. Monocentric, clinically prospective intervention study. Patients. Inclusion of 10 patients with bilateral spastic cerebral palsy. Methods. Equipment of all subjects with a dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS, dynamic elastic shank adaptation or ground reaction AFO). Integration of temperature sensors for recording the wearing time for a period of 3 months. Results. The actual wearing time was below the recommendations on actually worn days as well as the average of the entire study period. In addition, the actual usage in terms of days and hours was well below the recommendations. The wearing time showed differences between weekdays and weekend. Differences between DAFO and MSS were not detectable. Conclusion. The actual usage behavior of ankle-foot orthoses differs from the recommendations of the prescriber. This applies to both DAFOs and modular use with shank supplies. Environmental factors may have a significant impact on wearing times on weekdays and the weekend.

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Section: Introductionmentioning

confidence: 99%

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Schwarze

Horoba

Block

et al. 2019

Rehabilitation Research and Practice

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“…S1 TA was reduced by ~26%, and G was reduced by ~31%, while Mazumder reported that the TA and G reductions were ~26% and ~29%, respectively. The comparison may not be fair because each work invites different subjects, uses various methods of controlling the ankle movement, and uses different test rigs or prototypes [49]. Therefore, further study should focus on increasing the subject numbers to evaluate the walking gait control performance using PICAFO with the improved estimated ωref based on walking speed and BMI.…”

Section: Muscle Activity Resultsmentioning

confidence: 99%

Improving Passive Ankle Foot Orthosis System Using Estimated Ankle Velocity Reference

Adiputra¹,

Rahman

Ubaidillah

et al. 2020

IEEE Access

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This study aims to investigate an appropriate ankle velocity reference (ωref), which is the average ankle velocity of a certain healthy subject when walking with a certain walking speed. The goal is to improve a Passive Controllable Ankle Foot Orthosis (PICAFO) by implementing the ankle velocity reference. Firstly, the function to estimate ωref, based on walking speed and body mass index (BMI), is obtained from 16 able-bodied subjects walking gait data. The effect of controlled stiffness (based on ωref) to the user's ankle kinematics and muscle activity was evaluated by comparing it to other settings, such as walking barefooted and various constant damping stiffness (0%, 30%, 60%, and 100% of the maximum damping stiffness). Two able-bodied subjects (normal and overweight) participated in the evaluation, where they had to walk at two different walking speeds (1 and 2 km/h). The result showed that ankle kinematics and muscle activity were improved when ω was controlled during walking speed of 1 km/h for both subjects. In terms of ankle kinematics, the toe clearance occurred, and walking stability increased. In terms of muscle activity, the average muscle activity had reduced by ~29% for the normal subject and by ~57% for an overweight subject, which shows that PICAFO provides necessary damping stiffness to replace the muscle works partially. In the future, by using the ωref based on walking speed and BMI, the therapists can skip the trial and error process of finding an appropriate PICAFO prescription for a post-stroke patient.

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“…This study is the first to provide a detailed overview of the orthotic properties and effects of multiple AFO types provided in usual care to people with non-spastic neuromuscular disorders. Previous AFO studies lacked information about specific orthotic properties (12,23). Although our sample size is one of the largest so far evaluating AFOs in neuromuscular disorders, the heterogeneity in AFO types resulted in small subgroups.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Providing a detailed overview of the mechanical properties and effects of the different AFOs provided to persons with non-spastic calf muscle weakness will establish a baseline against which the effect of optimization of AFO properties can be measured. This will guide further research aiming to provide evidence for improved provision of orthotics, as recommended in recent reviews (12,23).…”

mentioning

confidence: 97%

“…Differences in orthotic properties, such as ankle and footplate stiffness, footplate length and mass, may explain the variation in effectiveness (15,18). Although, these mechanical properties have been evaluated in small clinical studies of patients with lower limb salvage (19), stroke (20,21) and cerebral palsy (22), the few studies evaluating AFOs in non-spastic neuromuscular disorders did not specify the mechanical properties of the investigated AFOs (12,23). Consequently, there is a lack of evidence-based guidelines to select the most effective AFO to improve gait in this population, and choices in current practice are based on the preferences of the prescribing physician or orthotist (12).…”

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confidence: 99%

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Description of orthotic properties and effects evaluation of ankle-foot orthoses in non-spastic calf muscle weakness

et al. 2020

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Ankle-foot orthoses are used to improve walking in persons with non-spastic calf muscle weakness. For best results the mechanical properties of the device should be matched with the patient's impairments. However, there are currently no guidelines about the optimal mechanical properties of ankle-foot orthoses, due to a lack of studies evaluating their effects and properties. In order to establish a baseline and guide further research, we conducted an overview of the mechanical properties and effects of the ankle-foot orthoses provided in usual care in the Netherlands. The results show that, in usual orthotic care, ankle-foot orthoses that are not optimally matched with the patient's impairments are provided to persons with non-spastic calf muscle weakness. Differences in ankle-foot orthoses ankle stiffness were related with their effects. In general, persons wearing ankle-foot orthoses with the greatest ankle and footplate stiffness showed the largest benefits with regard to improved walking ability, although this warrants further prospective research. Objective: To describe the orthotic properties and evaluate the effects of ankle-foot orthoses for calf muscle weakness in persons with non-spastic neuromuscular disorders compared with shoes-only. Design: Cross-sectional study. Subjects: Thirty-four persons who used ankle-foot orthoses for non-spastic calf muscle weakness. Methods: The following orthotic properties were measured: ankle-foot orthosis type, mass, and ankle and footplate stiffness. For walking with shoes-only and with the ankle-foot orthoses, walking speed, energy cost and gait biomechanics were assessed. Results: Four types of ankle-foot orthosis were identified: shaft-reinforced orthopaedic shoes (n = 6), ventral ankle-foot orthoses (n = 10), dorsal leaf ankle-foot orthoses (n = 12) and dorsiflexion-stop ankle-foot orthoses (n = 6). These types differed significantly with regards to mass, ankle-and footplate stiffness. Compared with shoes-only, all anklefoot orthoses/orthopaedic shoes groups combined increased walking speed by 0.18 m/s (95% confidence interval (95% CI) 0.13-0.23), reduced energy cost by 0.70 J/kg/m (95% CI 0.48-0.94) and limited ankle dorsiflexion by-3.0° (95% CI 1.3-4.7). Higher ankle-foot orthoses ankle stiffness correlated with greater reductions in walking energy cost and maximal ankle dorsiflexion angle. Conclusion: Ankle-foot orthoses for persons with non-spastic calf muscle weakness vary greatly in properties and effects on gait. The large variation in effectiveness may be due to differences in ankle stiffness, although this requires further prospective evaluation.

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The impact of ankle-foot orthosis stiffness on gait: A systematic literature review

Cited by 81 publications

References 42 publications

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Improving Passive Ankle Foot Orthosis System Using Estimated Ankle Velocity Reference

Description of orthotic properties and effects evaluation of ankle-foot orthoses in non-spastic calf muscle weakness

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