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

Abstract

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.

Stiff knee gait in stroke: Walking down the road of different treatment options

“…34,35,45,47,59 Selection of patients Reasons for exclusion were that same patients were used before in another included article, 32,41 no kinematics, 22,38,54 no RF injection, 21,23,[25][26][27][28]39,50 and no full text available in English. 24,29,31,33,36,37,43,44,48,49,[51][52][53][55][56][57][58]60 There was no disagreement in the selection of the remaining 9 articles 30,34,35,40,42,[45][46][47]59 between the 2 reviewers. The flow diagram of study retrieval and selection is presented in figure 1.…”

“…In clinical practice, there are two options available for establishing abnormal rectus femoris activity: surface electromyography (sEMG) and the Duncan Ely test. The generally accepted gold standard is sEMG of the rectus femoris during dynamic gait analysis 48 . However, sEMG measurements require expensive measurement equipment and specific expertise, which limits its applicability in daily clinical practice.…”