Article

OBJECTIVE: To evaluate the kinematic features of rear-foot motion during gait in
hemiplegic stroke patients, using anterior ankle-foot orthoses (AFOs), posterior
AFOs, and no orthotic assistance. DESIGN: Crossover design with randomization for
the interventions. SETTING: A rehabilitation center for adults with neurologic
disorders. PARTICIPANTS: Patients with hemiplegia due to stroke (n=14) and
able-bodied subjects (n=11). INTERVENTIONS: Subjects with hemiplegia were
measured walking under 3 conditions with randomized sequences: (1) with an
anterior AFO, (2) with a posterior AFO, and (3) without an AFO. Control subjects
were measured walking without an AFO to provide a normative reference. MAIN
OUTCOME MEASURES: Rear-foot kinematic change in the sagittal, coronal, and
transverse planes. RESULTS: In the sagittal plane, compared with walking with an
anterior AFO or without an AFO, the posterior AFO significantly decreased plantar
flexion to neutral at initial heel contact (P=.001) and the swing phase (P<.001),
and increased dorsiflexion at the stance phase (P=.002). In the coronal plane,
the anterior AFO significantly increased maximal eversion to neutral (less
inversion) at the stance phase (P=.025), and decreased the maximal inversion
angle at the swing phase when compared with using no AFO (P=.005). The posterior
AFO also decreased the maximal inversion angle at the swing phase as compared
with no AFO (P=.005). In the transverse plane, when compared with walking without
an AFO, the anterior AFO and posterior AFO decreased the adduction angle
significantly at initial heel contact (P=.004). CONCLUSIONS: For poststroke
hemiplegic gait, the posterior AFO is better than the anterior AFO in enhancing
rear-foot dorsiflexion during a whole gait cycle. The anterior AFO decreases
rear-foot inversion in both the stance and swing phases, and the posterior AFO
decreases the rear-foot inversion in the swing phase when compared with using no
AFO.
CI - Copyright (c) 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS