Article

In polio survivors with calf muscle weakness, dorsiflexion-restricting ankle-foot
orthoses (DR-AFOs) aim to improve gait in order to reduce walking-related
problems such as instability or increased energy cost. However, evidence on the
efficacy of DR-AFOs in polio survivors is lacking. We investigated the effect of
DR-AFOs on gait biomechanics, walking energy cost, speed, and perceived waking
ability in this patient group. Sixteen polio survivors with calf muscle weakness
underwent 3D-gait analyses to assess gait biomechanics when walking with a
DR-AFOs and with shoes only. Ambulant registration of gas-exchange during a 6 min
walk test determined walking energy cost, and comfortable gait speed was
calculated from the walked distance during this test. Perceived walking ability
was assessed using purposely-designed questionnaires. Compared with shoes-only,
walking with the DR-AFOs significantly increased forward progression of the
center of pressure (CoP) in mid-stance and it reduced ankle dorsiflexion and knee
flexion in mid- and terminal stance (p < 0.05). Furthermore, walking energy cost
was lower (-7%, p = 0.052) and gait speed was higher (p = 0.005). Patients were
significantly more satisfied, felt safer, and less exhausted with the DR-AFO,
compared to shoes-only (p < 0.05). DR-AFO effects varied largely across patients.
Patients who walked with limited forward CoP progression and persisting knee
extension during the shoes-only condition seemed to have benefitted least from
the DR-AFO. In polio survivors with calf muscle weakness, DR-AFOs improved gait
biomechanics, speed, and perceived walking ability, compared to shoes-only.
Effects may depend on the shoes-only gait pattern, therefore further study is
needed to determine which patients benefit most from the DR-AFO.
CI - Copyright (c) 2014 Elsevier B.V. All rights reserved.

Langue : ANGLAIS