Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations.
ABSTRACT To examine the effects of an ankle-foot orthosis (AFO) on balance performance in patients with hemiparesis of short and long duration.
Within-subject random order of intervention, cross-sectional study design.
Medical centres and district hospitals.
Forty-two subjects with hemiparesis of short duration (< six months) and 61 subjects of long duration ( > 12 months).
The balance and gait ability of subjects were evaluated both with an AFO and without. The static and dynamic balance activities were evaluated by the Balance Master System, whereas the functional balance was assessed with the Berg Balance Scale. The speed and cadence were also measured during a 10-metre walk. Paired t-test was used to determine the effect of the AFO.
In subjects with hemiparesis of short duration, we found that subjects wearing an AFO showed significant improvements in (1) weight-bearing distribution during quiet standing (p = 0.042, 95% confidence interval (CI) 0.521, 7.325), (2) body sway during standing on foam surface with eyes open (p = 0.020, 95% CI 0.020, 0.680) and eyes closed (p = 0.041, 95% CI 0.023, 0.921), (3) movement velocity during limit of stability test (LOS)--toward the affected side (p = 0.037, 95% CI - 0.978, - 0.042) and nonaffected side (p = 0.008, 95% CI -2.223, - 0.377), (4) maximal excursion toward the affected side (p= 0.042, 95% CI -19.546, -0.071), and (5) speed (p=0.028, 95% CI -0.204, -0.017) and cadence (p= 0.021, 95% CI - 22.983, - 1.864). Such effects were not observed in subjects with hemiparesis of long duration.
For the subjects with hemiparesis of short duration, the AFO improves the symmetry in quiet and dynamic standing balances. It also increases speed and cadence. However, its effectiveness is minimal for patients of long duration.
Article: A comparison of static and dynamic balance in patients with unilateral and bilateral total knee arthroplasty.[show abstract] [hide abstract]
ABSTRACT: Unilateral and bilateral total knee arthroplasty (TKA) patients were compared with respect to static and dynamic balance in the postoperative sixth and 12th months. Eighty TKA patients 35 unilateral, 45 bilateral were assessed for static and dynamic balance using the balance master test device in sixth and 12th months after surgery. Patients were also measured with respect to Hospital for Special Surgery knee score and range of motions. Differences between groups were statistically evaluated using independent t-tests. Within-group time differences were statistically examined using paired t-tests. Correlation between the measurements was evaluated by the Pearson,s analysis. Sensory interaction balance and unilateral stance test of static balance assessment were similar in unilateral and bilateral TKA (p>0.05). Patients with bilateral TKA had statistically significantly better performance at the limits of stability of dynamic balance evaluations (p<0.05). There was no significant difference between rhythmic weight shift tests in the sixth and 12th months after surgery (p>0.05). In our study we concluded that while dynamic balance parameters in the daily activities of patients with bilateral TKA were expected to be better than patients with unilateral TKA, there was no significant difference between static balance parameters between the two groups.Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery. 02/2009; 20(2):93-101.
Article: The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients.[show abstract] [hide abstract]
ABSTRACT: Ankle foot orthoses (AFO) are commonly used orthotic device in order to restore the ankle foot function and to improve the balance and gait in post-stroke hemiparetic patients. However, there remain some discussions about their effectiveness on long term hemiparetic patients who had mild to moderate spasticity. To investigate the relative effect of prefabricated thermoplastic posterior leaf spring AFO (PLS-AFO) on balance and fall risk. A cross-over interventional study The Department of PMR of a tertiary hospital. Twenty-five chronic post-stroke long duration hemiparetic patients who had Ashworth grade 1-2 spasticity at affected calf muscles and lower limb Brunnstrom stage 2-3 and also able to walk independently without an assistive device. Berg Balance Scale (BERG), and the postural stability test (PST) and the fall risk test (FRT) of Biodex balance systems were used for the assessments. All of the patients were assessed with AFO and without AFO. All assessments were made with footwear. The mean post-stroke duration was 20,32±7,46 months. The BERG scores were 42,12±9,05 without AFO and 47,52±7,77 with AFO; the overall stability scores of FRT were 3,35±1,97 without AFO and 2,69±1,65 with AFO (P<0,001). It was found that the prefabricated thermoplastic PLS-AFO improve balance and provide fall risk reduction in chronic post-stroke ambulatory hemiparetic patients who had mild to moderate spasticity on their affected lower limb. These results encourage the usage of AFO on long duration hemiparetic patients in order to provide better balance and lesser fall risk.European journal of physical and rehabilitation medicine 09/2010; 46(3):363-8. · 1.40 Impact Factor
Article: A candidate core set of outcome measures based on the International Classification of Functioning, Disability and Health for clinical studies on lower limb orthoses.[show abstract] [hide abstract]
ABSTRACT: Although many core sets of measurement concepts have been published in the literature, this has not been done for the field of lower limb orthoses. This paper provides an overview of the measurement concepts that are relevant in lower limb orthotic evaluations, and it proposes a candidate Core Set of outcome measures to be used in clinical studies on ankle-foot orthoses (AFOs) and knee-ankle-foot orthoses (KAFOs). Literature review. The International Classification of Functioning, Disability and Health (ICF) was used as framework to select relevant concepts. Measurement concepts covering all ICF levels of functioning were identified as relevant for the Core Set, including functions of the joints and bones (b710-b729), muscle functions (b730-b749), gait pattern functions (b770), walking (b450), moving around in different locations (d460), and daily-life functioning (d5-d9). Further validation of this candidate Core Set through a formal decision-making process is needed to obtain consensus among experts in the field. Based on such a consensus, the next step will be to systematically review the literature and identify those measurement instruments that are best suited to assess the proposed concepts, based on their psychometric properties in a given sample and context. Thereafter, we suggest that this ICF Core Set of measurement instruments should be applied in orthotic studies on AFOs and KAFOs in ambulatory patients with gait problems. Although many ICF Core Sets have been published, this has not been done for the field of lower limb orthoses. We feel that such a Core Set is urgently needed, to enable comparison of results, and establish evidence on the efficacy of orthotic treatment, which will improve patient care.Prosthetics & Orthotics International 09/2011; 35(3):269-77. · 0.56 Impact Factor