Literature Review of the Effect of Ankle-Foot Orthosis on Gait Parameters After Stroke

Objective Stroke occurs when the supply of blood to the brain is either interrupted or reduced. The clinical presentation varies from minor neurological symptoms to severe deficits, depending on the location and the size of the brain lesion. Hemiparesis is one of the most striking features in the acute phase. Many other deficits may also be present, including postural imbalance. All persistent neurological deficits may cause more or less severe activity limitations in several domains of human functioning. Regaining walking ability is a major goal during the rehabilitation of stroke patients. Therefore, using orthoses can be beneficial for them. Ankle-Foot Orthoses (AFOs) is one of the most common therapeutic approaches to control foot drop among stroke patients. AFOs prevent drooping or other unintended movements of the foot and ankle by providing stability in optimum conditions. It also helps in regaining normal walking posture in stroke patients. The aim of this review was to evaluate the efficiency of the AFOs on balance and examine the effectiveness of temporal spatial and kinetic gait kinematics in stroke patients with foot drop.
Materials & Methods Science Direct, Springer, Google Scholar, PubMed, Ovid databases were searched for articles published between 1996 and 2016 of studies on patients with drop foot wearing the AFOs. After reviewing and categorizing the articles, they were analyzed based on spatiotemporal parameters, gait kinetics, gait kinematics and stability. A total of 21 articles were selected for final evaluation.
Results Twenty-one articles were analyzed in relation to the effect of the AFOs on gait parameters in stroke patients. Spatiotemporal parameters were evaluated in 14 articles, and kinetics and kinematics parameters were analyzed in seven articles. AFOs have a significant impact on the length and width of the steps but had no significant effect on speed, cadence, symmetry of gait and balance. Also, AFOs improved kinetic parameters of gait, ankle kinematics and kinematics of the knee in the static phase but had no significant effect on knee joint kinematics and kinematics of the hip joint in the frontal and sagittal. There are a few studies with regard to the effects of AFOs on the moment of inertia and joints power, but the results of the present study showed no significant difference in these parameters.
Conclusion This study showed that the AFOs based on the models (static or dynamic) had a paradoxical effect on balance, kinetic and kinematic parameters of gait in the stroke patients. AFOs had a significant improvement in balance, kinetic and kinematic parameters of gait compared to those without orthosis situation in the stroke patients. According to the result of this study, depending on the patient's needs and situation, the best and the most suitable ankle foot orthoses should be designed and custom molded for them.