A randomized controlled trial on providing ankle-foot orthoses in patients with (sub-)acute stroke: Short-term kinematic and spatiotemporal effects and effects of timing

摘要

Initial walking function is often limited after stroke, and regaining walking ability is an important goal in rehabilitation. Various compensatory movement strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses (AFOs) are often prescribed to improve foot-clearance and may influence these strategies. However, research studying effects of actual AFO-provision early after stroke is limited. We conducted an explorative randomized controlled trial and aimed to study the short-term effects of AFO-provision on kinematic and spatiotemporal parameters in patients early after stroke. In addition, we studied whether timing of AFO-provision influenced these effects. Unilateral hemiparetic patients maximal six weeks post-stroke were randomly assigned to AFO-provision: early (at inclusion) or delayed (eight weeks later). Three-dimensional gait-analysis with and without AFO in randomized order was performed within two weeks after AFO-provision. Twenty subjects (8 early, 12 delayed) were analyzed. We found significant positive effects of AFO-provision for ankle dorsiflexion at initial contact, foot-off and during swing (-3.6 degrees (7.3) vs 3.0 degrees (3.9); 0.0 degrees (7.4) vs 5.2 degrees(3.7); and -6.1 degrees (7.8) vs 2.6 (3.5), respectively), all p < 0.001. No changes in knee, hip and pelvis angles were found after AFO-provision, except for knee (+2.3) and hip flexion (+1.6) at initial contact, p <= 0.001. Significant effects of AFO-provision were found for cadence (+2.1 steps/min, p= 0.026), stride duration (-0.08 s, p= 0.015) and single support duration (+1.0%, p = 0.002). Early or delayed AFO-provision after stroke did not affect results. In conclusion, positive short-term effects of AFO-provision were found on ankle kinematics early after stroke. Timing of AFO-provision did not influence the results. (C) 2017 Elsevier B.V. All rights reserved.