Customized passive-dynamic ankle-foot orthoses can improve walking economy and speed for many individuals post-stroke.
Jacob T Skigen, Corey A Koller, Luke Nigro and 6 others
PMID 39069629WHAT IT FOUND
Customized ankle-foot braces reduced walking effort and increased speed on average, but many people post-stroke did not benefit individually.
Usual braces did not consistently improve gait mechanics, although satisfaction was higher with the customized brace.
Key findings
01On group averages, customized PD-AFO lowered mechanical cost of walking and increased self-selected walking speed compared with no AFO and usual AFO.
02Individual responses varied: cost improved for many but not all, speed improved for fewer, and no participant had beneficial changes across all biomechanical measures.
03Participants reported higher satisfaction with the customized PD-AFO than with their usual AFO.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only 20 participants were analysed, from 33 enrolled; 12 withdrew or were withdrawn, and 1 had unusable visit 3 data. Participants had to be able to walk without an AFO or with a hinged AFO that did not resist dorsiflexion, so people who need more support were not studied. The study measured immediate walking after acclimation, not long-term use or training. Mechanical cost of transport was used instead of metabolic cost, and treadmill measurements were taken at one baseline speed, which may have hidden speed-related benefits. Only one prescribed stiffness was tested for each participant, and the prescription model may not have been optimal for everyone. Shoes were not controlled, and satisfaction surveys were modified by removing cost and provider questions. The authors note possible new-device bias in satisfaction scores.
Declared interests
The only funding statement provided is: Congressionally Directed Medical Research Programs.
The easy way to misread this
Do not conclude that stiffness-customized PD-AFOs improve walking for every patient post-stroke. Group averages were positive, but individual results were inconsistent: cost improved for 10 participants compared with no AFO and 6 compared with the usual AFO, and speed improved for 9 compared with no AFO and 3 compared with the usual AFO.