Early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke.
Tomohiro Ota, Hiroyuki Hashidate, Natsuki Shimizu and 1 others
PMID 30858650WHAT IT FOUND
With a knee-ankle-foot brace and a shoe on the unaffected leg, people with subacute stroke stood longer and in more positions than barefoot without the brace.
The brace and shoe cannot be separated.
Key findings
01In feet apart with eyes open, 15 participants could not stand without a KAFO and 9 could stand with a KAFO and a shoe on the non-paretic leg; in feet apart with eyes closed, 15 could not stand without a KAFO and 7 could stand with a KAFO and a shoe on the non-paretic leg.
02In participants who could stand without a KAFO, standing time was longer with a KAFO and a shoe on the non-paretic leg than with barefoot standing without the KAFO in each condition tested, including 57.4 ± 9.6 seconds with feet apart and eyes open versus 42.0 ± 24.1 seconds without.
03In feet together with eyes open, 17 participants could not stand without a KAFO and 3 could stand with a KAFO and a shoe on the non-paretic leg; in tandem stance, 20 could not stand without a KAFO and 2 could stand with a KAFO and a shoe on the non-paretic leg.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only 29 inpatients with subacute stroke who had already been chosen for a KAFO, so it does not show what happens in people who did not need or receive one. The order was fixed, with testing without the KAFO first and testing with the KAFO second on the same day, so the study did not use a randomised control order. The with-KAFO test included a shoe on the non-paretic limb, while the without-KAFO test was barefoot, so the brace effect cannot be separated from that footwear change. The outcomes were short standing-time tests, not transfers, walking, ADL participation, or longer-term recovery. In participants who could not stand without the KAFO, only 3 of 17 were able to stand with the KAFO in feet-together stance and only 2 of 20 in tandem stance. The authors state that results cannot be generalized to other post-stroke populations or other types of KAFO.
Declared interests
None declared.
The easy way to misread this
Do not read this as proof that a KAFO alone improves walking, transfers, or long-term balance. The brace was tested together with a shoe on the non-paretic leg, and the study measured only immediate standing tests.