Investigating the underlying biomechanical mechanisms leading to falls in long-term ankle-foot orthosis and functional electrical stimulator users with chronic stroke.
Masood Nevisipour, Claire F Honeycutt
PMID 34847412WHAT IT FOUND
Long-term AFO and FES users with chronic stroke fell significantly more often than non-users during simulated trips.
Wearing or removing the device made no difference to fall rates. The users' high fall risk stems from impaired trunk control and an inability to take a second step with the paretic leg.
Key findings
01Total fall rates were 2.5 times higher in AFO users and 2.77 times higher in FES users compared to non-users, with no significant difference between wearing or removing the device.
02AFO and FES users failed to take a second recovery step with their support leg more often than non-users, specifically during large perturbations.
03Users exhibited larger trunk flexion velocity at the end of the first step and a reduced ability to control whole-body angular momentum using the paretic leg compared to non-users.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study only included individuals who could walk unassisted for 5 minutes without their device, meaning the findings apply to higher-functioning stroke survivors and may not generalize to those with more severe impairment. The perturbations were delivered on a treadmill, which may not fully replicate the complex visual and cognitive demands of a real-world over-ground trip. The sample size for each group was small (10-18 participants). The study focused on posterior perturbations (trips); results may differ for slips (anterior perturbations).
Declared interests
The authors declare no conflict of interest regarding the present study.
The easy way to misread this
Do not conclude that AFOs or FES devices cause falls. The study found that users fell more often than non-users, but this was likely due to the users having more severe underlying leg impairments (such as weaker dorsiflexors and higher spasticity) rather than the device itself being harmful. Wearing or removing the device did not change the fall rate.