The impact of ankle-foot orthosis's plantarflexion resistance on knee adduction moment in people with chronic stroke.
Toshiki Kobayashi, Grace Hunt, Michael S Orendurff and 3 others
PMID 35532368WHAT IT FOUND
Raising plantarflexion resistance on an articulated ankle-foot orthosis increased the knee adduction moment, a measure of medial knee loading, and shifted the center of pressure medially in people with chronic stroke.
The participants did not have knee osteoarthritis.
Key findings
01Changing AFO plantarflexion resistance significantly affected maximum external knee adduction moment and center of pressure positions.
02Follow-up comparisons found significant differences between the no-spring baseline and each spring level for the maximum external knee adduction moment.
03No significant differences were found in the coronal ankle moment or ground reaction force magnitudes.
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 10 people with chronic stroke, so the result may not apply to a wider stroke population. The participants did not have knee osteoarthritis, so the study does not show what happens in people who already have knee osteoarthritis. People walked on an instrumented treadmill with a safety harness, which may have changed their natural gait. There was no healthy control group, so the comparisons were only within the same participants. The marker set used has not been rigorously validated. Center of pressure location is highly variable at initial contact and pre-swing, so that finding needs cautious interpretation. The authors say it is not clear whether the change in knee adduction moment has immediate clinical implications.
Declared interests
Two authors, Kobayashi T and Orendurff MS, were employees of Orthocare Innovations at the time of the study and designed the articulated AFO used in this work.
The easy way to misread this
Do not conclude that higher AFO plantarflexion resistance causes or worsens knee osteoarthritis in people with chronic stroke. The study was small, none of the participants had knee osteoarthritis, and the authors say the clinical effect of the knee adduction moment change is unclear.