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Lower Limb and Walking

Ankle Foot Orthosis in SCI

Author Year; Country
Score
Research Design
Sample Size
Methods Outcomes

Kim et al. 2004; Canada
PEDro=5
RCT
Level 2
N=19

Population: 19 participants with incomplete SCI who had dropfoot but were able to walk independently.
Treatment: Randomized to conditions of AFO, no AFO, FES and FES and AFO. They walked at their self-selected speed along a flat walkway.
Outcome Measures: Walking speed and 6MWT.
  1. Gait speed increased 7.5% from 0.4 m/s (no orthosis) to 0.43 (AFO).
  2. 6 Minute Walk Test increased 16% from 138 to 160 m.

Arazpour et al. 2013; Iran
PEDro=4
RCT
Level 2
N=5

Population: 5 participants with incomplete SCI (thoracic lesion).
Treatment: Gait evaluation while walking with 1) no shoe; 2) solid AFO and 3) hinged AFO.
Outcome Measure: Step length, cadence.
  1. Solid AFO improved step length from 28.5 from 26.3 cm and cadence from 52 to 62 steps/minute.
  2. No significant differences between the no shoe and hinged AFO condition.

Discussion

Both these studies (Kim et al. 2004Arazpour et al. 2013) examined the immediate effects of an ankle-foot-orthosis after randomizing different brace conditions. Positive effects consisted of increased gait speed, step length, cadence, and improved performance on the 6 Minute Walk Test. These are not typical experimental designs for an RCT as all the conditions were assessed within one single session rather than allowing participants to accommodate different brace conditions over several weeks or sessions. However, it is generally recognized in the clinical field that effects from an AFO are attained immediately, although it is likely that practice over a few sessions may improve a person’s confidence, learning, and function.

Conclusion

There is level 2 evidence (Arazpour et al. 2013Kim et al. 2004) that an ankle-foot-orthosis can enhance walking function in incomplete SCI patients who have drop-foot.

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