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; Darcy S. Reisman; Zahra McKee; Shay R. Pinhey; Adrienne Henderson; Jason M. Wilken; Elisa S. Arch

doi:10.1186/s12984-024-01425-7

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Customized passive-dynamic ankle–foot orthoses can improve walking economy and speed for many individuals post-stroke

Journal article

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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, Darcy S. Reisman, Zahra McKee, Shay R. Pinhey, Adrienne Henderson, Jason M. Wilken and Elisa S. Arch

Journal of neuroengineering and rehabilitation, Vol.21(1), 126

07/29/2024

DOI: 10.1186/s12984-024-01425-7

PMCID: PMC11285468

PMID: 39069629

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Abstract

Background Passive-dynamic ankle–foot orthoses (PD-AFOs) are often prescribed to address plantar flexor weakness during gait, which is commonly observed after stroke. However, limited evidence is available to inform the prescription guidelines of PD-AFO bending stiffness. This study assessed the extent to which PD-AFOs customized to match an individual’s level of plantar flexor weakness influence walking function, as compared to No AFO and their standard of care (SOC) AFO. Methods Mechanical cost-of-transport, self-selected walking speed, and key biomechanical variables were measured while individuals greater than six months post-stroke walked with No AFO, with their SOC AFO, and with a stiffness-customized PD-AFO. Outcomes were compared across these conditions using a repeated measures ANOVA or Friedman test (depending on normality) for group-level analysis and simulation modeling analysis for individual-level analysis. Results Twenty participants completed study activities. Mechanical cost-of-transport and self-selected walking speed improved with the stiffness-customized PD-AFOs compared to No AFO and SOC AFO. However, this did not result in a consistent improvement in other biomechanical variables toward typical values. In line with the heterogeneous nature of the post-stroke population, the response to the PD-AFO was highly variable. Conclusions Stiffness-customized PD-AFOs can improve the mechanical cost-of-transport and self-selected walking speed in many individuals post-stroke, as compared to No AFO and participants’ standard of care AFO. This work provides initial efficacy data for stiffness-customized PD-AFOs in individuals post-stroke and lays the foundation for future studies to enable consistently effective prescription of PD-AFOs for patients post-stroke in clinical practice.

Details

Title: Subtitle: Customized passive-dynamic ankle–foot orthoses can improve walking economy and speed for many individuals post-stroke
Creators: Jacob T. Skigen - University of Delaware
Corey A. Koller - University of Delaware
Luke Nigro - University of Delaware
Darcy S. Reisman - University of Delaware
Zahra McKee - University of Delaware
Shay R. Pinhey - University of Delaware
Adrienne Henderson - University of Delaware
Jason M. Wilken - University of Iowa
Elisa S. Arch - University of Delaware
Resource Type: Journal article
Publication Details: Journal of neuroengineering and rehabilitation, Vol.21(1), 126
Publisher: BioMed Central
DOI: 10.1186/s12984-024-01425-7
PMID: 39069629
PMCID: PMC11285468
ISSN: 1743-0003
eISSN: 1743-0003
Language: English
Date published: 07/29/2024
Academic Unit: Physical Therapy and Rehabilitation Science
Record Identifier: 9984691559602771

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