Posts Tagged Ankle Foot Orthoses

[ARTICLE] Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research – Full Text PDF

Abstract

Objective: To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions.
Data sources: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov.
Study selection: One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles.
Data extraction: One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool.
Data synthesis: Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4–6 weeks’ use (p = 0.49) showed equal improvement for both devices.
Conclusion: Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user’s own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses.

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[ARTICLE] Functional electrical stimulation versus ankle foot orthoses for foot-drop: a meta-analysis of orthotic effects – Full Text PDF

ABSTRACT

Objective: To compare the effects on walking of Functional Electrical Stimulation (FES) and Ankle Foot Orthoses (AFO) for foot-drop of central neurological origin, assessed in terms of unassisted walking behaviours compared with assisted walking following a period of use (combined-orthotic effects).

Data Sources: MEDLINE, AMED, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination and clinicaltrials.gov. plus reference list, journal, author and citation searches.

Study Selection: English language comparative Randomised Controlled Trials (RCTs).

Data Synthesis: Seven RCTs were eligible for inclusion. Two of these reported different results from the same trial and another two reported results from different follow up periods so were combined; resulting in five synthesised trials with 815 stroke participants. Meta-analyses of data from the final assessment in each study and three overlapping time-points showed comparable improvements in walking speed over ten metres (p=0.04-0.95), functional exercise capacity (p=0.10-0.31), timed up-and-go (p=0.812 and p=0.539) and perceived mobility (p=0.80) for both interventions.

Conclusion: Data suggest that, in contrast to assumptions that predict FES superiority, AFOs have equally positive combined-orthotic effects as FES on key walking measures for foot-drop caused by stroke. However, further long-term, high-quality RCTs are required. These should focus on measuring the mechanisms-of-action; whether there is translation of improvements in impairment to function, plus detailed reporting of the devices used across diagnoses. Only then can robust clinical recommendations be made.

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[ARTICLE] Effectiveness of Single Functional Electrical Stimulation in Neurological Patients with Ankle-Foot Orthoses – Full Text PDF

Abstract

Background: Drop foot is a distal deficiency common in patients with central nervous system diseases that makes clearance difficult during swing phase, contributes to inefficient gait compensations, contributes to increase incidence of falls and energy expenditure. Aim of this study is to evaluate the effectiveness of a single application of functional electrical stimulation compared with ankle-foot orthoses in patients with drop foot.

Methods: Patients enrolled were unable to walk and to perform test without ankle-foot orthoses. They were evaluated by 10-meters walk test, obstacles test, up-and-down stair test, six-minute walk test and gait analysis with inertial sensors. All tests were performed with ankle-foot orthoses and with no ankle-foot orthoses and application of single functional electrical stimulation.

Results: Thirteen patients (8 males and 5 females) were recruited for this study out of 41 potential subjects. Data collected were processed by Student’s t test and by Wilcoxon test for paired observations and by Student’s t test and Mann-Whitney test for independent samples. P ≤ 0.05 were considered significant. For each test suitable effect sizes (Cohen’s d, and Pearson’s r) were calculated. Analysis of results with ankle-foot orthoses and with no anklefoot orthoses and application of single functional electrical stimulation showed no statistically significant difference in all test.

Conclusions: The use of single functional electrical stimulation showed same effects of ankle-foot orthoses on walking capacity and motor performance in chronic neurological diseases. More studies would be required to assess the long term effectiveness of functional electrical stimulation and to evaluate if its application in acute-phase may be used in association with traditional treatment.

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[ARTICLE] Long-Term Follow-up to a Randomized Controlled Trial Comparing Peroneal Nerve Functional Electrical Stimulation to an Ankle Foot Orthosis for Patients With Chronic Stroke

Abstract

Background: Evidence supports peroneal nerve functional electrical stimulation (FES) as an effective alternative to ankle foot orthoses (AFO) for treatment of foot drop poststroke, but few long-term, randomized controlled comparisons exist.

Objective: Compare changes in gait quality and function between FES and AFOs in individuals with foot drop poststroke over a 12-month period.

Methods: Follow-up analysis of an unblinded randomized controlled trial (ClinicalTrials.gov #NCT01087957) conducted at 30 rehabilitation centers comparing FES to AFOs over 6 months. Subjects continued to wear their randomized device for another 6 months to final 12-month assessments. Subjects used study devices for all home and community ambulation. Multiply imputed intention-to-treat analyses were utilized; primary endpoints were tested for noninferiority and secondary endpoints for superiority. Primary endpoints: 10 Meter Walk Test (10MWT) and device-related serious adverse event rate. Secondary endpoints: 6-Minute Walk Test (6MWT), GaitRite Functional Ambulation Profile, and Modified Emory Functional Ambulation Profile (mEFAP).

Results: A total of 495 subjects were randomized, and 384 completed the 12-month follow-up. FES proved noninferior to AFOs for all primary endpoints. Both FES and AFO groups showed statistically and clinically significant improvement for 10MWT compared with initial measurement. No statistically significant between-group differences were found for primary or secondary endpoints. The FES group demonstrated statistically significant improvements for 6MWT and mEFAP Stair-time subscore.

Conclusions: At 12 months, both FES and AFOs continue to demonstrate equivalent gains in gait speed. Results suggest that long-term FES use may lead to additional improvements in walking endurance and functional ambulation; further research is needed to confirm these findings.

via Long-Term Follow-up to a Randomized Controlled Trial Comparing Peroneal Nerve Functional Electrical Stimulation to an Ankle Foot Orthosis for Patients With Chronic Stroke.

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[THESIS] Design of Customized Rehabilitation Devices and Bench Testing System – Full Text PDF

ABSTRACT

Off-the-shelf rehabilitation devices are currently prescribed to assist patients with stroke. Current fabrication processes of custom-made rehabilitation devices are time consuming and laborious. The process could be only performed by skilled therapists. In addition, quantitative assessment of mechanical properties is crucial in the design of customized rehabilitation devices. By the design and the real time implementation of a 3D printed hand exoskeleton and a biomimetic testbed for AnkleFoot Orthoses (AFOs), the improved digitalized methodologies of design and bench testing systems for customized rehabilitation devices were presented in this study.

A customized 3D printed hand exoskeleton (the EXCELSIOR) was developed and prototyped to assist stroke patients for finger extension exercises. 3D printing was combined with 3D scanning to create a custom-fit clamp. Compliant finger elements were designed and optimized utilizing Finite Element Analysis. Embedded strain gauges were applied to measure angular positions of the finger joints. In addition, a novel biomimetic testbed was designed to perform stiffness measurement and functional analysis for AFOs.

A biomimetic footplate was designed to adjust pivot centers for the metatarsophalangeal (MTP) joint and the ankle joint according to the patient specific anatomy. Feedback control systems were developed and real time implemented to perform AFO stiffness measurement. An impedance control system was developed and real time implemented to simulate the kinematics of the human ankle for further functional analysis in gait. Real time implementation of the hand exoskeleton and AFO testbed proved the concepts of the design and the testing for customized rehabilitation devices.

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