Posts Tagged ankle-foot orthosis

[Abstract + References] The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials



The aim of this study was to evaluate the effects of ankle-foot orthoses on speed walking in patients with stroke.

Data sources:

PubMed, Embase, Web of Science, Scopus, CENTRAL, PEDro, RehabData, RECAL, and ProQuest were searched from inception until 30 September 2019.

Review methods:

This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Risk of bias assessment was performed using the Cochrane Risk of Bias Tool. Begg’s test and Egger’s regression method were used to assess the publication bias. Trim and fill analysis was also used to adjust any potential publication bias. Sensitivity analysis was performed to evaluate the effect of individual studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.


Overall, 14 studies were included with a total of 1186 participants. A small-to-moderate and non-significant improvement in favor of the ankle-foot orthosis versus without ankle-foot orthosis (standardized mean difference (SMD) = 0.41, 95% confidence interval = −0.15 to 0.96), similar effects of ankle-foot orthosis and functional electrical stimulation (SMD = 0.00, 95% confidence interval = −0.16 to 0.16), and a small and non-significant improvement in favor of ankle-foot orthosis versus another type of ankle-foot orthosis (SMD = 0.22, 95% confidence interval = −0.05 to 0.49) in walking speed were found. However, the quality of evidence for all comparisons was low or very low.


Despite reported positive effects in some studies, there is no firm evidence of any benefit of ankle-foot orthoses on walking speed.


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[ARTICLE] The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials – Full Text

The aim of this study was to evaluate the effects of ankle-foot orthoses on speed walking in patients with stroke.

PubMed, Embase, Web of Science, Scopus, CENTRAL, PEDro, RehabData, RECAL, and ProQuest were searched from inception until 30 September 2019.

This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Risk of bias assessment was performed using the Cochrane Risk of Bias Tool. Begg’s test and Egger’s regression method were used to assess the publication bias. Trim and fill analysis was also used to adjust any potential publication bias. Sensitivity analysis was performed to evaluate the effect of individual studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

Overall, 14 studies were included with a total of 1186 participants. A small-to-moderate and non-significant improvement in favor of the ankle-foot orthosis versus without ankle-foot orthosis (standardized mean difference (SMD) = 0.41, 95% confidence interval = −0.15 to 0.96), similar effects of ankle-foot orthosis and functional electrical stimulation (SMD = 0.00, 95% confidence interval = −0.16 to 0.16), and a small and non-significant improvement in favor of ankle-foot orthosis versus another type of ankle-foot orthosis (SMD = 0.22, 95% confidence interval = −0.05 to 0.49) in walking speed were found. However, the quality of evidence for all comparisons was low or very low.

Despite reported positive effects in some studies, there is no firm evidence of any benefit of ankle-foot orthoses on walking speed.

A total of 50% of patients with stroke suffer from diminished mobility due to hemiparesis.1 Impaired walking is one of the major problems occurring for stroke patients;2 although 70% of patients regain their ability for walking, they experience functional constraints due to spasticity, muscle weakness, and poor balance.3 Foot drop is among main causes of improper walking related to affected individuals. In response to this abnormality, clearance in swing phase and stability in stance phase are impaired, resulting in reduced walking speed and increased risk of falling.4

The use of ankle-foot orthosis and functional electrical stimulation as two major rehabilitation interventions is propounded to improve walking speed of individuals with stroke.5 An ankle-foot orthosis contributes to stabilization of the foot and ankle in stance phase, keeping the toes up while taking steps, and improving heel strike.6,7 Ankle-foot orthoses are used in different models and designs such as articulated, non-articulated, rigid, and dynamic.8 Functional electrical stimulation refers to the usage of musculoskeletal electrical stimulation to activate the muscles while performing functional tasks,9 which has been established as an alternative to ankle-foot orthoses for patients with stroke.

To the best of our knowledge, a limited systematic review and meta-analysis has also been performed in 2013,10 aimed at investigating the effects of ankle-foot orthosis on balance and gait after stroke. In that review, different study designs were included with heterogeneous methodologies, and short-term effects were only assessed. Although the study was published in 2013, the authors only included the studies published until 2011. In recent years, two meta-analyses11,12 have been carried out which aimed at comparing the therapeutic effects of ankle-foot orthoses and functional electrical stimulation on drop foot in central nervous system (CNS) diseases. In these reviews, stroke was considered along with other CNS diseases, and ankle-foot orthoses and functional electrical stimulation were found to have the same effects. Lack of publication bias assessment, quality of evidence evaluation, and combined different types of interventions resulted in inconclusive findings in these meta-analyses.

The primary objective of this up-to-date study is systematically reviewing the literature with regard to the effects of ankle-foot orthoses on walking speed of patients with stroke.[…]


Continue —->  The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials – Saeed Shahabi, Hosein Shabaninejad, Mohammad Kamali, Maryam Jalali, Ahmad Ahmadi Teymourlouy,

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[BLOG POST] The Best AFO for Foot Drop Reviews in 2018


Life is not fair to all of us. Sometimes our bodies betray us giving abnormalities. One such abnormality is foot drop. However, with science and medicine reaching its peaks, everyone can be helped.

It is now easier than ever to bring back normality into life using the gifts from technology. People whose life has been suffering because of foot drop can now have some normality back in life with AFOs.

It is essential to choose only the best AFO for foot drop that will have an impact on every movement of yours. To ensure the maximum amount of comfort, one must be careful while buying the best foot drop braces. Here is a list of things to memorize before you buy one.

  • The best AFO for foot drop must be comfortable.
  • It should be designed to support your foot firmly.
  • The structure of the AFO should ensure that the weight of the body should be balanced on both feet properly.
  • It ought to fit in your shoes properly to avoid discomfort.
  • Most importantly, it must provide ease in movement.

Best AFO for Foot Drop

MARS Wellness Ankle Foot Orthosis Support – AFO – Drop Foot Support Splint Right, Medium

Ankle Foot Orthosis Support - AFO - Drop Foot Support Splint

This product is specially designed keeping the foot anatomy in mind. Due to this, the AFO supports the foot perfectly well. The discomfort in the heel can be minimized as the foot is entirely balanced. This increases the stability and assists in walking steadily.

It has a thicker rare portion near surrounding the heel and a thinner footplate on the front which gives the heel more support. The front portion gets more comfortable as it gets softer.

The front portion can also be cut with scissors according to your comfort and desired size. This makes the product much convenient to wear and walk in.

The product is designed to fit in almost all kinds of shoes. So even with this condition, you can wear the shoes you like most. You can do that without being bothered by the AFO braces for foot drop.

To support the foot more conveniently, the AFO braces come with a hook and loop straps. You can tie these around the calf of your leg. This ties it securely to your foot as you walk.  In our opinion, it is the best drop foot brace for people suffering this due to nerve palsy or heel cord tightness.

Ossur AFO Leaf Spring – Small/Medium – Right

Ossur AFO Leaf Spring - Small Medium

Ossur offers a product of extraordinary strength. This product is designed to have a variable texture and width. This design gives the foot brace its strength, providing support and comfort.

It weighs much less than regular foot braces, making it much more comfortable to wear and convenient to walk in. However, even with a lesser weight the quality and strength are uncompromised. The stability it provides is ideal.

The product comes in varied sizes according to height. You can choose a brace according to your height which in turn makes it much more suitable to wear and use.

The footplate of this AFO brace for foot drop has viscosity. It supports the foot and is comfortable to wear. The footplate can be trimmed into the shape of your desire.

This brace has a hollow portion over the heels. Because of this, the product is the right one to use with a variety of shoes and is also brings you more comfort.  This is the best AFO to use for long walks.

FREEDOM Swedish AFO, Black, Men’s Right

FREEDOM Swedish AFO, Black, Men's Right

This product reduces the angle between your toes and the shin to a comfortable position. This reduces the effects of drop foot and makes it easier for you to walk in. It stabilizes the foot and brings in the sense of relaxation to the foot.

The product is made of injection molded polyethylene which makes it resilient. A strong enough AFO will provide the necessary support. The material used for the manufacturing of this foot brace makes it very durable.

The hook and lock strap that ties over the calf to fasten it is padded. This makes it soft and comfortable to wear. The splint can also be altered to an extent according to your desire by using a heat gun. So you can adjust your comfort level with the AFO.

Comfortland Foot Drop Splint (Large Left)

Comfortland Foot Drop Splint (Large Left)

The flexibility and shape of the splint make it the best AFO for foot drop. This product will make life so much easier for you. Especially for people who have busy schedules and often need to wear shoes, this is the one for them.

The shape fits perfectly well in most shoes. Even if it doesn’t, all you need to do is trim it a little the way you want, and it will work just fine.

An elastic band secures the AFO with the leg. So if you happen to wear tight jeans, this won’t be bulging out to show you are wearing an AFO. The elastic band also makes it painless to wear.

The reinforcement to the foot is flawless with polyethylene structure. The quality and durability remain uncompromised.

Rolyan A508RL Large Ankle Foot Orthosis for Right Leg

Rolyan Small Large Ankle Foot Orthosis for Right Leg

This product can help people with a more severe problem of foot drop. It can hold up an unsteady ankle and provide support to the ankle and foot region, backed by the calf.

It is made of a hard material which can help with minor involuntary muscular contractions.

This contributes a lot of stability to the foot and assists in the regular walking, reducing the effects of the abnormality.

The foot plate is larger than the average size usually found in the markets. This provides aid to the forefoot during motion, keeping the foot steady. It can be modified slightly with the help of ordinary scissors or a heat gun.

BOLD Foot Drop Splint Left Small White

BOLD Foot Drop Splint Left Small White

This product is excellent for people who develop the foot drop due to some neurological issues. It has better strength to provide for walking and can help in foot drop brace running.

This is usefectiveul in assisting with dorsiflexion and gives better control to the foot.

It is manufactured in a pre-dorsiflexion pose, which makes motion a lot more convenient. The comfortable straps that go around your calf to fasten it securely now come with padding.

So, this makes it easy to wear all day long without any inconveniences. Also, this can be used for rehabilitation purposes and offers some cure for foot drop.

Sky Medical Products (v) Semi-Solid Ankle Foot Orthosis Drop Foot Brace Medium Left

Sky Medical Products (v) Semi-Solid Ankle Foot Orthosis Drop Foot Brace Medium Left

The shape of this product ensures a correction to the foot drop problem as you wear it. It assists in bringing your feet in a right posture, which in turn will help you carry out the daily life activities such as walking more easily.

This product will reduce the pain that may arise in the ankles and prevents calcaneus agitation. The heels are positioned in a convenient pose. It holds and supports the foot by reducing the angle of the foot. This angle is made abnormally large due to neurological issues which result in this condition.

The foot plate ends right before the toes to make their move easier and give more stability to you. The comfortable design of this AFO can aid the foot; it can be the foot drop brace for sleeping.

Since the design is convenient from the edges at the forefoot to the buckle strap at the leg, one can even sleep in this without much discomfort.

Frequently Asked Questions About The Best AFO For Foot Drop:

Q: What the best AFO for foot drop does?

A: It helps people with a condition of foot drop that comes due to neurological abnormalities. It stabilizes the foot and holds it in a healthy posture which makes it easy for a person to walk and stand correctly.

Q: Which is the best AFO for foot drop?

A: The best AFO will be the one which is comfortable to wear and provides the essential support to the foot. It also has a soft strap to avoid unease and blisters on the lower limbs.

Q: Does an AFO help in jogging?

A: If the foot drop is mild and the AFO is strong enough to support the foot and leg, then with time the person might be able to jog.

Q: Do AFOs cure foot drop?

A: They do not cure foot drop, but they can help in the therapy and make it easier to overcome mild foot drop.


By going through this list, one can decide which one is the best AFO for them. It is essential to choose thebest AFO for foot drop because it will affect all the things you do in routine. It aids in standing and walking correctly.

The best AFO is the one which goes best with the level of your case and brings most support and convenience. So, when choosing an AFO one must choose wisely.


via 7 Best AFO for Foot Drop Reviews | (Revealed) Mobility Pedia

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[BLOG POST] Things to Know the Foot Drop Treatment


Foot drop (now and again called drop foot or dropped foot) is the failure to raise the front of the foot because of shortcoming or loss of motion of the muscles and nerves that lift the foot. Foot drop itself isn’t a sickness; it is a manifestation of a more outstanding issue or restorative condition.

You can perceive foot drop by how it influences your step. Somebody with foot drop may drag their toes along the ground when strolling because they can’t lift the front of their foot with each progression. With a particular end goal to abstain from hauling their toes or stumbling they may lift their knee higher or swing their leg in a full bend. That is called steppage walk and is a way of dealing with stress for foot drop issues.

Reasons for Foot Drop

There is three primary driver of the debilitated nerves or muscles that quick foot drop:

1: Nerve Injury

The peroneal nerve is the nerve that imparts to the muscles that lift the foot. Harm to the peroneal nerve is the most popular reason for foot drop. The nerve wraps from the back of the knee to the front of the shin and sits intently to the surface, making it simple to harm. Harm to the peroneal nerve can be caused by sports wounds, hip or knee substitution medical procedure, a leg cast, labor or notwithstanding folding your legs.

2: Muscle Disorders

A condition that makes the muscles gradually debilitate or break down can likewise cause foot drop. This clutter may incorporate muscular dystrophy, amyotrophic sidelong sclerosis (Lou Gehrig’s malady) and polio.

3: Brain or Spinal Disorders

Neurological conditions can likewise cause foot drop. States may incorporate stroke, multiple sclerosis (MS), cerebral paralysis and Charcot-Marie-Tooth illness.

How Foot Drop is Treated

Treatment for foot drop requires treating the hidden therapeutic condition that caused it. At times foot drop can be lasting, but numerous individuals can recoup. Various medications can help with foot drop:

1: Surgery

If a squeezed nerve or herniated circle cause your foot drop, then you will probably have a medical procedure to treat it. The medical system may likewise be necessary to repair muscles or ligaments if they were explicitly harmed and are causing foot drop. In severe or long haul cases, you may have the medical procedure to intertwine your ankle and foot bones and enhance your stride.

2: Functional Electrical Stimulation

A little device can be worn or carefully embedded just beneath the knee that will empower the typical capacity of the nerve, making the muscle contract and the foot to lift while at the same time strolling.

3: Braces or Ankle Foot Orthosis (AFO)

Wearing an AFO knee brace that backings the foot in a typical position are a standard treatment for foot drop. The gadget will balance out your foot and ankle and hold the front piece of the foot up when strolling. While generally, specialists have endorsed massive stiff braces that go inside the shoe, the Saebo Step is a lightweight and practical alternative that offers help outside the shoe.

4: Physical Therapy

Treatment to fortify the foot, ankle and lower leg muscles are the essential treatment for foot drop and will by, and large be recommended notwithstanding the treatment alternatives specified previously. Extending and scope of movement activities will likewise help keep stiffness from creating in the rear foot area.


via Things to Know the Foot Drop Treatment | Minds

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[WEB SITE] Several Types of Foot Drop Treatment

Recuperation relies upon the reason for foot drop and to what extent you’ve had it. Now and again it can be lasting. Rolling out little improvements in your home, for example, expelling mess and utilizing non-slip mats and tangles, can help avoid falls. There are likewise measures you can take to help settle your foot and enhance your strolling capacity.

Medicines for drop foot include:

  • Physiotherapy – to reinforce your foot, ankle and lower leg muscles
  • Wearing an ankle-foot orthosis – to hold your foot in a typical position
  • Electrical nerve incitement – in specific cases it can help lift the foot.
  • Surgery – an activity to combine the ankle or foot bones might be conceivable in extreme or long haul cases

Non-intrusive treatment:

In circumstances where foot drop has caused a significant walk unsettling influence, exercise-based recuperation might be required. Specific practice based recovery for foot drop may incorporate stride preparing that encourages the patient how to walk once more.

In less emotional circumstances, specific activities may essentially be encouraged to encourage the influenced muscles. Active recuperation might be called for in blend with different types of treatments, for example, those demonstrated as follows.

Ankle-foot orthosis:

An ankle-foot orthosis for foot drop is worn on the lower some part of the leg to help manage the ankle and foot. If your GP figures an AFO will enable, they’ll to allude you for an evaluation with an orthopedist. Wearing a snug sock between your skin and the AFO will guarantee solace and help anticipate rubbing. Your footwear ought to be fitted around the orthosis.

Ribbon up shoes or those with Velcro fastenings are prescribed for use with AFOs because they’re anything but trying to alter. Shoes with a removable trim are likewise valuable because they give additional room. High-obeyed shoes ought to be kept away from.

Breaking your orthosis in gradually is essential. Once broken in, wear it however much as could reasonably be expected while strolling because it will enable you to walk all the more proficiently and keep you stable. There exists a wide assortment of orthosis so discovering one that is agreeable and practical gives numerous alternatives.

Electrical nerve incitement:

Now and again, an electrical incitement gadget, like a TENS machine, can be utilized to enhance strolling capacity. It can enable you to walk quicker, with not so much exertion but rather more certainty. Two self-glue anode patches are set on the skin. One is placed near the nerve providing the muscle and the other over the focal point of the muscle.

The trigger produces electrical driving forces that animate the nerves to contract (abbreviate) the influenced muscles. The trigger is activated by a sensor in the shoe and is initiated each time your sole foot area leaves the ground as you walk.

Medical procedure:

The medical process might be an alternative in severe or long haul instances of foot drop that have caused perpetual development misfortune from muscle loss of motion. The technique more often than not includes exchanging a ligament from the more grounded leg muscles to the muscle that ought to pull your ankle upwards. Another sort of medical procedure comprises combining the foot or ankle unresolved issues balance out the ankle.

via Several Types of Foot Drop Treatment


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[ARTICLE] Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis – Full Text



Robot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is capable of detecting walking intentions using sensor feedback of wearer’s gait pattern. This study aims to investigate the therapeutic effects of robot-assisted gait training with ankle dorsiflexion assistance.


This was a double-blinded randomized controlled trial. Nineteen chronic stroke patients with motor impairment at ankle participated in 20-session robot-assisted gait training for about five weeks, with 30-min over-ground walking and stair ambulation practices. Robot-assisted AFO either provided active powered ankle assistance during swing phase in Robotic Group (n = 9), or torque impedance at ankle joint as passive AFO in Sham Group (n = 10). Functional assessments were performed before and after the 20-session gait training with 3-month Follow-up. Primary outcome measure was gait independency assessed by Functional Ambulatory Category (FAC). Secondary outcome measures were clinical scores including Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Timed 10-Meter Walk Test (10MWT), Six-minute Walk Test (SMWT), supplemented by gait analysis. All outcome measures were performed in unassisted gait after patients had taken off the robot-assisted AFO. Repeated-measures analysis of covariance was conducted to test the group differences referenced to clinical scores before training.


After 20-session robot-assisted gait training with ankle dorsiflexion assistance, the active ankle assistance in Robotic Group induced changes in gait pattern with improved gait independency (all patients FAC ≥ 5 post-training and 3-month follow-up), motor recovery, walking speed, and greater confidence in affected side loading response (vertical ground reaction force + 1.49 N/kg, peak braking force + 0.24 N/kg) with heel strike instead of flat foot touch-down at initial contact (foot tilting + 1.91°). Sham Group reported reduction in affected leg range of motion (ankle dorsiflexion − 2.36° and knee flexion − 8.48°) during swing.


Robot-assisted gait training with ankle dorsiflexion assistance could improve gait independency and help stroke patients developing confidence in weight acceptance, but future development of robot-assisted AFO should consider more lightweight and custom-fit design.


Stroke is caused by intracranial haemorrhage or thrombosis, which cuts off arterial supply to brain tissue and usually damages the motor pathway of the central nervous system affecting one side of the body. About half of the stroke survivors cannot walk at stroke onset, but they have 60% chance to regain independent walking after rehabilitation [1]. Reduced descending neural drive to the paretic ankle joint causes muscle weakness and spasticity, often accompanied with drop foot which is characterized by the foot pointing downward and dragging on the ground during walking [23]. To maintain sufficient foot clearance in swing phase, people with dropped foot have to compensate either by hip hiking with exaggerated flexion in hip and knee joints, or circumduction gait with the body leaning on the unaffected side and the leg swinging outward through an arc away from the midline [456]. These inefficient asymmetric gait patterns hinder the walking ability and contribute to slower walking speed [78], increasing risk of falling [910], and greater energy expenditure [11]. Poor mobility results in sedentary lifestyle and limited physical exercise [12], which further deteriorates lower-limb functionality.

Foot drop can be managed using ankle-foot-orthosis (AFO), which is rigid or articulated ankle brace that controls ankle range of motion (ROM). Meta-analysis shows walking in conventional AFO has immediate or short-term beneficial effects on gait pattern and mobility of stroke patients, including an overall increase in ankle dorsiflexion throughout gait cycle, improvements in Functional Ambulatory Category (FAC), walking speed, and stairs-climbing speed [131415]. Recent development in robot-assisted AFO demonstrates power assistance at ankle joint can facilitate walking of patients presenting with foot drop, by actively assisting ankle dorsiflexion for foot clearance in swing phase and minimizing occurrence of foot slap at initial contact [161718]. Previous studies only evaluated the immediate effects of stroke patients walking in passive AFO [1415] or robot-assisted AFO [1920], but they were not sure whether any assistive effects could be carried over to unassisted gait after the patients had taken off the devices, i.e. the therapeutic effects.

Neuroscience studies suggest the brain is capable of altering its functions and structures for adapting to internal and external environment; an ability known as neuroplasticity [22122]. Researches show intensive repetitive skill training can enhance neuroplasticity and promote motor relearning of stroke patients [2324], which is achievable utilizing robot-assistance in clinical setting. The Anklebot that was developed in MIT can provide power assistance to stroke patients performing repetitive voluntary ankle sagittal movements in seated position, and a single-arm pilot study reports stroke patients (n = 8) had improved volitional ankle control and spatial-temporal gait parameters after 6-week 18-session training using the Anklebot [25]; 30-min seated skill training at ankle joint can induce plastic changes in cortical excitability in area controlling dorsiflexor [26]. Thus robot-assisted AFO with dorsiflexion assistance can potentially stimulate motor recovery of stroke patients with foot drop problem. Neuroscience studies further show the functional outcome of neuroplasticity is task-specific and dependent on the training nature [2212227]. It implies that in order to improve independent walking ability, stroke patients are expected to practise real over-ground walking instead of seated training. Incorporation of stair ambulation into gait training could facilitate generalization towards activity of daily-living, which requires stroke patients to perform skilled ankle dorsiflexion and plantarflexion when they are negotiating steps. Another characteristics of neuroplasticity is the importance of salient experiences for motor relearning from error correction [22122]. During gait training, powered ankle assistance from a robot-assisted AFO could serve as a source of salient proprioceptive feedback synchronized to gait pattern [28]. The robot can strengthen the experience-driven neuroplasticity by producing this proprioceptive feedback at each successfully triggered ankle power assistance [28]. In summary, researches on experience-driven neuroplasticity suggest stroke patients presenting with foot drop problem can potentially restore some level of independent walking ability through robot-assisted gait training with ankle dorsiflexion assistance on over-ground walking and stair ambulation.

To our knowledge, up to now no randomized controlled trial (RCT) has been carried out to validate the rehabilitation approach of robot-assisted AFO [2930]. The current study aims to evaluate whether gait training with robot-assisted AFO with dorsiflexion assistance can bring greater improvement in independent walking ability than training with passive AFO. In each session, stroke patients were trained in 20-min over-ground walking and 10-min stair ambulation. Assessments on the participating stroke patients focused on functional changes in unassisted gait after they had discontinued to wear the devices, i.e. the therapeutic effects. A meta-analysis study recommends FAC to be the primary outcome measure for clinical trials involving electromechanical gait training [30]. FAC is a reliable measurement of independent walking ability on level ground walking and stair ambulation, which is a good prediction of independent community walking post-stroke [31]. The demonstration of safety and effectiveness of the robot-assisted gait training can have positive impact on post-stroke rehabilitation and can potentially establish a new treatment method for stroke patients presenting with foot drop.[…]


Continue —>  Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis | Journal of NeuroEngineering and Rehabilitation | Full Text

Figure 1

Fig. 1a Robot-assisted AFO, and b Stroke patients walking on stairs wearing the robot-assisted AFO

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[WEB SITE] Foot Drop: Causes, Prevention and How You can Treat It

What is foot drop & what causes it?

Foot drop is a simple name but its cause and treatment may be less than simple.

If you are unable to lift your foot up at the ankle and it makes walking difficult, you may have something called foot drop. This could be due to weakness in one of the muscles responsible for lifting, or dorsiflexing, your foot. It could also be caused by tightness or spasticity in the calf muscles of your leg that cause your toes to point downward.

The cause of foot drop can be from several different sources – neurological, muscular, a side effect from medication, or from a lack of movement.

People with stroke, multiple sclerosis, acquired brain injury, spinal cord injury, or cerebral palsy have a central neurological reason causing weakness, tightness or spasticity. People with peripheral neurologic disease may also have foot drop. These diagnoses could include neuropathy, injury to the lower spinal cord, nerve damage, or illnesses like Guillain-Barre syndrome.

Those who have a traumatic accident or muscular damage could also suffer from foot drop because of damage from swelling and compression.

Certain medications are known to potentially cause foot drop. Talk to your doctor about your medications.

Foot drop can also occur in people who are in bed for a prolonged amount of time. When lying on your back, gravity pulls down your foot, and can cause weakness and overstretch the muscles and nerves on the front of your lower leg.

Can foot drop be prevented?

If you or your loved one is required to be on bedrest or immobile, you can help to prevent foot drop by using a padded splint, by doing stretching, and by doing active exercises like ankle pumps.

If you have an underlying condition, it may be impossible to fully prevent foot drop from occurring. But often you can improve the flexibility and strength in your leg, or use an orthosis or splint to help maintain your foot in a position that will allow you to walk and move safely.

How can foot drop be treated?

The treatment of foot drop depends on the cause and the symptoms you have. Below are some suggestions on what you can do, but make sure to talk to your doctor, therapist or orthotist about the best treatment options for you.

Keep your foot and ankle flexible:

  • Use a foot splint at night

  • Complete daily stretches. The ProStretch gives a great stretch

Improve the tone in your leg:

  • Use an orthosis that puts your ankle in a slight stretch

Strengthen your leg:

  • Use neuromuscular electrical stimulation

  • Complete exercises against gravity or with resistance like a Theraband

  • Stand on a variety of surfaces like an Airex balance pad or a Bosu ball to challenge your muscles in your legs. Hold onto something sturdy or have someone nearby to help

Improve the safety of your walking and prevent falls:

  • Use an ankle foot orthosis to keep your toes up when walking. Depending on your strength level, you may need a flexible one or a rigid one

  • Walk with an assistive device, like a walker or cane

  • Modify your home to prevent you from tripping or falling – consider removing rugs and floor clutter, sitting on a shower chair instead of standing, and observe your home for other potential hazards

Prevent skin problems with the use of splints and orthotics:

  • Make sure to check your skin after you’ve been wearing it, and more often if you have impaired sensation in your legs, diabetes, or a history of wounds. Use a hand held inspection mirror to help

Keep the rest of yourself of healthy:

  • Consider activities like stationary biking or swimming to complete overall strengthening and conditioning

  • Strengthen your core muscles to improve your overall balance and stability

What are the dangers of not treating foot drop?

The biggest risk of not treating foot drop is tripping and falling. Falls lead to injury and other unnecessary treatments or hospitalizations. In order to clear your toes to avoid falling, you will have to change the way you walk. Over time, this could lead to pain or discomfort in your back or legs. Also, if your ankle loses flexibility and you cannot move it at you may need surgery.

Most importantly, without treatment you will have more difficulty doing the things in life that you enjoy doing. Unfortunately, there may be no cure, but there are things you can do to help improve the quality of your life.

Who should I ask for more information?

If you have already been diagnosed or are concerned about your risk for foot drop, you should speak with your healthcare provider about what you can do to prevent and treat it.

Source: Foot Drop: Causes, Prevention and How You can Treat It

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[ARTICLE] Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients – Full Text PDF


[Purpose] This study investigated the short-term effects of a combination therapy consisting of repetitive facilitative exercises and orthotic treatment.

[Subjects and Methods] The subjects were chronic post-stroke patients (n=27; 24 males and 3 females; 59.3 ± 12.4 years old; duration after onset: 35.7 ± 28.9 months) with limited mobility and motor function. Each subject received combination therapy consisting of repetitive facilitative exercises for the hemiplegic lower limb and gait training with an ankle-foot orthosis for 4 weeks. The Fugl-Meyer assessment of the lower extremity, the Stroke Impairment Assessment Set as a measure of motor performance, the Timed Up & Go test, and the 10-m walk test as a measure of functional ambulation were evaluated before and after the combination therapy intervention.

[Results] The findings of the Fugl-Meyer assessment, Stroke Impairment Assessment Set, Timed Up & Go test, and 10-m walk test significantly improved after the intervention. Moreover, the results of the 10-m walk test at a fast speed reached the minimal detectible change threshold (0.13 m/s).

[Conclusion] Short-term physiotherapy combining repetitive facilitative exercises and orthotic treatment may be more effective than the conventional neurofacilitation therapy, to improve the lower-limb motor performance and functional ambulation of chronic post-stroke patients.



The mobility of many stroke survivorsislimited, and most identify walking as a top priority for rehabilitation1) . One way to manage ambulatory difficulties is with an ankle-foot orthosis (AFO) or a foot-drop splint, which aims to stabilize the foot and ankle while weight-bearing and lift the toes while stepping1) . In stroke rehabilitation, various approaches, including robotic assistance, strength training, and task-related/virtual reality techniques, have been shown to improve motor function2) . The benefits of a high intensity stroke rehabilitation program are well established, and although no clear guidelines exist regarding the best levels of intensity in practice, the need for its incorporation into a therapy program is widely acknowledged2) . Repetitive facilitative exercises (RFE), which combine a high repetition rate and neurofacilitation, are a recently developed approach to rehabilitation of stroke-related limb impairment2–5) . In the RFE program, therapists use muscle spindle stretching and skin-generated reflexes to assist the patient’s efforts to move an affected joint5) . Previous studies have shown that an RFE program improved lower-limb motor performance (Brunnstrom Recovery Stage, foot tapping, and lower-limb strength) and the 10-m walk test in patients with brain damage3) . An AFO is an assistive device to help stroke patients with hemiplegia walk and stand. A properly prescribed AFO can improve gait performance and control abnormal kinematics arising from coordination deficits6) . Gait training with an AFO has been also reported to improve gait speed and balance in post-stroke patients7, 8) . Therefore, we hypothesized that short-term physiotherapy combining RFE and orthotic treatment would improve both lower-extremity motor performance and functional ambulation. The present study aimed to confirm the efficacy of a combination therapy consisting of RFE for the hemiplegic lower limb and gait training with AFO.

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[ARTICLE] A user-centered qualitative study on experiences with ankle-foot orthoses and suggestions for improved design – Full Text

Improving ankle-foot orthosis design can best be done by implementing a user-centered approach.

To provide insight into the ideas of ankle-foot orthosis users with flaccid ankle muscle paresis on the importance of activities and suggestions for an improved ankle-foot orthosis design.

A focus-group discussion with eight ankle-foot orthosis users (57 ± 5 years, 50% female).

Main inclusion criteria were as follows: ⩾18 years, unable to stand on tip-toe and unable to lift toes. Main exclusion criterion was spasticity of lower extremity muscles. Transcribed data were coded according to the International Classification of Functioning, Disability and Health. Thematic analysis with inductive approach was chosen to order and interpret codes.

Ankle-foot orthosis users ranked walking the most important activity followed by sitting down/standing up from a chair. Their opinion was that ankle-foot orthoses facilitate walking and standing. Ankle-foot orthosis users suggested that an improved ankle-foot orthosis design should balance between stability and flexibility.

Current ankle-foot orthoses facilitate walking which was the most important activity according to ankle-foot orthosis users. An improved ankle-foot orthosis design should enable walking and should optimize between stability and flexibility dependent on the activity and the paresis severity.

Experienced users of ankle-foot orthosis agreed that matching ankle-foot orthosis functions to daily-life activities is a trade-off between stability and flexibility. An improved ankle-foot orthosis design should at least enable level walking.


People with flaccid ankle muscle paresis generally experience problems during walking due to reduced dorsiflexion strength (needed for clearance and controlled plantarflexion during loading response) and/or plantarflexion strength (needed for push-off).1 To improve functioning, an ankle-foot orthosis (AFO) can be prescribed.2 The function of an AFO determines what it must do.3 For people with flaccid paresis, the main AFO function is to compensate for muscle weakness, while for people with spastic paresis, this function is to re-align the joint.2 Due to these function differences, different AFOs can be used depending on the paresis, and therefore, these paresis types should be evaluated separately.

AFOs prescribed for people with flaccid ankle muscle paresis can improve walking.4 However, using an AFO can also come with disadvantages.4 Dorsal AFOs, for example, limit ankle range of motion (ROM).4 This can hamper activities that require a large ankle ROM such as slope walking.5 Improving AFO design can be done best by implementing a user-driven design process as the factors that are most important to users will be taken into account.6 User-driven design is more and more applied in product design to improve acceptance of an innovation by the user.7 In this case, when an AFO fits the needs of users better, adherence to using AFOs can improve.8,9Especially, a qualitative study design can reveal the most important factors since AFO users are not limited by pre-specified questions as is usually the case in quantitative study designs.10 More specifically, a focus-group discussion allowing users to interact is likely to reveal common issues.11 We found one study that evaluated experiences with AFOs.9 However, as they included people with spastic paresis, findings may not be applicable to people with flaccid paresis.

The aim of this explorative study was to provide insight into the ideas of AFO users with flaccid ankle muscle paresis, on the importance of activities and suggestions for an improved AFO design. Providing insight into the importance of activities requires ranking activities according to importance and exploring experiences with these activities.

Figure 3. Thematic map on suggestions for an improved AFO design.

Continue — > A user-centered qualitative study on experiences with ankle-foot orthoses and suggestions for improved design – Jan 18, 2017


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[ARTICLE] Effect of ankle foot orthosis on gait parameters and functional ambulation in patients with stroke – Full Text PDF


Objectives: This study aims to investigate the effect of ankle foot orthosis (AFO) on temporospatial parameters, ankle kinematics, and functional ambulation level in patients with stroke.

Patients and methods: Records of 286 adult patients with stroke assessed in the gait and motion analysis laboratory between April 2005 and January 2013 were reviewed. The data of 28 patients (16 males, 12 females; mean age 43.2±15.9 years; range 20 to 72 years) who were analyzed with and without AFO during the same session were selected for the study. Temporospatial parameters (walking speed, cadence, opposite foot contact, double support time, single support time, step time, and step length) and ankle kinematics (ankle dorsiflexion at initial contact and midswing) were measured using the Vicon 512 motion analysis system. The video and medical records of patients were examined to determine their ambulation level according to Functional Ambulation Category.

Results: Walking speed, cadence, and ankle dorsiflexion at initial contact and midswing were significantly increased while walking with AFO compared to walking barefoot (p<0.05). There were significant reduction in step time and significant increase in step length and opposite foot contact with AFO on the affected side (p<0.05). Single support time reduced significantly with AFO on the unaffected side (p<0.05). Functional Ambulation Category score improved significantly with use of AFO (p<0.05).

Conclusion: The use of AFO has positive effects on gait parameters and functional ambulation in patients with stroke.

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