Effectiveness of elastic band-type ankle–foot orthoses on postural control in poststroke elderly patients as determined using combined measurement of the stability index and body weight-bearing ratio

Purpose Poor recovery of postural stability poststroke is the primary cause of impairment in activities and social participation in elderly stroke survivors. The purpose of our study was to experimentally evaluate the effectiveness of our new elastic ankle–foot orthosis (AFO), compared to a traditional AFO fabricated with hard plastic, in improving postural stability in elderly chronic stroke survivors. Patients and methods Postural stability was evaluated in ten chronic stroke patients, 55.7±8.43 years old. Postural stability was evaluated using the standardized methods of the Biodex Balance System combined with a foot pressure system, under three experimental conditions, no AFO, rigid plastic AFO, and elastic AFO (E-AFO). The following dependent variables of postural stability were analyzed: plantar pressure under the paretic and nonparetic foot, area of the center of balance (COB) and % time spent in each location, distance traveled by the COB away from the body center, distance traveled by the center of pressure, and calculated index of overall stability, as well as indices anterior–posterior and medial–lateral stability. Results Both AFO designs improved all indices of postural stability. Compared to the rigid plastic AFO, the E-AFO produced additional positive effects in controlling anterior–posterior body sway, equalizing weight bearing through the paretic and nonparetic limbs, and restraining the displacement of the center of pressure and of the COB. Conclusion Based on our outcomes, we recommend the prescription of E-AFOs as part of a physiotherapy rehabilitation program to promote recovery of postural stability poststroke. When possible, therapeutic outcomes should be documented using the Biodex Balance System and foot pressure system, as used in our study, to provide evidence needed to support the development of a larger controlled trial to generate high-quality evidence on the effectiveness of E-AFOs.

[1]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[2]  R W Bohannon,et al.  Standing balance and function over the course of acute rehabilitation. , 1995, Archives of physical medicine and rehabilitation.

[3]  Ruth Barclay-Goddard,et al.  Force platform feedback for standing balance training after stroke. , 2004 .

[4]  J. Perry,et al.  Factors Affecting Balance and Ambulation Following Stroke , 1984, Clinical orthopaedics and related research.

[5]  V. Feigin,et al.  Long-Term Neuropsychological and Functional Outcomes in Stroke Survivors: Current Evidence and Perspectives for New Research , 2008, International journal of stroke : official journal of the International Stroke Society.

[6]  Bart Nienhuis,et al.  Effects of visual center of pressure feedback on postural control in young and elderly healthy adults and in stroke patients. , 2003, Human movement science.

[7]  R. D'Agostino,et al.  The influence of gender and age on disability following ischemic stroke: the Framingham study. , 2003, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[8]  A. Forster,et al.  Incidence and consequences offalls due to stroke: a systematic inquiry , 1995, BMJ.

[9]  J. Perry,et al.  Gait Analysis , 2024 .

[10]  K. Fong,et al.  Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation. , 2001, Brain injury.

[11]  Gert Kwakkel,et al.  Effects of visual feedback therapy on postural control in bilateral standing after stroke: a systematic review. , 2006, Journal of rehabilitation medicine.

[12]  M. Y. Lee,et al.  Clinical evaluation of a new biofeedback standing balance training device. , 1996, Journal of medical engineering & technology.

[13]  A. Shumway-cook,et al.  Postural sway biofeedback: its effect on reestablishing stance stability in hemiplegic patients. , 1988, Archives of physical medicine and rehabilitation.

[14]  S. Taback,et al.  Force Platform Feedback for Standing Balance Training After Stroke , 2005, The Cochrane database of systematic reviews.

[15]  E. Çakar,et al.  The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients. , 2010, European journal of physical and rehabilitation medicine.

[16]  V. Pomeroy,et al.  An exploration of the effects of weighted garments on balance and gait of stroke patients with residual disability , 2001, Clinical rehabilitation.

[17]  T. Thom,et al.  American Heart Association Statistics Committee and Stroke Statistics Subcommittee : Heart disease and stroke statistical-2006 update : A report from the American Heart Association Statistics Committee and Stroke statistics subcommittee , 2006 .

[18]  J. Duysens,et al.  A review of standing balance recovery from stroke. , 2005, Gait & posture.

[19]  J. Desrosiers,et al.  Predictors of handicap situations following post-stroke rehabilitation , 2002, Disability and rehabilitation.

[20]  B. Brouwer,et al.  Use of visual feedback in retraining balance following acute stroke. , 2000, Physical therapy.

[21]  C. L. Chen,et al.  Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients. , 1999, Archives of physical medicine and rehabilitation.

[22]  C. Wolfe,et al.  Older stroke patients in Europe: stroke care and determinants of outcome. , 2004, Age and ageing.

[23]  C. Hsieh,et al.  Predicting long-term care institution utilization among post-rehabilitation stroke patients in Taiwan: a medical centre-based study. , 2001, Disability and rehabilitation.

[24]  D. Winter,et al.  Unified theory regarding A/P and M/L balance in quiet stance. , 1996, Journal of neurophysiology.

[25]  E. Çakar,et al.  Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility. , 2010, European journal of physical and rehabilitation medicine.

[26]  P. Langhorne,et al.  Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke. , 2007, The Cochrane database of systematic reviews.

[27]  T. Mulder,et al.  Long‐term outcome after stroke: a disability‐orientated approach , 1996, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[28]  V. Weerdesteyn,et al.  Falls in individuals with stroke. , 2008, Journal of rehabilitation research and development.

[29]  Alfred D. Grant.  Gait Analysis: Normal and Pathological Function , 2010 .

[30]  Alan D. Lopez,et al.  Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study , 1997, The Lancet.

[31]  Yasushi Akazawa,et al.  The effect of varying the plantarflexion resistance of an ankle-foot orthosis on knee joint kinematics in patients with stroke. , 2013, Gait & posture.

[32]  B. S. Smith,et al.  The measure of balance in sitting in stroke rehabilitation prognosis. , 1990, Stroke.

[33]  Marco Baccini,et al.  Efficacy of physiotherapy interventions late after stroke: a meta-analysis , 2010, Journal of Neurology, Neurosurgery & Psychiatry.

[34]  Michael Brainin,et al.  Rehabilitation after stroke in older people. , 2012, Maturitas.

[35]  L. Nyberg,et al.  Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. , 1995, Stroke.

[36]  P. Anslow,et al.  Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study) , 2006 .

[37]  S. Gutnikov,et al.  Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study) , 2005, The Lancet.

[38]  G. Mead,et al.  Physical fitness training for stroke patients. , 2009, The Cochrane database of systematic reviews.

[39]  T. Olsen,et al.  Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. , 2004, Age and Ageing.

[40]  Eric E. Smith,et al.  Age-Related Differences in Characteristics, Performance Measures, Treatment Trends, and Outcomes in Patients With Ischemic Stroke , 2010, Circulation.

[41]  Stephanie Studenski,et al.  Falls in community-dwelling stroke survivors: an accumulated impairments model. , 2002, Journal of rehabilitation research and development.