The influence of ankle joint mobility when using an orthosis on stability in patients with spinal cord injury: a pilot study

Objectives:Perceived risk of falling is an important factor for people with spinal cord injury (SCI). This study investigated the influence of ankle joint motion on postural stability and walking in people with SCI when using an orthosis.Methods:Volunteer subjects with SCI (n=5) participated in this study. Each subject was fitted with an advanced reciprocating gait orthosis (ARGO) equipped with either solid or dorsiflexion-assist type ankle–foot orthosis (AFOs) and walked at their self-selected speed along a flat walkway to enable the comparison of walking speed, cadence and endurance. A force plate system and a modified Falls Efficacy Scale (MFES) were utilized to measure postural sway and the perceived fear of falling, respectively.Results:There were significant differences in the mean MFES scores between two types of orthosis (P=0.023). When using two crutches, there was no significant difference in static standing postural sway in the medio-lateral (M/L) direction (P=0.799), but significant difference in the antero-posterior (A/P) direction (P=0.014). However, during single crutch support, there was a significant difference in both M/L (P=0.019) and A/P (P=0.022) directions. Walking speed (7%) and endurance (5%) significantly increased when using the ARGO with dorsi flexion assisted AFOs. There was no significant deference between two types of orthoses in cadence (P=0.54).Conclusions:Using an ARGO with dorsiflexion-assisted AFOs increased the fear of falling, but improved static postural stability and increased walking speed and endurance, and should therefore be considered as an effective orthosis during the rehabilitation of people with SCI.

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