The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users' opinions

Objective: To assess the effect of a hinged ankle foot orthosis (AFO) on functional mobility and gait impairments in people with a severe hemiplegia undergoing rehabilitation, and to investigate the patients' views of the hinged AFO. Design: With/without group comparison, and face-to-face questionnaire. Subjects and setting: Twenty-five subjects over 18 years, with a hemiplegia following cerebrovascular accident (CVA) undergoing rehabilitation in a regional rehabilitation unit. Outcome measures: Functional Ambulation Categories as a measure of disability. Paper walkways to measure gait impairments - stride length, step length, symmetry, cadence and velocity. Face-to-face questionnaire to determine the users' opinion of the hinged AFO. Results: Comparison of gait with and without the hinged AFO showed significant improvements in functional mobility (p = 0.000) and in some gait impairments; stride length of the weak (p < 0.005, 95% CI -8.1, -1.6) and sound legs (p < 0.014, 95% CI -8, -1), velocity (p = 0.00, 95% CI -0.1, -0.03) and cadence (p < 0.002, 95% CI -15.1, -3.8). No effect was found for step length in the weak or sound leg or symmetry. The subjects' response was positive, 24 (96%) felt they walked better with the AFO and found it comfortable. Twenty-three (92%) were unbothered by the appearance and 16 (64%) could doff and don it. Conclusion: The hinged AFO improved objective measures of gait impairments and disability and patients were positive about it.