Improvement in gait parameters following late intervention in traumatic brain injury: a long-term follow-up report of a single case

Objective: To evaluate the effect of using an optimally adjusted fixed ankle foot orthosis to control knee pain and promote improvement in gait parameters in a subject with hemiplegia following a traumatic brain injury 11 years previously. Design: This is the report of a single case, using gait laboratory facilities to monitor force alignment relative to the knee and single leg balance time with the subject barefoot. Subject: A 35-year-old woman with a right hemiplegia seen 11 years after onset. Intervention: A polypropylene fixed ankle foot orthosis was supplied to the hemiplegic limb and shoe modifications were made to optimize the position of the ground reaction force relative to the knee during stance phase of gait. This orthosis was used on a daily basis for one year. Results: Knee pain was controlled after three months use of the orthosis. Graphical results of force alignment during stance phase of gait are presented for initial assessment and at one and four years postorthotic supply. A large knee-extending effect was noted on the hemiplegic limb at initial assessment and this was reduced by 67% of its initial value at one year. A compensatory early heel lift was initially noted on the opposite limb and this was reduced by 42% of the initial height at one year. These results were maintained at four years. Right leg standing balance was not initially possible but was recorded as 5 s duration at three months and this was maintained at one and at four years. Conclusions: The use of an optimally adjusted ankle foot orthosis was effective in controlling knee pain and improving barefoot gait parameters with maintenance of the improvement alter use of the orthosis was discontinued. Further research is required to fully establish the potential of this approach in subjects with traumatic brain injury.