Ankle-Foot Orthosis Selection to Facilitate Gait Recovery in Adults After Stroke

In Brief Ankle-foot orthoses (AFOs) are commonly prescribed to address gait dysfunction after stroke. Despite their widespread use, little is reported about the impact of AFOs on long-term motor recovery. The purpose of this report was to describe the muscle activation patterns and gait characteristics of three persons after stroke who wore an AFO designed to facilitate typical gait mechanics. Participants were three adults (two men, one woman) who were admitted to an inpatient rehabilitation unit after first-time stroke. All participants were trained with a thermoplastic AFO with a metal double action joint and metal upright. Each participated in early standardized task-specific training during which the AFO was worn. Clinical assessments (6-Minute Walk Test and Stroke Rehabilitation Assessment of Movement Test of Motor Recovery) were completed at the time of discharge from inpatient rehabilitation. Additional measures, including computerized gait analysis (GAITRite) and electromyographic (EMG) testing, were completed between 80 and 919 days after stroke. All persons demonstrated marked improvements in gait endurance, velocity, and symmetry from time of initial testing to final testing. Electromyographic testing revealed general temporal symmetry across testing conditions as well as muscle firing patterns that were characteristic of normative gait. The persons in this case report were all trained exclusively with an AFO that was designed to retrain typical gait, including typical muscle firing patterns. Each demonstrated a very fast, symmetrical, and typical motor pattern (EMG) at the time of final testing, and each was able to do so without an assistive device or AFO. Application of AFOs to address gait dysfunction after stroke is common. A comprehensive approach to gait training necessitates awareness of the impact of AFO design on motor recovery. Subjects were trained exclusively with a double adjustable joint AFO that was designed to retrain typical gait, including typical muscle firing patterns. Each demonstrated a very fast, symmetrical, and typical motor pattern (EMG) at the time of final testing and each was able to do so without an assistive device or AFO.