Article

Initial walking function is often limited after stroke, and regaining walking
ability is an important goal in rehabilitation. Various compensatory movement
strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses
(AFOs) are often prescribed to improve foot-clearance and may influence these
strategies. However, research studying effects of actual AFO-provision early
after stroke is limited. We conducted an explorative randomized controlled trial
and aimed to study the short-term effects of AFO-provision on kinematic and
spatiotemporal parameters in patients early after stroke. In addition, we studied
whether timing of AFO-provision influenced these effects. Unilateral hemiparetic
patients maximal six weeks post-stroke were randomly assigned to AFO-provision:
early (at inclusion) or delayed (eight weeks later). Three-dimensional
gait-analysis with and without AFO in randomized order was performed within two
weeks after AFO-provision. Twenty subjects (8 early, 12 delayed) were analyzed.
We found significant positive effects of AFO-provision for ankle dorsiflexion at
initial contact, foot-off and during swing (-3.6 degrees (7.3) vs 3.0 degrees
(3.9); 0.0 degrees (7.4) vs 5.2 degrees (3.7); and -6.1 degrees (7.8) vs 2.6
degrees (3.5), respectively), all p<0.001. No changes in knee, hip and pelvis
angles were found after AFO-provision, except for knee (+2.3 degrees ) and hip
flexion (+1.6 degrees ) at initial contact, p</=0.001. Significant effects of
AFO-provision were found for cadence (+2.1 steps/min, p=0.026), stride duration
(-0.08s, p=0.015) and single support duration (+1.0%, p=0.002). Early or delayed
AFO-provision after stroke did not affect results. In conclusion, positive
short-term effects of AFO-provision were found on ankle kinematics early after
stroke. Timing of AFO-provision did not influence the results. TRIAL REGISTRATION
NUMBER: NTR1930.
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