Optimizing spring hinged ankle foot orthoses for patients with neurological gait disorders using separate adjustability of plantarflexion and dorsiflexion resistance (original) (raw)

Introduction

Spring hinged ankle foot orthoses (sh-AFOs) improve walking in patients with neurological gait disorders [1]. The sh-AFOs patient specific adjustment of alignment as well as plantarflexion and dorsiflexion resistance is important for a successful intervention [2]. In a clinical environment, the input of a multidisciplinary team in identifying gait problems, discussing social impact, building and tuning the sh-AFO plays a crucial role for an optimal outcome of the orthotic intervention.

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Research question

Can the individual adjustment of plantarflexion and dorsiflexion resistance improve the success of sh-AFOs in patients with neurological gait disorders?

Methods

39 patients (19.4 ± 13.1 years) were supplied with sh-AFOs as part of gait analysis and orthotic testing at two hospitals (Olgahospital and Rummelsberg). The sh-AFOs were made from carbon, had a ventral shell as well as a system ankle joint with five interchangeable spring units (separately adjustable spring force each for dorsiflexion and plantarflexion resistance). The evaluation was performed by either a bioengineer, a physiotherapist or a certified prosthetist and orthotist (CPO) and

Results

Majority of the patients had cerebral palsy (n = 21, 52.8%) followed by hemi-/tetraparesis (n = 8, 20.5%), incomplete spinal cord injury and spina bifida (each n = 2, 5.1%), other indications (n = 5, 12.8%) and an unknown indication (n = 1, 2.6%). 54 legs were analysed; 77.8% showed a hyperflexed (n = 42) and 16.7% a hyperextended gait type (n = 9). In 29.6%, spring units were used as recommended by the manufacturer of the system ankle joint, in another 44.4% the team identified an alternative

Discussion

The results show that the individual adjustment of sh-AFOs spring force resisting dorsiflexion and plantarflexion can lead to a perceived and measurable gait improvement in patients with neurological gait disorders. In this study, two hospitals implemented a clinical treatment routine for orthotic intervention with a multidisciplinary team of physicians, physiotherapists, bioengineers and CPOs to achieve an optimal outcome of orthotic intervention, facilitated by the adjustability of joint