File
Brogårdh C1,2, Espelund C2, Lexell J1,3
1Lund University, Dept of Health Sciences, Lund, Sweden, 2Skåne University Hospital, Dept of Neurology and Rehabilitation Medicine, Lund, Sweden, 3Uppsala University, Dept of Neuroscience, Rehabilitation Medicine, Uppsala, Sweden
Background: Many persons with late effects of polio (LEoP) have muscle weakness in the lower limbs, which affects balance, walking ability and increases the risk of falls and fear of falling. To improve balance and walking ability in ambulatory persons with LEoP and distal lower limb muscle weakness an Ankle-Foot Orthosis (AFO) is often prescribed. An AFO aims to reduce drop-foot by supporting the foot into dorsiflexion, facilitate toe clearance in the swing phase, and promote heel strike. Several AFOs are commercially available, such as flexible orthoses, carbon composite orthoses, or custom-made orthoses by an orthotist. Even though an ankle-foot orthosis (AFO) is commonly prescribed for persons with mild to moderate LEoP, there is limited knowledge if an AFO improves their balance and walking ability in terms of walking speed, distance and perceived safety.
Purpose: The aims of the present study were: (i) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and (ii) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO.
Methods: A mixed-methods, repeated-measures, cross-over design was used. Nineteen participants (mean age 70 years (SD 8.3)) were included and prescribed the following types of flexible AFOs: Dictus Band, Foot-Up® and NavigateTM. They were assessed at two test occasions, with and without the AFO, with a one-week interval. Dynamic balance was evaluated with the Timed Up and Go (TUG) test and walking ability by the 10-meter Fast Gait Speed (FGS) test, the 6-Minute Walk Test (6MWT) and timed walking over a 340-meter long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety, as well as advantages and disadvantages with an AFO were evaluated with questionnaires.
Results: The AFO significantly improved (p 0.05) gait speed, outdoor walking and reduced perceived exertion at one of the test occasion, but had no effect on dynamic balance (p>0.6). A majority perceived significantly improved walking ability (p 0.05) and increased walking safety (p 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability, walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear.
Conclusion(s): A flexible AFO only marginally improves walking ability in persons with LEoP, as assessed quantitatively. The subjective benefit on walking ability and safety, however, suggests that an AFO can be useful to improve daily functioning. In the future, the design of the flexible AFOs needs to be more user-friendly.
Implications: Ambulatory persons with mild to moderate late effects of polio and calf muscle weakness perceive a clear benefit of the AFO. Based on this, a flexible AFO can be recommended in this population to make the person to feel safer when walking.
Keywords: Foot Orthoses, Post-polio myelitis, Walking
Funding acknowledgements: Grants were received from Stiftelsen för bistånd åt rörelsehindrade i Skåne and Faculty of Medicine at Lund University, Sweden
Purpose: The aims of the present study were: (i) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and (ii) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO.
Methods: A mixed-methods, repeated-measures, cross-over design was used. Nineteen participants (mean age 70 years (SD 8.3)) were included and prescribed the following types of flexible AFOs: Dictus Band, Foot-Up® and NavigateTM. They were assessed at two test occasions, with and without the AFO, with a one-week interval. Dynamic balance was evaluated with the Timed Up and Go (TUG) test and walking ability by the 10-meter Fast Gait Speed (FGS) test, the 6-Minute Walk Test (6MWT) and timed walking over a 340-meter long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety, as well as advantages and disadvantages with an AFO were evaluated with questionnaires.
Results: The AFO significantly improved (p 0.05) gait speed, outdoor walking and reduced perceived exertion at one of the test occasion, but had no effect on dynamic balance (p>0.6). A majority perceived significantly improved walking ability (p 0.05) and increased walking safety (p 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability, walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear.
Conclusion(s): A flexible AFO only marginally improves walking ability in persons with LEoP, as assessed quantitatively. The subjective benefit on walking ability and safety, however, suggests that an AFO can be useful to improve daily functioning. In the future, the design of the flexible AFOs needs to be more user-friendly.
Implications: Ambulatory persons with mild to moderate late effects of polio and calf muscle weakness perceive a clear benefit of the AFO. Based on this, a flexible AFO can be recommended in this population to make the person to feel safer when walking.
Keywords: Foot Orthoses, Post-polio myelitis, Walking
Funding acknowledgements: Grants were received from Stiftelsen för bistånd åt rörelsehindrade i Skåne and Faculty of Medicine at Lund University, Sweden
Topic: Neurology; Disability & rehabilitation; Musculoskeletal: lower limb
Ethics approval required: No
Institution: Skåne University Hospital
Ethics committee: N/A
Reason not required: The assessments are included in the clinical management of persons with post-polio. All participants received verbal and written information about the study and gave their informed consent to participate. The principles of the Helsinki Declaration were followed.
All authors, affiliations and abstracts have been published as submitted.
