Effects of an ankle-foot orthosis on balance in hemiplegic patients

Objective:Balance disorders seen after stroke are affiliated with decrease in muscle strength and reduction of sensory input from the affected leg. Recovery of stable standing position in hemiplegic patients is a critical step in the rehabilitation process and a priority objective of the stroke rehabilitation. Orthosis are devices which are externally applied to any part of the body. They are frequently used to support existing neuromuscular deficiencies in stroke patients. They effect by modifying the structural and functional characteristics of neuro-muscular-skeletal system. The purpose of this study was to evaluate efficacy of short and long term use of AFO on dynamic balance and static balance in stroke patients objectively. Efficacy on dynamic balance was evaluated clinically with Berg Balance Scale (BDS) and Time Up & Go Test (TUG) and efficacy on static balance was evaluated with SportKAT (Kinesthetic Ability Trainer) in the laboratory. Material and Method: 25 patients were included in the study who admitted to Dokuz Eylul University Faculty of Medicine, Neurology and Physical Medicine and Rehabilitation Clinics with hemiplegia after cerebrovascular events. All of the patients were selected according to inclusion and exclusion criteria from patients who are eligible for AFO. All patients were evaluated twice by the same physician both with and without AFO. Patients were randomized into two groups according to the random numbers table to investigate the difference between the balance measurements made first done with AFO and then without AFO(Group 1), first done without AFO then with AFO (Group 2). The first evaluation was performed in the first week to acclimate to the AFO use, the second evaluation was performed at the end of the second month after at least four hours per day AFO usage. All patients were evaluated by Brunnstrom for motor recovery level, Modified Ashworth Scale (MAS) for the presence of spasticity, cerebellar signs, star cancellation test for neglect, Functional Ambulation Scale (FAS) for ambulation ability and Functional Independence Measure (FIM) for level of independence in activities of daily living. Static balance of the patients were evaluated with sportKAT device by calculating the Mean balance index (BI) (mean value of three measurements) in the laboratory and dynamic balance of the patients were evaluated with Berg Balance Scale (BBS) and Time Up & Go Test (TUG) clinically both with and without AFO. Results: In our study the first and the final assessment at the end of the second month of immediate BBS, Mean BI and TUG values with and without AFO there were statistically significant differences (p<0.05) in the first measurements of BBS, Mean BI and TUG values. The final measurements of Mean BI and TUG values with and without AFO there were statistically significant differences (p <0.05). In the final immediate assessment of BBS there was no statistically significant difference (p> 0.05) between the measurements with and without AFO. There were statistically significant differences (p <0.05) between first and final measurements of BBS, Mean BI and TUG without AFO, Mean BI and TUG values with AFO, in the values of motor and total FIM, upper extremity and hand Brunnstrom stage, lower extremity and total spasticity score. There was no statistically significant difference between the distributions of the groups for gender, age, daily exercise time, AFO daily usage time (p> 0.05). There was a statistically significant difference (p <0.05) between CVE (Cerebrovascular events) times.When two groups were compared, there was no statistically significant difference (p> 0.05) between the first measurement results and the final measurement results at the end of the second month for BBS, Mean BI and TUG values. There was no statistically significant correlation (p> 0.05) between measurements of BBS, Mean BI, TUG, FIM values and upper extremity Brunnstrom stage. The first and at the end of second month values of BBS, Mean BI, TUG, FIM measurements according to the affected side there was no statistically significant difference between the right and left sides (p> 0.05). However when the differences of measurements of the first and the final values of BBS, Mean BI, FIM, TUG and FAS according to the affected side, in patients with affected left side without AFO, Mean BI and TUG values and in patients with affected right side without AFO, BBS, Mean BI, TUG and with AFO Mean BI, motor and total FIM values were found to be statistically significant (p <0.05) Conclusions: In this study, it was found that the use of immediate AFO has a statistically significant effect on the balance parameters and is helpful on the improvement of the measurement results with long-term us. Also it was found that to make measurement first with or without AFO does not produce any statistically significant difference. Keywords: Hemiplegia, balance, ankle-foot orthosis (AFO)