Ankle-foot orthotic management in neuromuscular disorders: recommendations for future research

Abstract

Purpose: To describe research evidence supporting clinical recommendations for ankle-foot orthotic (AFO) prescription and examine common limitations in current research among individuals with stroke and cerebral palsy. Method: Three databases and one journal website were searched for articles reporting AFO interventions on gait and functional mobility outcome measures in participants with stroke or cerebral palsy. The International Society for Prosthetics and Orthotics (ISPO) best practice recommendations from consensus conferences were reviewed. Data extracted from the articles include participant characteristics, AFO intervention details, evaluation methods, and outcome measures. Results: Sixty articles were included; twenty-seven on stroke and thirty-three on cerebral palsy participants. Many articles reported insufficient detail on severity of lower limb impairment. Type of interventions included nineteen nonarticulating AFO studies, twelve articulating AFO studies and twenty-three studies testing both. Confounding factors, such as compliance, activity level and footwear, need to be considered in longitudinal studies. Conclusions: Most studies demonstrated improvement in walking speed and ankle dorsiflexion, whereas the indirect effect on knee stability remains unclear. Future research needs to provide detailed information on type and severity of lower limb impairment of participants and design features of the AFO intervention.

Implications for Rehabilitation

• Research reports need to provide clinical measures of impairment and function to facilitate understanding the AFO’s mechanical effect during gait.

• Standardized outcome measures related to the prescription goals and patient’s functional mobility is essential to determine whehter the orthotic effect is beneficial.

• ISPO recommendations should be consulted for reporting orthotic design characteristics.

Keywords::

• AFO
• stroke
• cerebral palsy
• gait

Declaration of Interest: The authors acknowledge the support of the Toronto Rehabilitation Institute which receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario. Support was also provided by Natural Sciences and Engineering Research Council (PGS-D), Canadian Institute of Health Research (MOP-77772), and University of Toronto.