To honor this educational health incentive, The O&P PT will be addressing stroke awareness and the role of ankle foot orthoses in rehabilitation.

Every 40 seconds, someone in the United States suffers a stroke and approximately 1 in 4 of those individuals will have a recurrent stroke.1 This interruption of blood flow to the brain deprives the victim of vital oxygen and nutrients causing cell death.2 The result could lead to  permanent brain damage, long-term disability and mortality.1,2  Recognizing the signs of stroke and obtaining life-saving care is imperative.

Think F.A.S.T.

Signs of a stroke can vary, however, the hallmark symptoms are face drooping, arm weakness and difficulty with speech.2,3 Using the F.A.S.T. test to spot theses signs and calling emergency services can significantly impact one’s recovery.2,3

Additional symptoms include numbness of the face and extremities often occurring on one side of the body, confusion with answering or understanding questions, difficulty with vision & balance, dizziness and severe headache.2,3

Lasting results of stroke-associated conditions such as hemiparesis and tone in the affected arm and leg can lead to long-term impairments impacting one’s mobility.4,5  Participating in rehabilitation, working on daily strengthening and range of motion exercises, can help mitigate the negative effects. Use of orthoses with mobility training can help augment function specifically gait speed, balance and energy efficiency.4

Ankle Foot Orthoses

Foot drop is a common form of motor dysfunction following stroke which impacts gait and mobility.6,7 This weakness of the ankle-foot complex is often addressed during stroke rehabilitation with the use of an Ankle Foot Orthosis (AFO).7,8,9 An AFO aids with positioning the foot & ankle in a neutral position, allowing the foot to clear the floor during swing, and promoting heel strike during early stance phase of gait.6,8,9

Ankle foot orthoses can be made from different materials (e.g., thermoplastic; carbon fiber) and designs allowing for various levels of support in all planes of motion.6,7 Depending on a patient’s needs, different types can be prescribed to address weakness, increased/decreased tone, loss of range of motion and joint instability. A Certified Orthotist will make recommendations accordingly and determine whether off-the-shelf, custom fit or custom molded orthoses are appropriate.

Dynamic AFOs (e.g., posterior leaf spring; carbon fiber; articulating) allow for movement at the ankle joint and progression of the tibia during stance phase of gait.7,9 Static AFOs (e.g., solid AFO; floor reaction AFO) provide triplanar stabilization helping to reduce spasticity and support lower extremities with low tone and significant weakness.7,9 The angle of the ankle and design of the AFO can utilize ground reaction forces to influence flexion or extension of the knee joint during stance.7,9

A Physical Therapist may introduce other types of orthotic interventions during early stages of rehabilitation. A common gait training diagnostic tool is a stirrup orthosis which provides medial-lateral stability of the ankle in conjunction with an elastic wrap to help hold the ankle in neutral. Stretching exercises and weight-bearing activities are instrumental to maintaining range of motion. For those who require a prolonged stretch outside of therapy, an AFO with adjustable pull straps may be required. These are also known as night splints for those who can tolerate 6-8 consecutive hours of use will often don this during the evening while resting.

Prescription of an AFO takes into account multiple factors related to structure and function of the ankle-foot complex, health and mobility of the user, personal preference and payor sources. While there is a lack of studies investigating long-term effects of ambulatory AFO use following stroke, there is sufficient evidence supporting AFO interventions for early mobilization.6,8  Foot drop is addressed via reduction of foot slap, promotion of swing phase clearance and improvement of gait stability.6,7.8,9

References

  1. Tsao, Connie W., et al. “Heart Disease and Stroke Statistics-2023: A Report from the American Heart Association.” Circulation (New York, N.Y.), vol. 147, no. 8, 2023, pp. e93-e621.
  2. “Stroke Symptoms.” National Heart, Lung, and Blood Institute, March 24, 2022, https://www.nhlbi.nih.gov/health/stroke/symptoms
  3. “Stroke Symptoms.” American Stroke Association, https://www.stroke.org/en/about-stroke/stroke-symptoms. Accessed May 12, 2023.
  4. Saghir, Faisal, and Galina Mratskova. “Use of Assistive Technology Devices in Rehabilitation of Patients with Post-Stroke Hemiparesis.” Science & Research, 2023.
  5. Pundik, Svetlana, et al. “Association of Spasticity and Motor Dysfunction in Chronic Stroke.” Annals of Physical and Rehabilitation Medicine, vol. 62, no. 6, 2019, pp. 397-402.
  6. Daryabor, Aliyeh, Mokhtar Arazpour and Gholamreza Aminian. “Effect of Different Designs of Ankle-Foot Orthoses on Gait in Patients with Stroke: A Systematic Review.” Gait & Posture ,vol. 62, 2018, pp. 268-279.
  7. Chui, Kevin K., et al. Orthotics and Prosthetics in Rehabilitation. Elsevier, St. Louis, Missouri, 2020. doi:10.1016/C2017-0-00955-2.
  8. Cui, Yinxing, et al. “Advances in the Clinical Application of Orthotic Devices for Stroke and Spinal Cord Injury since 2013.” Frontiers in Neurology, vol. 14, 2023, pp. 1108320-1108320.
  9. Webster, Joseph B., Douglas Murphy, and Elsevier. Atlas of Orthoses and Assistive Devices. Elsevier, Philadelphia, PA, 2019; 2018;.
Tagged