Effects of ankle-foot orthosis with dorsiflexion resistance on the quasi-joint stiffness of the ankle joint and spatial asymmetry during gait in patients with hemiparesis

 I consider AFOs as preventing recovery of correct walking, they may get you mobile faster but do nothing for recovery!

I seriously believe that an AFO actually hinders recovery, you do no training of your dorsiflexion while wearing an AFO.  I went cold turkey on using one on a 21 day canoe trip in Canada and Alaska, 3 years after stroke. It forced me to immediately strengthen my ankle to keep it from rolling and get toe clearance. Didn't fall on that trip.  

Peter Levine does a much better explanation of prolonged AFO use;

AFO after stroke: Once its on there, its on there for life.

But you can't listen to anyone but your doctor. But does your doctor know anything EXACT about stroke recovery?

The latest here:

 

Effects of ankle-foot orthosis with dorsiflexion resistance on the quasi-joint stiffness of the ankle joint and spatial asymmetry during gait in patients with hemiparesis

• Keita Honda
• Yusuke Sekiguchi
• Dai Owaki
• 
  
• Shino Inuzuka
• Norihiro Morimoto
• Shin-Ichi Izumi
• Show all authors

Published:May 08, 2024DOI:https://doi.org/10.1016/j.clinbiomech.2024.106263

Highlights

• •
  Ankle joint stiffness during gait in post-stroke patients is increased by orthotics.
• •
  Increased ankle joint stiffness does not improve ankle power generation.
• •
  Step length asymmetry improves even if paretic ankle power generation does not.

Abstract

Background

Reduced ankle quasi-joint stiffness affects propulsion in the paretic side of patients with hemiparesis, contributing to gait asymmetry. We investigated whether the use of an ankle-foot orthosis with dorsiflexion resistance to compensate for reduced stiffness would increase quasi-joint stiffness and spatiotemporal symmetry in patients with hemiparesis.

Methods

Seventeen patients walked along a 7-m walkway in both ankle-foot orthosis with dorsiflexion resistance and control (i.e., ankle-foot orthosis) conditions. Dorsiflexion resistance by spring and cam was set to increase linearly from zero-degree ankle dorsiflexion. Gait data were analyzed using a three-dimensional motion analysis system.

Findings

Ankle-foot orthosis with dorsiflexion resistance significantly increased the quasi-joint stiffness in the early and middle stance phase (P = 0.028 and 0.040). Furthermore, although ankle power generation in the ankle-foot orthosis with dorsiflexion resistance condition was significantly lower than in the control condition (P = 0.003), step length symmetry significantly increased in the ankle-foot orthosis with dorsiflexion resistance condition (P = 0.016). There was no significant difference in swing time ratio between conditions.

Interpretation

Applying dorsiflexion resistance in the paretic stance phase increased quasi-joint stiffness but did not lead to an increase in ankle power generation. On the other hand, applying dorsiflexion resistance also resulted in a more symmetrical step length, even though the ankle joint power generation on the paretic side did not increase as expected. Future research should explore whether modifying the magnitude and timing of dorsiflexion resistance, considering the biomechanical characteristics of each patients' ankle joint during gait, enhances ankle joint power generation.