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An Advanced Ground Reaction Design Ankle-Foot Orthosis to Improve Gait and Balance in Individuals With Post-Stroke Hemiparesis: A Case Series

Hale, Jennifer PT, DPT, NCS; Seale, Jill PT, PhD, NCS; Jennings, Jason CO, LO, FAAOP; DiBello, Thomas CO, LO, FAAOP

JPO: Journal of Prosthetics and Orthotics: January 2013 - Volume 25 - Issue 1 - p 42–47
doi: 10.1097/JPO.0b013e31827ba11e
Case Report

ABSTRACT The purpose of this case series was to explore the impact of a novel design for an ankle-foot orthosis (AFO) on gait and balance in persons with post-stroke hemiparesis. Five subjects with hemiparesis after cerebrovascular accident were referred for evaluation for an AFO because of gait and balance impairments. All subjects were found to have difficulty in both the swing and stance phases of gait, exhibiting difficulty with swing limb clearance and stance limb stability. The advanced ground reaction design of AFO (A-GRAFO) was chosen as the most appropriate device for orthotic management. The specific orthotic design used in this study was a Dynamic Bracing Solutions Balancer™. Advanced triplanar control of the limb was achieved through the use of a unique segmented weight-bearing impression technique, specific cast modifications, specific alignment parameters, intimate fit, and rigid materials. Gait speed, gait endurance, and balance were assessed for each subject using the 10-m walk test, 6-minute walk test, and Timed Up and Go Test (TUG) before and after receiving the A-GRAFO. All subjects improved in gait speed and gait endurance, whereas four of the five improved in balance. Gait speed increased an average of 0.30 m/second (55%), 6-minute walk distance increased an average of 96 m (52%), and time to complete the TUG decreased by 5 seconds (24%) for subjects using the A-GRAFO compared with the no-orthosis condition. The results of this case series suggest that this orthosis design should be considered for patients with residual hemiparesis after stroke. Further research is warranted to compare the A-GRAFO against more traditional designs.

JENNIFER HALE, PT, DPT, NCS is affiliated with TIRR Memorial Hermann Adult and Pediatric Outpatient Rehabilitation, The Challenge Program, Houston, Texas, and Texas State University, San Marcos.

JILL SEALE, PT, PhD, NCS is affiliated with the University of Texas Medical Branch, Galveston, Texas.

JASON JENNINGS, CO, LO, FAAOP, AND THOMAS DIBELLO, CO, LO, FAAOP are affiliated with Hanger Clinic/Dynamic Orthotics and Prosthetics, Houston, Texas.

Disclosure: The authors declare no conflict of interest.

Correspondence to: Jennifer Hale, PT, DPT, NCS, 601 University Drive, San Marcos TX, 78666; e-mail:

© 2013 American Academy of Orthotists & Prosthetists