Effect Of Ankle-foot Orthosis On Walking Function During Different Task Activities For Stroke Patients

Background and objectiveStroke is a cerebrovascular disease with high morbidity and mortality and poor prognosis.The motor dysfunction of lower extremities is a common functional defect in patients with stroke.Nowadays,the single repeated gait rehabilitation in the hospital is difficult to meet the dynamic and complex motor needs faced by patients after returning to their families and communities(mostly doing dual-task,whcih is performing motor-cognitive dual tasks at the same time).The study found that stroke patients with dual-task walking are prone to worse walking performance,limiting their walking function and participation in returning to community life.The effective improvement of dual-task walking function is helpful to improve the patients’ ability to move and live independently in real life after discharge.Ankle-foot orthosis(AFO)can improve the speed and walking stability,as well as improve the motor ability and balance function of lower limbs,but the effect of AFO on motor function of stroke patients during dual-task walking is not clear.Therefore,this 2×2 factorial design clinical trial was designed to determine the effect of AFO use on walking function in stroke patients during different task activities(single-task walking and dual-task walking).Subjects and methodsFrom April 2020 to October 2021,stroke patients were treated in the Department of Rehabilitation Medicine,Department of Neurology and Neurosurgery of Zhujiang Hospital of Southern Medical University.The eligible stroke patients were selected after signing the informed consent,according to the designated inclusion and exclusion criteria,and four kinds of tests were carried out according to the randomized test order assigned to the group(the test sequence has been randomized).The test included:walking with AFO;walking with AFO;walking without AFO;walking with single task without AFO.After completing each test,the patients set a 5-minute elution period between the groups,then completed the next test,and finally completed the walking function test and cognitive function test under four conditions.Timed Up and Go(TUG),Tinetti balance and gait scale(Performance Oriented Mobility Assessment,POMA)and N-back test were used to evaluate walking function,gait and balance function and cognitive function.Descriptive statistics are used to summarize the subjects’ demographic characteristics,balance function and clinical characteristics of the disease.The continuous data with normal distribution are represented by mean and standard deviation,and the classified variables are expressed by frequency and percentage.The 2×2 factorial analysis of variance was used to determine the single effect of AFO and dual-task effect on the outcome index and the interaction effect between them.The difference between different conditions(with or without AFO and dual task)was determined by paired t-test.Statistical test level α=0.05.The IBM SPSS24.0 software was used for statistical analysis.ResultsA total of 55 eligible patients were included in the trial,7 subjects dropped out,and 48 patients completed all trial assessments.The results showed that compared with non-AFO condition,patients with AFO had shorter TUG time to perform the walking task,higher scores on the Tinetti scale,better values for related gait parameters,shorter reaction times and higher accuracy in performing cognitive tasks(P<0.05).And the dual-task effects improved in TUG,reaction time,and accuracy,with differences of Statistical significance(P<0.05).Compared with single-task walking,the above indicators were all worse when performing dual-task walking(no matter with or without AFO),and the difference was statistically significant(P<0.05).ConclusionThe lower limb motor function of stroke patients during dual task walking was significantly worse than during single task walking.The use of AFO can improve the walking function of stroke patients in different task activities(single-task walking and dual-task walking).Based on the results of this study,it can be speculated that the use of AFO can improve the stability of foot and ankle,thus to spread more reserves of brain function to attention to control its walking posture,then improve patients’performance in walking under different task activity.