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- Title
RELATIVE EFFECTS OF ANKLE FOOT ORTHOSES ON BALANCE.
- Authors
Ramstrand, Nerrolyn; Ramstrand, Simon
- Abstract
Background Ankle foot orthoses (AFOs) are typically designed to limit motion of the ankle joint in one or more planes. Given that balance is compromised when joint range of motion is restricted, an understanding of the relative effects of ankle foot orthoses on balance performance is clinically relevant. Balance is a complex skill necessary to maintain the body's center of gravity within the base of support while stationary (static balance) and to control the center of mass in dynamic situations such as walking or when subject to a destabilizing event (dynamic balance). This presentation will focus on results of a systematic review that aimed to evaluate evidence related to the effects of ankle foot orthoses on static and dynamic balance. Methods A search of medical databases was conducted. 37 articles were found to satisfy the predetermined inclusion criteria. Articles were categorized under two main areas; those investigating the use of ankle foot orthoses designed for sporting applications (sports orthoses, 18 studies) and those investigating orthoses that are intended to facilitate ambulation in subjects with locomotor disorders (ambulatory orthoses, 19 studies). Methodological quality of articles was evaluated using the American Academy for Prosthetics and Orthotics SSC Quality Assessment Form (1). Results Sports orthoses: The majority of research addressing the influence of sports orthoses on balance utilized either lace-up and/or semi-rigid Off-The-Shelf designs. Design of the orthoses did not appear to have any effect on balance performance. Most studies included able-bodied subjects and results largely indicate that sports orthoses have neither a positive or negative effect on balance in this population. A small number of studies included persons with diagnosed ankle instability. Results from these studies suggest, with a moderate level of confidence, that sports orthoses can facilitate balance in this cohort. Two papers specifically addressed the issue of orthoses as a potential facilitator for proprioception. Unfortunately, study design limitations in both papers preclude any conclusive statements. Ambulatory orthoses: Low to moderate evidence was found to suggest that performance on certain balance related outcome measures is dependent upon the specific biomechanical design of the AFO. Of interest is that use of rigid orthoses tended to result in either no change, or improvement of performance on static balance tests but was associated with a deterioration in performance under dynamic test conditions for persons with gait abnormalities. Results from several studies suggest, with a high level of confidence, that leaf spring orthoses may have positive effects on balance in adults with stroke induced hemiplegia. Results about the use of supra-malleolar orthoses suggested, with a moderate level of confidence, that they can enhance balance for children diagnosed with cerebral palsy. Conclusion Combined results from studies investigating sports orthoses suggest that these devices are unlikely to compromise balance when used as a prophylactic measure in normal populations. When used as a means of preventing further injury in populations with ankle instability they may even offer positive effects on various balance related outcome measures. Results of studies investigating ambulatory AFOs provide some evidence to suggest that balance outcomes are dependent on the specific design of the device. While rigid designs appear to be beneficial in static balance tasks, more flexible designs appear to be superior under dynamic balance conditions.
- Subjects
FOOT orthoses; HEMIPLEGIA; CHILDREN with cerebral palsy; RANGE of motion of joints; GAIT disorders; ANKLE
- Publication
Rehabilitation / Rehabilitacija, 2019, Vol 18, p11
- ISSN
1580-9315
- Publication type
Article