Purpose: This case report describes the effects of a new ankle foot orthosis with bi-channel adjustable ankle locks combined with physical therapy intervention on gait parameters in a subject with longstanding hemiplegia.
Clinical problem: A 69-year old male, 4.5 years post cerebrovascular accident with residual right hemiplegia, demonstrated impaired lower extremity muscle performance and motor control, with difficulty performing graded knee extension and achieving active knee flexion except in synergy, and slow gait (0.34 m/sec) with decreased left step time (0.57 sec) and length (26.3 cm) compared to the right (1.26 sec and 35.5 cm, respectively), decreased foot clearance during swing and knee hyperextension during stance.
Intervention: Collaboration between the PT and orthotist with attention to the subject's knee control and history of lower extremity edema determined orthotic prescription. The subjects then received 24 outpatient physical therapy visits over 11 weeks.
Results: The new orthosis and PT intervention resulted in improved foot clearance, usual and fast velocity, with increased cadence, and better step length differential and step time differential at usual speed. Following physical therapy, muscle performance of quadriceps and hamstring improved, with no knee hyperextension during stance. The subject demonstrated increased confidence in gait and a positive attitude toward his right lower extremity.
Conclusions: An appropriate orthosis combined with PT intervention can decrease energy expenditure in walking and increase confidence and attitude in a subject with longstanding hemiplegia.