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This study evaluates the effects of dynamic foot orthoses (DFO) on walking and balance performance in people with multiple sclerosis (MS). Sixteen ambulant subjects with MS and ten age-matched healthy control subjects were studied on initial receipt of foot orthoses and after four weeks of daily wear. Walking speed, MS Walking Scale-12 (MSWS-12) and standing balance were assessed with and without orthoses at both these times. During standing, stance width and vision were varied, and performance was quantified using the velocity of the centre of pressure (COP), body sway velocity and the mean COP position relative to the shoe. People with MS walked slower (P <0.001) and showed increased sway when standing (P <0.001). At the first assessment, the foot orthoses caused an increase in sway and a medial and posterior shift of the COP position. At repeat measurement, the DFOs continued to increase sway compared to a shoe only condition. However, MS subjects reported an improvement in the MSWS-12 (P <0.05) and, compared to the initial session, showed decreased sway when eyes were closed both with and without DFOs. Dynamic foot orthoses may increase sway and change COP position by altering foot alignment and/or plantar afferent stimulation. Improvement in body sway over time may be an overall training effect of the DFOs, as MS subjects adapt to the initial de-stabilization
Previous research has identified areas under the foot where stimulation evokes specific tonic reflexes. The term "tonic" is used because these reflex movements occur slowly, as if tonus or tension were accumulating, in contrast to the abrupt phasic response of a tendon jerk. The concept of tonic reactions has now been incorporated into the design of dynamic foot orthoses to help provide improved orthotic treatment with a better functional outcome. This article describes the background of this technique, briefly describes the manufacture of the dynamic orthosis, and outlines some of its uses.
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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Functional effect of an ankle foot orthosis on gait in multiple sclerosis: a pilot study.
Sheffler LR, Hennessey MT, Knutson JS, Naples GG, Chae J: Am J Phys Med Rehabil 2007;86:000-000.
Quote:
OBJECTIVE:: The objective was to determine whether an ankle foot orthosis improves gait velocity and tasks of functional ambulation in multiple sclerosis (MS).
DESIGN:: This cross-sectional study enrolled 15 participants with diagnosis of MS, dorsiflexion and eversion weakness, and more than 3 mos of using a physician-prescribed ankle foot orthosis (AFO). Subject ambulation was evaluated (1) without an AFO and (2) with an AFO. Outcome measures were the Timed 25-Foot (T25-FW) Walk portion of the Multiple Sclerosis Functional Composite (MSFC) and the five trials (Floor, Carpet, Up and Go, Obstacles, Stairs) of the Modified Emory Functional Ambulation Profile (mEFAP).
RESULTS:: The mean timed differences on the T25-FW and the five components of the mEFAP between the AFO vs. no device trials were not statistically significant.
CONCLUSIONS:: In MS subjects with dorsiflexion and eversion weakness, no statistically significant improvement was found performing timed tasks of functional ambulation with an AFO.
Spatiotemporal and kinematic effect of peroneal nerve stimulation versus an ankle-foot orthosis in patients with multiple sclerosis: a case series.
Sheffler LR, Bailey SN, Chae J. PM R. 2009 Jul;1(7):604-11.
Quote:
OBJECTIVE: To compare the effect of a surface peroneal nerve stimulator (PNS) versus an ankle-foot orthosis (AFO) on spatiotemporal and kinematic parameters of gait in patients with multiple sclerosis.
DESIGN: This was a case series design. PARTICIPANTS: Four subjects with multiple sclerosis and dorsiflexion weakness. INTERVENTION: Quantitative gait analysis with the use of (1) no device, (2) AFO, and (3) PNS as a single point-in-time assessment. OUTCOME MEASURES: Included walking speed, stride length, cadence, and double support time; kinematic parameters included peak pelvic obliquity during swing, peak contralateral hip abduction during stance, peak knee flexion and hip flexion during swing, ankle dorsiflexion at initial contact, and peak ankle internal rotation during swing.
RESULTS: One-way analysis of variance was used to compare intrasubject performance under the 3 device conditions. The PNS significantly increased ankle dorsiflexion angle at initial contact, as compared with both no device and the AFO, in 3 of the 4 subjects. However, other spatiotemporal and kinematic gait parameters were more variably affected by the device conditions.
CONCLUSIONS: With the exception of ankle dorsiflexion angle at initial contact, PNS and AFO have a variable effect on spatiotemporal and kinematic gait parameters in individual subjects with multiple sclerosis. Further studies are indicated to determine the clinical significance of intrasubject differences between device conditions
Foot orthoses and multiple sclerosis
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