Effects of Different Orthoses Used for Gait Training on Gait Function among Patients with Subacute Stroke

OBJECTIVES: To facilitate selection of the appropriate orthosis, this study assessed functional ambulation outcomes of subacute stroke patients using either an ankle–foot orthosis (AFO) or a knee–ankle–foot orthosis (KAFO). METHODS: The subjects were newly diagnosed hemiplegic stroke patients admitted to Hatsudai Rehabilitation Hospital between January and June 2016. Differences between the AFO group and the KAFO group were examined using unpaired t-tests. Multiple regression analysis with stepwise regression was used to identify predictive factors for the functional ambulation category (FAC) score at discharge. RESULTS: A total of 164 patients (99 men and 65 women; mean age, 69.2 ± 15.3 years; mean days from onset to admission, 31.9 ± 12.3 days) were included in the study. The AFO, KAFO, and non-orthosis groups contained 38, 79, and 47 patients, respectively. In the AFO group, the median Stroke Impairment Assessment Set (SIAS) motor scores were 2.5–3, and the median sensory scores were 2. In the KAFO group, the median SIAS motor scores were 0–1, and the median sensory scores were 1. At discharge, 32 (84.2%) patients in the AFO group and 20 (25.3%) patients in the KAFO group had an FAC score ≥3. Multiple regression analysis found that age and the Functional Independence Measure cognitive score could be used to predict the FAC score at discharge in the AFO group. The Berg Balance Scale score was an additional predictive factor in the KAFO group. CONCLUSIONS: This study showed that the AFO group had good outcomes for independent ambulation. Furthermore, balance control is an important factor contributing to walking ability in patients with severe hemiparesis.