The Effect of a Powered Ankle Foot Orthosis (PAFO) on Function, Safety, and Quality of Life in Military Service Members and Veterans Who Wear a Prescribed Orthosis
Abstract
In times of conflict, necessary advancements in brace (orthosis) and artificial limb (prosthesis) design accelerates to provide the Service members the best available technology to enhance their recovery. In fact, the newest orthotic technology for military use, a powered exoskeleton, was developed to enhance the healthy Soldier’s ability to carry heavy loads and to improve endurance. The technology behind this system is groundbreaking for the healthy Soldier, but a more widespread need for the innovation in orthosis development is essential to assist the typical Veteran, and civilian, who has suffered a stroke, spinal cord injury, traumatic brain injury, or a trauma to their leg creating weakness and poor coordination and now require an orthosis just to walk. In these cases, a brace to position and support the ankle, called an ankle foot orthosis (AFO), is often prescribed to improve walking ability. Unfortunately, the design of the most commonly prescribed AFO, which has not changed for over 30 years, does not adequately substitute for lost function as it cannot replicate the complicated ankle movement and muscle power necessary for a safe and normal walking pattern. Walking with an abnormal walking pattern puts the person at risk for balance problems including falling, which is a leading risk factor, in and of itself, for fractures and further disability. Thus, we believe the newest technology, designed to enhance function in the healthy Soldier, may benefit the typical Veteran who wears a prescribed AFO for lower extremity impairment. The powered ankle foot orthosis (PAFO) combines the new robotic exoskeletal technology with currently used AFO design to assist with toe clearance and provide push off power when a step is taken. Unfortunately, there have not been any studies conducted on the effect a PAFO may have to improve functional performance in the typical Veteran with lower extremity neurological impairment who needs and AFO to walk. In addition to functional performance, we will also examine the effect of the PAFO on walking ability, safety, and quality of life. Finally, due to its innovative design that allows the affected ankle to move, there is evidence to suggest that the PAFO may actually improve long-term function even when not worn. We will test this by examining our participants both when wearing and when not wearing their (P)AFO. A limitation of the PAFO is that it is a heavier AFO and the added ankle motion may be difficult for the typical Veteran in need of an AFO to get used to, thus it may pose some associated risk. Nevertheless, we believe with proper training, the typical Veteran with neurological impairment would benefit from an opportunity to use a PAFO. Therefore, the purpose of this study is to determine if exchanging a typically prescribed AFO for a PAFO will provide a suitable alternative for the typical Veteran amputee and improve their functional performance, ambulatory ability, safety, and quality of life. For this study, we will recruit of 64 typical Veterans with lower extremity impairment from neurologic injury who currently walk with a prescribed AFO. All participants will receive a new pair of shoes while half of them (32) will receive the PAFO and the appropriate training and compare them to the other half who will only receive training on their current AFO. All participants will be followed for 7 months. We will test all of the Veterans three times over the course of the study to evaluate their functional performance, ambulatory ability, safety (including risk of falls and fall history), and quality of life. In the Memphis metropolitan area, stroke, the most prevalent cause of all lower extremity impairments resulting from neurologic injury, and its primary risk factors, hypertension and diabetes, are among the highest in the nation, making this an ideal location to conduct this study. Given these staggering statistics, the need for innovative orthotic interv
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710451
Entities
People
- Phyllis Richey
Organizations
- United States Army
- University of Tennessee Health Science Center