Objective Clinical Prescription of Passive-Dynamic Ankle-Foot Orthoses to Optimize Patient Outcomes
Abstract
Spring-like ankle braces are a special type of ankle brace that can replicate, and replace, the function of muscles that has been lost due to injury or disease. In the past decade, the rate of development and clinical prescription of these spring-like ankle braces has dramatically increased. To date, development and prescription of these spring-like ankle braces has primarily been targeted for high-functioning individuals, such as Wounded Warriors with limb salvage. While prescribing these ankle braces to other patient populations has not been widely considered, the ankle braces are actually ideally suited for application in populations with lower functional levels, such as those who have suffered a stroke. Stroke is the leading cause of disability in the United States and one of the leading causes of disability in Veterans. Ankle muscle weakness is a common impairment in individuals who have sustained a stroke, and this often results in reduced walking ability. This reduced walking ability has debilitating long-term health consequences. Current rehabilitation strategies do not sufficiently improve the factors that limit walking ability after a stroke, suggesting a need for new and innovative approaches, such as new approaches for prescribing ankle braces. To optimize a patient s outcomes, such as an individual s walking ability, the characteristics of these spring-link ankle braces must be matched to each individual patient s needs (i.e., muscle strength, ability of joints to move). However, despite increasing prescription of these spring-like ankle braces, little information exists to guide prescription (how brace characteristics are matched to patient s needs) of these or any other types of ankle braces. Currently, the prescription process for ankle braces requires trial and error over numerous clinical visits, which results in highly variable, and often suboptimal, patient outcomes. We contend that prescribing ankle braces with a quantitative prescription model, by measuring the characteristics of the ankle braces and matching those characteristics to each patient s needs, will provide meaningful improvements to every patient s outcomes. Thus, the overall objective of this study is to compare effectiveness of traditionally prescribed ankle braces to quantitatively prescribed spring-like ankle braces for individuals post-stroke. This study will take place over a 3-year period. During the study, participants will have measurements (outcomes) taken in the laboratory while they walk while wearing their current, traditionally prescribed ankle brace, and a quantitatively prescribed spring-like ankle brace that we will make for them. These measurements will include how well they walk, how quickly they walk, and their satisfaction with the ankle brace. Participants will also be given a step-activity monitor to wear outside the laboratory to measure the number of steps they take each day with their current traditionally prescribed ankle brace and then with their quantitatively prescribed spring-like ankle brace. We expect that the quantitatively prescribed spring-like ankle brace will provide superior outcomes compared to the traditionally prescribed ankle brace. We will also be able to identify the prescription guidelines (how the ankle brace characteristics were matched to each participant s needs) for whichever ankle brace provides the best outcome for each participant. The risks associated with this study are small, such as experiencing mild skin irritation from the ankle brace or a minor fall during the walking tests. These risks are no more than an individual would incur during their typical activities of daily living, and precautions will be taken to minimize the risks, including adjusting fit of the ankle brace if the participant experiences discomfort or skin irritation and having the participants wear a safety harness during the walking tests in the laboratory. Moreover, the potential benefits of this study ou
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810502
Entities
People
- Elisa Arch
Organizations
- United States Army
- University of Delaware