IMPROVEMENT IN GAIT PARAMETERS FOLLOWING LATE INTERVENTION IN TRAUMATIC BRAIN INJURY - A LONG-TERM FOLLOW-UP REPORT OF A SINGLE-CASE

Objective: To evaluate the effect of using an optimally adjusted fixed ankle foot orthosis to control knee pain and promote improvement in g ait parameters in a subject with hemiplegia following a traumatic brai n injury 11 years previously. Design: This is the report of a single c ase, using gait laboratory facilities to monitor force alignment relat ive to the knee and single leg balance time with the subject barefoot. Subject: A 35-year-old woman with a right hemiplegia seen 11 years af ter onset. Intervention: A polypropylene fixed ankle foot orthosis was supplied to the hemiplegic limb and shoe modifications were made to o ptimize the position of the ground reaction force relative to the knee during stance phase of gait. This orthosis was used on a daily basis for one year. Results: Knee pain was controlled after three months use of the orthosis. Graphical results of force alignment during stance p hase of gait are presented for initial assessment and at one and four years postorthotic supply. A large knee-extending effect was noted on the hemiplegic limb at initial assessment and this was reduced by 67% of its initial value at one year. A compensatory early heel lift was i nitially noted on the opposite limb and this was reduced by 42% of the initial height at one year. These results were maintained at four yea rs. Right leg standing balance was not initially possible but was reco rded as 5 s duration at three months and this was maintained at one an d at four years.Conclusions: The use of an optimally adjusted ankle fo ot orthosis was effective in controlling knee pain and improving baref oot gait parameters with maintenance of the improvement alter use of t he orthosis was discontinued. Further research is required to fully es tablish the potential of this approach in subjects with traumatic brai n injury.