GAIT FUNCTION IN SPASTIC HEMIPARETIC PATIENTS WALKING BAREFOOT, WITH FIRM SHOES, AND WITH ANKLE-FOOT ORTHOSIS

The purpose of the study was to investigate the effect of firm shoes a nd a particular type of a frequently prescribed ankle-foot orthosis in Germany, the Valens calliper, on functional gait parameters in hemipa retic patients with marked extensor spasticity and corresponding heel- strike problems. Cycle times, vertical ground reaction forces, traject ories of the centre of pressure (gait line) under the soles and the mo de of initial contact were assessed in 19 hemiparetic patients walking barefoot, with firm shoes and the orthosis. With the shoes, significa nt improvements (p < 0.006) were observed for: walking velocity, strid e length, initial double stance duration and gait line of the non-affe cted foot. The pattern of the vertical force diagram improved qualitat ively in six patients. With the orthosis the following variables showe d an even more marked improvement (p < 0.006): walking velocity, caden ce, stride length, and gait line of both the affected and non-affected foot. Fourteen patients became rear-foot strikers and the vertical fo rce pattern further improved in six patients. It is concluded that the ankle-foot orthosis (more than the shoes) provide a useful support in the early rehabilitation of hemiparetic patients with marked spastici ty.