Physiotherapy November 2000/vol 86/no 11

594

Effect of a Hinged Ankle FootOrthosis on Hemiplegic Gait

S F TysonBrunel University

H ThorntonNorthwick Park Hospital TrustObjective To assess the effect of a hinged ankle foot orthosis(AFO) on functional mobility and gait impairments in peoplewith a severe hemiplegia undergoing rehabilitation, and toinvestigate the patients’ views of the hinged AFO.

Design With/without group comparison, and face-to-facequestionnaire.

Analysis Paired t-tests, Wilcoxon’s signed rank test anddescriptive statistics.

Subjects and setting Twenty-five subjects over 18 years, withhemiplegia following CVA undergoing rehabilitation in aregional rehabilitation unit.

Outcome measures Functional ambulation categories as ameasure of disability. Paper walkways to measure gaitimpairments – stride length, step length, symmetry, cadenceand velocity. Face-to-face questionnaire to determine the users’opinion of the hinged AFO.

Results Comparison of gait with and without the hinged AFOshowed significant improvement in functional mobility (p =0.000) and in some gait impairments; stride length of the weak(p < 0.005, 95% CI – 8.1, --1.6) and sound legs (p < 0.014, 95%CI –8, --1), velocity (p = 0.00, 95% CI –0.03) and cadence (P ,0.002. 95% CI 15.1, --3.8. No effect was found for step length inthe weak or sound leg or symmetry. The subjects’ response waspositive, 24 (96%) said they walked better with the AFO andfound it comfortable. 23 (92%) were unbothered by theappearance and 16 (64%) could doff and don it.

Conclusion The hinged AFO improved objective measures ofgait impairments and disability and patients were very positiveabout it.

Evidence-based ExerciseProgramme to Reduce Falls in anElderly Population

J C Adams, S L MitchellLightburn Hospital, GlasgowIntroduction There is mounting evidence to suggest thatphysical exercise reduces the risk of falling in older people. Thepurpose of this service development project was to investigate ifa more structured measurable format of physiotherapy inputwould help to reduce the incidence of falls in an elderlycommunity-dwelling population.

Methods A six-week evidence-based programme was initiatedtargeting fallers. Outcome measures used were leg extensorpower (LEP), elderly mobility scale (EMS), functional reach(FR), one repetition maximum (1RM) and Tinetti balanceassessment scale. Measurements were taken at weeks 1 and 6.Home exercises, advice and telephone follow-up werecontinued for three months after the programme finished.

Results Using paired t-test analysis there were significantimprovements for all measures used. Mean change of EMS was2.9, SD 2.7, P = 0.000; FR mean change of 4.1 cm, SD 8.2, P =0.002; LEP mean change of 8.9 watts, SD 12.4, P = 0.000; 1RMmean change of 4.6 kg, SD 0.9, P = 0.000; and Tinetti meanchange of 3.7, SD 09, P = 0.002. A retrospective comparison ofearlier physiotherapy input to a similar population showed onlychanges of 2.1, SD 2.6 for the EMS and 1.3, SD 1.3 for the FR. Interms of falls at the end of the three-month follow-up, 63% ofthe group had had no further falls.

Discussion Our data suggest that there are greater improve-ments in both the EMS and FR when a structured exerciseprogramme is implemented, when compared to our earlierdata.

Conclusion The development of an integrated pathway and fallsclinic to be established, followed by a randomised controlledtrial for a definitive analysis.