Comparative analysis of leg posture in stroke patients with and without Ankle Foot Orthosis (AFO)

Background: Stroke causes long-term disability with reduced joint Range of Motion (ROM), muscle spasticity, hemiparesis and abnormal gait. Ankle Foot Orthoses (AFOs) improve alignment and gait pattern in rehabilitation; however, few studies assess their combined effects on ROM, muscle spasticity and gait parameters in same subjects. 
Purpose: To observe and describe changes in joint ROM, muscle spasticity and gait parameters among stroke patients using AFOs over 8 weeks. 
Methodology: A multiple case within-subject repeated-measure observational study was conducted on 3 stroke survivors. Assessments were performed without AFO and at 0, 4 and 8 weeks of use. Joint ROM was measured by Goniometer, muscle spasticity by Modified Ashworth Scale (MAS) and gait parameters by Kinovea video analysis. 
Results: Hip ROM (flexion, extension, abduction) increased over 8 weeks, while knee ROM remained stable. Ankle dorsiflexion improved in two subjects (5^°→13^°, 3^°→11^°) with slight improvement in one (6^°→8^°). Spasticity of plantarflexor decreased (MAS 2→1+) in two subjects, while one showed no changed; inversion spasticity (MAS 2) remained unchanged. Cadence improved in all participants (52→58, 48→55, 45→66 steps/min). Step and stride length showed variable but improved in Subject 3 (44.3→51.4 cm). Without AFO, excessive plantarflexion (25.6°-35.8°) resulted loss of heel rocker. AFO restored neutral alignment, enhancing heel strike and tibial advancement. 
Conclusion: Rigid AFO use improved ankle dorsiflexion, decreased plantarflexor spasticity in some individuals, increased cadence and improved ankle alignment. Results varied among individuals, indicating proper orthotic prescription must be tailored to improve gait and posture of stroke patients.