Category: Stroke; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Genu recurvatum (GR) in persons who are post-stroke can lead to excessive peak knee extension (>5 degrees) during the stance phase of gait. If untreated, GR can contribute to knee instability, weakness, osteoarthritis, and chronic pain. The purpose of this study was to investigate the effect of combining a heel lift with an ankle-foot orthosis (AFO) on genu recurvatum during gait in persons who are post-stroke. We hypothesized that the heel lift would result in a decrease in peak knee extension during the stance phase of gait.
Cross sectional cohort study
Department of Physical Medicine and Rehabilitation outpatient clinic and a Biomechanics lab in Academic Health Care Centers
Participants (or Animals, Specimens, Cadavers) :
Five persons with GR post-stroke [3 females, 2 males, mean age 66.6 years (SD 6.08), mean time since stroke 106.8 months (SD 94.00)].
Three conditions were tested: (1) No AFO (2) AFO (3) AFO with 1cm heel lift. A motion capture system (9 cameras) was used to record kinematic data. Data was processed in Nexus version 2.6.1.
Main Outcome Measure(s) :
Participants walked 10m over ground in 3 trials under 3 conditions. The difference in peak knee extension range in stance was compared between the AFO and the AFO with heel lift conditions.
Peak knee extension range decreased from AFO to AFO with heel lift: (Chi Square = 8.4, p = 0.008). Post hoc analysis using Wilcoxon Signed Ranking revealed a trend toward decreased peak knee extension range from the AFO condition to the AFO with heel lift condition (z= -2.023, p=0.03, r=1.08).
These preliminary findings illustrate the potential value of adding a heel lift to an AFO in individuals with GR post-stroke to help control peak knee extension during stance.
Courtney Whyte– Doctor of Physical Therapy Student, New York Institute of Technology, Plainview, New York
Alexandros Savva– Student Physical Therapist, New York Institute of Technology, Franklin Square, New York
Nadia Zaman– Chief Resident, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
Calvin Chen– Resident Physician, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Jericho, New York
Chory Ashley– Research Coordinator, The Feinstein Insitute for Medical Research, Manhasset, New York
William Werner– Associate Professor, New York Institute of Technology, Old Westbury, New York
Ona Bloom– Associate Professor, Dept. of Physical Medicine and Rehabilitation, Northwell Health, Manhasset, New York
Anthony Oreste– Staff Physiatrist, Northwell Health System, Manhasset, New York
Rosemary Gallagher– Associate Professor, New York Institute of Technology, Point Lookout, New York