Saturday, October 20, 2012

Article: Sharon - Experiences with Ankle Foot Orthosis and Functional Electric Stimulation Foot Drop Devices

Sharon
On the stroke lists recently, there have been lots of questions and complaints about various devices for drop-foot. As you can see from John’s review, there are numerous devices with a wide range of costs.  So what is the evidence? What is most effective for you at the least cost?

After assessing the biomechanics of 10 people’s gaits with and without an Ankle Foot Orthosis [AFO], Gatti (2012) concluded that an AFO did increase walking velocity in the 10 people he tested. These people had mild to moderate stroke with plantar-flexor spasticity hemiplegia.   A recent book chapter from Geriatric Physical Therapy (Edelstein, 2012) essentially says the same thing,  AFO’s are useful to improve gait and walking speed.  Other studies have demonstrated: reduced risk of tripping and falling, increased walking distance, and more ability to exercise (Bulley, 2010).

Similarly, the Functional Electric Stimulation devices, the WalkAide and Bioness foot drop system will increase walking speed and produce a more normal gait pattern.  They reduce the risk of tripping and falling and many people say they can walk further with less fatigue.  So what is better?

It is worthwhile to read Catherine Bulley’s (2010) recent article of the experiences of nine people with AFO’s and FES systems for foot drop. These people were between 2 and 9 years post stroke, with different degrees of walking difficulty due to foot drop.  They echoed many of the same problems as people have been talking about on the stroke lists —

Some people:
  • Say the AFO is easy to get on and  requires little maintenance, 
  • Prefer the FES because it is less bulky,
  • Find the AFO difficult to get on and requires a larger shoe size. 
  • Complain that the FES devices have to be turned up so much to get the toe to kick up that it is painful,
  • Discover the connections of FES are difficult to manage with one hand,
  • Learn FES devices are not easy to adjust,
  • Find the AFO rubs or burns on their leg, 
  • Find the FES devices un-reliable.

On the stroke lists, many people are not happy with their AFO or FES foot drop device and just don’t wear it. Service is a key factor in satisfaction with both FES and AFO foot drop devices. Ask your physiatrist for a list of people who make or sell the devices. You might be able to purchase a suitable device at more than one place. Ask what the return policy is before you purchase it. Ask if they charge for adjustments and training?  It is likely worthwhile before purchasing either device to ask for some references from other customers like you.  Check out whether the FES or AFO device fitted other stroke survivors well, how much training came with the device, and how strong it is.  Many people complain that their AFO or FES was not very robust and broke within a few days or weeks. Did it fit well or did it need lots of adjustments? Did it pinch, burn, or hurt? What did the orthopedic maker or physiotherapist do when it didn’t work or fit well? How long did it take to get a replacement?  If you are checking references of the orthotic maker / FES delivery person, ask the person how happy they were with the service when they had a problem. Did you have to wait a long time for a replacement?

Just because you had a stroke doesn’t mean that you have to settle for inferior service.

References and reading:
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1 comment:

  1. Unknown10:36 PM, July 10, 2013

    Hi there: You may have to try and wear a foot support like a sports wrap. But if you could rest your foot would help lots. I know at times we cant. I found this out while i was playing football. You have a fine day.
    http://www.footcentersofnc.com/our-services/pediatric-footcare.html

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