Stroke Connection - Summer 2012 - (Page 17)
The challenges presented by foot drop can affect a person’s quality of life and their ability to be an active member of the community.
— Physical Therapist Jody Feld Impact on a survivor’s life
A change in normal walking pattern affects a person’s ability to safely and independently make his or her way around the home and community. Foot drop can result in slower walking, fatigue at short distances, higher energy use, pain and a lot of falls. A person with foot drop may choose to walk less often and require more assistance to do so safely. All these challenges affect the person’s quality of life and ability to be an active member of the community. When asked to explain how foot drop has affected her life, Elizabeth, a survivor I worked with, said, “Foot drop has made the ability to walk and be functional a challenge. I was falling constantly. I hesitated to go anywhere because I was so unstable and I was so slow in my walking. I was constantly left behind in the crowd.” There are different types of AFOs, made with a variety of materials such as polypropylene or carbonfiber and with varying degrees of stability (rigid or flexible). The cost of an AFO is often covered at least in part by insurance. The style and fit are tailored for each person. A physician, physical therapist and an orthotist (a professional who works with orthotics) will often work together to determine whether a brace would be helpful, select the type of device, and fit and train the user. An AFO can help increase walking speed. It also may provide needed stability for the ankle and knee when standing on the affected leg. This may improve the survivor’s balance, posture, safety and confidence. Although advances in bracing materials have improved the functionality and benefits of AFOs, there are drawbacks. Rigid materials often limit air circulation, leading to greater risk of skin breakdown. The stability provided by the brace may affect normal movement of the leg, which can result in decreased walking efficiency. Some AFOs may limit recovery of movement because the patient uses the muscles around the ankle joint less. The AFO may also make it harder for a survivor to feel the walking surface, which is important for balance and the potential for recovery. “I started out with an AFO and a cane,” Elizabeth said, “My gait was awkward, due to swinging my leg out to clear my foot. I felt that the AFO was confining. I would often fall just trying to stand up.” But the benefits provided by an AFO often outweigh the drawbacks, and the appropriate type and consistent use of the AFO by survivors with foot drop are important for a meaningful outcome.
Recent advances in treating foot drop have provided a number of alternatives, including: • strengthening • stretching • balance training to decrease risk of falls • gait training with an assistive device • use of a brace or orthotic • electrical stimulation for strengthening and/or walking • surgery (in rare cases) The goal of a treatment plan for foot drop is for the survivor to have a more normal and comfortable walking pattern while being as safe and independent as possible. Two of the most common treatments today are bracing with an ankle foot orthosis (AFO) and functional electrical stimulation (FES).
Functional Electrical Stimulation (FES)
FES was first introduced as an alternative treatment for foot drop in the early 1960s. FES sends small pulses of electrical stimulation to the nerve that controls the muscles that lift the foot. This is delivered through surface electrodes placed on the skin. The stimulation is given in a specific sequence to help with functional movement such as walking.
Ankle Foot Orthosis (AFO)
Foot drop after stroke has traditionally been treated with an AFO. This is a device that keeps the ankle and foot in position to help the foot clear the ground while walking. An AFO is often the first line of defense and prescribed early in rehabilitation.
If you would like to try to load the digital publication without using Flash Player detection, please click here.