How Does A Personalized Rehabilitative Model Influence the Functional Response of Different Ankle Foot Orthoses in A Cohort of Patients Affected by Neurological Gait Pattern?Name : Dr. Falso Maurizio Vincenzo
Affliation : Professor
University : Clinical Institute Of City Brescia
Country : Italy
Orthoses need to support physiotherapy as well as surgical treatment. Related to patient’s rehabilitative goals and pathological gait pattern, orthotists has to produce an orthoses that using an adjustable ankle joint system with preloaded disc springs can store the energy brought in by the body weight and produce a tuning effect on patient’s gait and sense of balance. The purpose of this study was to establish how a personalized proprioceptive individualized rehabilitative treatment can influence the functional response of different AFOs in a cohort of patients affected by neurological gait pattern.
Methods: Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 conditions: 1) without AFO or free-walk; 2) wearing a Codivilla spring, 3) wearing a carbon non-jointed AFO (“Toe-Off”); 4) wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS = Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3 = time of recruitment) and after our individualized rehabilitative treatment course (time T4 = 1 month from T3) by using: a. BTS spatio-temporal measures in different gait performances; b. clinical/functional outcome measures (MAS for the affected upper and lower limb; MRC; orthostatic stability evaluation by using the Berg Balance Scale).
Findings: A comparative analysis of clinical and instrumental data, performed in the pre-defined four investigational conditions, showed:
Interpretation: In line with our observational and instrumental and functional pre and post-treament analysis, we emphasized the future role of physiotherapist as a figure who needs to assist his rehabilitative attitude with the knowledge and task-specific use of DAFONS, which allow to reach functional goals as a neurorehabilitative re-learning process of physiological gait pattern (peripheral assisted neuroplasticity facilitation) and an increase of patient’s motor abilities and quality of life in his personal milieu. For this reason, this kind of dynamic joint assisted ankle-foot orthosis, can only be realized by orthotics with technical attitudes and biomechanical and neurorehabilitative clinical
Dr. Falso MV received his degree in Medicine in 1999 and his specialization in Physical Medicine and Rehabilitation in 2004 from the University of Medicine of Verona (Italy). This was followed by a post-specialization research on the management of spasticity and movement disorders at the Department of Neurological Sciences and Vision of the University of Verona (Italy), by using botulinum toxin and baclofen pumps and analyzing motor patterns with video-surface EMG. He is a Professor at the Physiotherapist School of the Medicine University of Brescia (Italy) and a past-member of the Italian Consensus Table on the use of Xeomin in adult spasticity.