ArticleJournal of neuroengineering and rehabilitation2026
Relationship between anterior-posterior ground reaction force patterns and immediate effect of different types of ankle-foot orthoses in individuals with post-stroke hemiparesis: a cross-sectional study.
Article in Journal of neuroengineering and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAnkle-foot orthoses (AFOs) are commonly prescribed to improve gait after stroke; however, their effectiveness varies among individuals. Limited evidence exists on how AFOs specifically influence ground reaction force (GRF) patterns during gait. This study investigated how baseline anterior-posterior GRF (A-P GRF) patterns, reflecting braking and propulsive abilities, influence the immediate effects of distinct AFO designs.
methodsThis retrospective cross-sectional study included 66 community-dwelling individuals with hemiparesis who underwent gait analysis under three conditions: without AFO (noAFO), with oil-damper AFO (odAFO), and with plastic AFO (pAFO). A-P GRF impulse and mean were assessed across four stance phase bins (Bin 1: initial double support following heel contact, Bin 2: first half of the single support, Bin 3: second half of the single support, Bin 4: terminal double support preceding toe-off), alongside gait speed and limb kinematics. Hierarchical cluster analysis identified distinct A-P GRF patterns based on the impulse from Bins 1-4 during the baseline noAFO condition; immediate AFO effects were compared across clusters.
resultsBoth AFO types significantly but modestly increased gait speed overall, with variable responses across clusters. Three baseline A-P GRF patterns were identified: favorable propulsion (Cluster 1, n = 19), moderate impairment (Cluster 2, n = 27), and poor propulsion with excessive braking (Cluster 3, n = 20). Participants with the poorest gait function (Cluster 3) demonstrated the most significant improvements in gait speed with both AFO types (odAFO: p < 0.001; pAFO: p = 0.006), through different biomechanical mechanisms: odAFO improved propulsive forces in Bin 4 (impulse: p < 0.001; mean: p = 0.012), whereas pAFO reduced excessive braking forces in Bin 1 (impulse: p < 0.001; mean: p = 0.048). Participants with favorable baseline A-P GRF patterns showed minimal immediate effects.
conclusionAFO effectiveness depends on baseline A-P GRF patterns, with the greatest benefits observed in participants exhibiting poor propulsive forces and excessive braking, through different biomechanical mechanisms. These findings highlight the importance of considering individual A-P GRF patterns when prescribing orthotic interventions in post-stroke rehabilitation.
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