The effect of different shoes on functional mobility and energy expenditure in post-stroke hemiplegic patients using ankle-foot orthosis.

BACKGROUND: Ankle-foot orthoses could be utilized both with and without shoes. While several studies have shown that ankle-foot orthoses improve gait abilities in hemiplegic patients, it remains unclear whether they should be used with shoes or without. OBJECTIVES: The study purpose was to compare the effect of standard shoes and rocker shoes on functional mobility in post-stroke hemiplegic patients utilizing ankle-foot orthosis. STUDY DESIGN: Randomized clinical study. METHODS: Thirty post-stroke hemiplegic patients participated in this study randomly assigned to two groups. Group I received standard shoes + ankle-foot orthosis and group II were provided with rocker shoes + ankle-foot orthosis. Their functional mobility and energy expenditure parameters including timed up and go, timed up stairs, timed down stairs, preferred walking speed, and oxygen (O2) cost (mL/kg/m) were measured. RESULTS: In group I, no significant changes were seen in outcome measures after wearing standard shoes. While in group II, O2 cost and timed up and go time significantly decreased, and preferred walking speed increased when patients wore rocker shoes. Also, there was a significant difference between rocker shoes and standard shoes in improvement of timed up and go, preferred walking speed, and O2 cost. CONCLUSION: When patients using ankle-foot orthosis wore rocker shoes, their functional mobility improved and oxygen cost diminished. Also, rocker shoes was significantly more effective than standard shoes in improving functional mobility parameters. CLINICAL RELEVANCE: This study suggests that in post-stroke hemiplegic patients using ankle-foot orthosis, wearing rocker shoes can lead to much more improved functional mobility and decreased energy expenditure compared to ankle-foot orthosis only. Thus, in stroke patients, the combination of ankle-foot orthosis-rocker shoes is recommended for both rehabilitation programs and ankle-foot orthosis efficacy investigations.

Undergraduate prosthetics and orthotics teaching methods: A baseline for international comparison.

BACKGROUND: Education of Prosthetics and Orthotics is a relatively recent professional program. While there has been some work on various teaching methods and strategies in international medical education, limited publication exists within prosthetics and orthotics. OBJECTIVES: To identify the teaching and learning methods that are used in Bachelor-level prosthetics and orthotics programs that are given highest priority by expert prosthetics and orthotics instructors from regions enjoying a range of economic development. STUDY DESIGN: Mixed method. METHODS: The study partly documented by this article utilized a mixed method approach (qualitative and quantitative methods) within which each phase provided data for other phases. It began with analysis of prosthetics and orthotics curricula documents, which was followed by a broad survey of instructors in this field and then a modified Delphi process. RESULTS: The expert instructors who participated in this study gave high priority to student-centered, small group methods that encourage critical thinking and may lead to lifelong learning. Instructors from more developed nations placed higher priority on student's independent acquisition of prosthetics and orthotics knowledge, particularly in clinical training. CONCLUSIONS: Application of student-centered approaches to prosthetics and orthotics programs may be preferred by many experts, but there appeared to be regional differences in the priority given to different teaching methods. CLINICAL RELEVANCE: The results of this study identify the methods of teaching that are preferred by expert prosthetics and orthotics instructors from a variety of regions. This treatment of current instructional techniques may inform instructor choice of teaching methods that impact the quality of education and improve the professional skills of students.