Effects of community ambulation training with 3D-printed ankle–foot orthosis on gait and functional improvements: a case series of three stroke survivors

Abstract

Introduction: Many of the patients using ankle–foot orthoses (AFOs) experience poor fit, pain, discomfort, dislike of the aesthetics of the device, and excessive range of motion restrictions, which diminish the use of AFOs. Although 3D-printed ankle–foot orthoses (3D-AFOs) affect patient satisfaction and overall gait functions such as ankle moment, joint range of motion (ROM), and temporal-spatial parameters, the material properties and manufacturing process of 3D-AFOs are still diverse; the clinical effects of community ambulation using 3D-AFOs and satisfaction in patients with stroke are poorly understood. Case description: Case 1: A 30-year-old man, with a history of right basal ganglia hemorrhage, presented with marked foot drop and genu recurvatum. Case 2: A 58-year-old man, with a history of multifocal scattered infarction, presented with an asymmetrical gait pattern due to abnormal pelvic movement. Case 3: A 47-year-old man, with a history of right putamen hemorrhage, presented with recent poor balance and a prominent asymmetrical gait pattern due to increased ankle spasticity and tremor. All patients could walk independently with AFOs. Interventions and outcomes: Gait was assessed under three walking (even, uneven, and stair ascent/descent) and four AFO (no shoes, only shoes, shoes with AFOs, and shoes with 3D-AFOs) conditions. After 4 weeks of community ambulation training with 3D-AFO or AFO, the patients were followed up. Spatiotemporal parameters; joint kinematics; muscle efficiency; clinical evaluations including impairments, limitations, and participation; and patient satisfaction with wearing 3D-AFO were evaluated. Results and conclusion: 3D-AFOs were suitable for community ambulation of patients with chronic stroke and effective on step length, stride width, symmetry, ankle range of motion, and muscle efficiency during even surface walking and stair ascent in patients with chronic stroke. The 4-week community ambulation training with 3D-AFOs did not promote patient participation; however, it increased ankle muscle strength, balance, gait symmetry, and gait endurance and reduced depression among patients with a history of stroke. The participants were satisfied with 3D-AFO's thinness, lightweight, comfortable feeling with wearing shoes, and gait adjustability.