Adapting AFO parameters to optimise true neuromotor recovery of gait during early phases of rehabilitation following a stroke

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Outcomes from the gait rehabilitation of stroke survivors are disappointing with mean walking speeds at discharge - 0.7m/s - that are well below aged matched healthy peers and too slow to safely use a pedestrian crossing. This is despite recovery of walking being a priority for therapists and stroke survivors. The ability to generate forward propulsion is clearly important for achieving the walking speeds (and changes in speed) necessary for everyday mobility. The positioning of the lower limb plays a key part in creating this forward impulse. It is possible that the prescription of an AFO, during the early phases of stroke rehabilitation, could impede recovery of the natural propulsion mechanisms by constraining the ankle rotation during the terminal phase of stance. Our recent work from the SWIFTcast study has shed some light on this problem by identifying the tibia to vertical angle as a key correlate of walking speed recovery among sub-acute stroke patients. The objectives for this PhD are: Identify the biomechanical, clinical and neural (EMG) variables most closely associated with gait speed recovery. This will be done through a combination of literature review and analysing a large (n=90) database of biomechanical and EMG measurements taken from acute/sub-acute stroke survivors before and after a 6 week rehabilitation programme. This will be followed by a clinical study prospectively testing tailored AFO prescriptions that account for the variables identified previously and which aim to support recovery of the pre-morbid gait pattern. This study will consider the clinical, biomechanical and neural outcomes as well as the acceptability to users through a mixed methods approach. Our intention is to collaborate with the NHS as well as orthotics companies such as Peackocks(?/Buchanans) to progress towards a more tailored approach to prescribing AFOs during the early stages of recovery from a stroke. Without prejudicing the findings of the study there may be outcomes that could be exploited for both AFO design and how they are prescribed.