Authors (including presenting author) :
Wong SM (1), TSE PH (2),Wong WM (2), Lo TM (1), Lau FO (1), Sin SW (2)
Affiliation :
(1)Physiotherapy Department, Tai Po Hospital (2) Prosthetic and Orthotic Department NTEC
Introduction :
Manual assisted standing and walking training for dense stroke patients with lower limb paralysis are labor- intensive. Existing standing and walking equipment like standing frame and Lokomat are relatively huge and complex, which cannot be applied easily in ward environment and to patients in early stage of stroke with poor motor control and poor exercise tolerance. Use of external support such as orthosis seems to be the easiest way to assist patients to try standing and walking, especially in the early stage of stroke. However, conventional gaiter, ankle-foot orthosis (AFO) or air splint can only be able to support knee or ankle joint separately.
Objectives :
To investigate the effectiveness of KAFO (Knee-Ankle-Foot Orthosis) training on stroke patients with lower limb paralysis.
Methodology :
The project was implemented in 3 phases. Preparation phase was to develop the selection criteria, training intensity and workflow of the project and to liaise with P&O colleague on the details of collaboration. Introduction session was provided to all clinical staff regarding the project and the application of KAFO. Implementation phase was to implement the program which included 1) Recruitment of stroke patients (total 10) from Tai Po Hospital; 2) Provision of standing and walking training as early as possible with KAFO for total 10 sessions; 3) P&O referral for custom-moulded insole and calf padding and 4) Collection of patients’ functional mobility, feedback and therapists’ feedback after completion of training. Evaluation Phase was to analyze the functional outcome of patients and the feedback from patients and case physiotherapists for evaluation on the effectiveness of the project.
Result & Outcome :
Result There were total 10 patients recruited from September to November 2019. Seven of them improved in functional mobility. Two patients improved from MFAC CAT I (lyer) to CAT II (Sitter); two patients improved from CAT II (Sitter) to CAT III (dependent walker) and three patients improved from CAT II (Sitter) to CAT IV (assisted walker). Although the other three patients cannot be able to walk with one assistant, improvement was still found. Among those 2 non-walkers, the standing tolerance improved from one minute to five minutes and from fifteen seconds to two minutes respectively, while for the one who need two assistants in walking improved from 3 meters to 20 meters Regarding patients’ feedback of KAFO training, total 9 questionnaires were collected and all patients agreed that KAFO is useful especially in the early stage of stroke rehab and they were very satisfied with the custom-moulded insole and calf padding provided by P&O colleagues, by which the affected foot and calf can be protected and supported comprehensively. Regarding therapists’ feedback on KAFO application, all case physiotherapists agreed that KAFO is user-friendly and less labor-intensive especially in the training of severe stroke patient with lower limb paralysis in early stage. One year review found that there were 33 stroke patients received KAFO training, the main changes of MRMI and MFAC were 10.73 and 1.24 respectively and there was no any adverse side effect detected.
Conclusion All positive outcomes proved that KAFO can improve walking ability and tolerance in highly dependent stroke patients. All patients and physiotherapists were very satisfied with the KAFO in training and KAFO was adopted as one of the training modalities for stroke rehab in Tai Po Hospital especially for stroke patients with lower limb paralysis in early stage.
