EUR J PHYS REHABIL MED 2010;46:363-8 The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients E. CAKAR 1 , O. DURMUS 1 , L. TEKIN 2 , U. DINCER 1 , M. Z. KIRALP 1 Background. Ankle foot orthoses (AFO) are commonly used orthotic device in order to restore the ankle foot function and to improve the balance and gait in post- stroke hemiparetic patients. However, there remain some discussions about their effectiveness on long term hemi- paretic patients who had mild to moderate spasticity. Aim. To investigate the relative effect of prefabricated thermoplastic posterior leaf spring AFO (PLS-AFO) on balance and fall risk. Design. A cross-over interventional study Setting. The Department of PMR of a tertiary hospital. Population. Twenty-five chronic post-stroke long dura- tion hemiparetic patients who had Ashworth grade 1-2 spasticity at affected calf muscles and lower limb Brunnstrom stage 2-3 and also able to walk indepen- dently without an assistive device. Methods. Berg Balance Scale (BERG), and the postural sta- bility test (PST) and the fall risk test (FRT) of Biodex bal- ance systems were used for the assessments. All of the patients were assessed with AFO and without AFO. All assessments were made with footwear. Results. The mean post-stroke duration was 20,32±7,46 months. The BERG scores were 42,12±9,05 without AFO and 47,52±7,77 with AFO; the overall stability scores of FRT were 3,35±1,97 without AFO and 2,69±1,65 with AFO (P<0,001). Acknowledgements.—The authors want to thank to orthotist Hakan Kaya, physiotherapist Hilmi Kilac and statistician Ozlem Koksal for their contributions to the orthosis planning, patient education and statistical advisory, respectively. Conflicts of interest.—None. Received on December 21, 2009. Accepted for publication on June 10, 2010. Epub ahead of print on July 1, 2010. Corresponding author: E. Cakar, GATA Haydarpasa Egitim Hastanesi, Fiziksel T›p ve Rehabilitasyon Klinigi, 34668 Uskudar Turkey. E-mail: drecakar@yahoo.com Vol. 46 - No. 3 EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE 363 1 Gülhane Military Medical Academy Haydarpasa Training Hospital Department of Physical Medicine and Rehabilitation Istanbul, Turkey 2 Corlu Military Hospital, Tekirdag, Turkey Conclusion. It was found that the prefabricated ther- moplastic PLS-AFO improve balance and provide fall risk reduction in chronic post-stroke ambulatory hemi- paretic patients who had mild to moderate spasticity on their affected lower limb. Clinical rehabilitation impact. These results encourage the usage of AFO on long duration hemiparetic patients in order to provide better balance and lesser fall risk. KEY WORDS: Stroke - Postural balance - Hemiplegia - Orthotic devices. I mpaired balance and altered gait patterns which caused by muscle weakness, abnormal movement synergies and spasticity in post-stroke hemiplegic patients contribute increased fall risk and consequent decreased independence in activities of daily living (ADL). 1-4 Falls are one of the most frequent compli- cations in stroke rehabilitation, 4 and may contribute to serious morbidity and life threatening consequences. 5 Therefore improving balance and gait pattern and consequently reduce falls is one of the major targets of the stroke rehabilitation. Ankle foot orthosis (AFO) is commonly used orthot- ic device in order to restore the ankle foot function and MINERVA MEDICA COPYRIGHT®