Original Research Objective Assessment of Functional Ambulation in Adults with Hemiplegia using Ankle Foot Orthotics after Stroke Karen J. Nolan, PhD, Krupa K. Savalia, BS, Anthony H. Lequerica, PhD, Elie P. Elovic, MD Objective: To objectively evaluate the effect of ankle foot orthotics (AFOs) on functional ambulation in individuals with hemiplegia secondary to stroke using quantifiable outcome measures. Design: With-without repeated measures design. Setting: Rehabilitation research center. Participants: Eighteen adults with stroke-related hemiplegia 6 months using a prescribed AFO. Interventions: Not applicable. Main Outcome Measurements: The distance (m) and velocity (m/s) during the 6-Minute Walk Test (6MWT) and total time (s) and velocity (m/s) during the 25-ft walk (25ftW). Secondary analysis evaluated the 6MWT and 25ftW grouped by the time compo- nent of the Ambulatory Index (AI). Results: Distance walked during the 6MWT was significantly greater with AFO (228.54  103.93) than without AFO (197.49  104.13), P = .002. Time to complete the 25ftW was significantly greater without AFO (21.22  20.57) than with AFO (15.49  14.65), P = .010. There was a significant difference in average velocity between the 25ftW and 6MWT during the with AFO condition, P = .010. Secondary analysis grouped by the AI time showed that as level of function decreases, brace effect on functional ambulation increases (Group 3: 25ftW with AFO, P = .040). Conclusions: AFO usage in hemiplegic stroke patients improves functional ambulation, particularly in individuals with a slower gait velocity. The 25ftW, with and without AFO, may be useful to the patient and clinician when determining the importance of brace utilization. Speed modulation was improved when the AFO was added to the paretic limb, and AI grouping indicated that the AFO was more beneficial in people with a slower gait velocity (20 seconds for the 25ftW). A more definitive study is needed to more completely address this issue. As an exploratory study, the feasibility of different walking assessments was determined so that future studies can validate which objective measures can be used and easily implemented in clinical settings. INTRODUCTION Stroke is the leading cause of serious long-term disability in the United States; more than 1 million Americans experience functional limitations in activities of daily living as a result of stroke [1]. Addressing deficits in mobility after stroke is extremely important to the patient with hemiplegia and is often one of the first physical impairments to be addressed in the early stages of rehabilitation [2,3]. Patient goals for rehabilitation after stroke are primarily functional in nature and regaining the ability to walk is a key objective [4,5]. Assistive technology devices such as ankle foot orthotics (AFOs) can be incredibly useful in accommodating the limitations in mobility that result from stroke [3]. AFOs serve to assist, control, and maintain the desired position of the ankle and foot during walking, potentially leading to improved functional ambulation [6]. Functional ambulation includes the extent to which an individual is capable and willing to move around in their environment [7]. Previous research has attempted to group or define K.J.N. Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ 07052; Department of Physical Medi- cine and Rehabilitation, UMDNJ - New Jer- sey Medical School, Newark, NJ. Address correspondence to: K.J.N.; e-mail: knolan@ kesslerfoundation.net Disclosure: 7A, Innovative Neurotronics; 8A, NIDRR Switzer Grant and NIDRR TBI Model Systems K.K.S. Kessler Foundation Research Center, West Orange, NJ Disclosure: nothing to disclose A.H.L. Kessler Foundation Research Center, West Orange, NJ; Department of Physical Medicine and Rehabilitation, UMDNJ - New Jersey Medical School, Newark, NJ Disclosure: 8A, NIDRR TBI Model Systems E.P.E. Division of Physical Medicine and Re- habilitation, School of Medicine, University of Utah, Salt Lake City, UT. Formerly: Kessler Foundation Research Center, West Orange, NJ; Department of Physical Medicine and Rehabilitation, UMDNJ - New Jersey Medical School, Newark, NJ Disclosure: 2A, Allergan; 7A, Allergan; 8A, NIDRR TBI Model Systems Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org The contents of this publication were developed under a grant from the Department of Education, NIDRR grant number H133P020012. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. Supported by the Department of Education Na- tional Institute on Disability and Rehabilitation Research (grant no. H133P020012), New Bal- ance Athletic Shoe, Inc, and Kessler Foundation. Submitted for publication January 21, 2009; accepted April 28. PM&R © 2009 by the American Academy of Physical Medicine and Rehabilitation 1934-1482/09/$36.00 Vol. 1, 524-529, June 2009 Printed in U.S.A. DOI: 10.1016/j.pmrj.2009.04.011 524