An advanced ground reaction design ankle-foot orthosis to improve gait and balance in individuals with post-stroke hemiparesis: A case series

Jennifer Hale, Jill Seale, Jason Jennings, Thomas Dibello

    Research output: Contribution to journalArticle

    1 Scopus citations


    The purpose of this case series was to explore the impact of a novel design for an ankle-foot orthosis (AFO) on gait and balance in persons with post-stroke hemiparesis. Five subjects with hemiparesis after cerebrovascular accident were referred for evaluation for an AFO because of gait and balance impairments. All subjects were found to have difficulty in both the swing and stance phases of gait, exhibiting difficulty with swing limb clearance and stance limb stability. The advanced ground reaction design of AFO (A-GRAFO) was chosen as the most appropriate device for orthotic management. The specific orthotic design used in this study was a Dynamic Bracing Solutions Balancer™. Advanced triplanar control of the limb was achieved through the use of a unique segmented weight-bearing impression technique, specific cast modifications, specific alignment parameters, intimate fit, and rigid materials. Gait speed, gait endurance, and balance were assessed for each subject using the 10-m walk test, 6-minute walk test, and Timed Up and Go Test (TUG) before and after receiving the A-GRAFO. All subjects improved in gait speed and gait endurance, whereas four of the five improved in balance. Gait speed increased an average of 0.30 m/second (55%), 6-minute walk distance increased an average of 96 m (52%), and time to complete the TUG decreased by 5 seconds (24%) for subjects using the A-GRAFO compared with the no-orthosis condition. The results of this case series suggest that this orthosis design should be considered for patients with residual hemiparesis after stroke. Further research is warranted to compare the A-GRAFO against more traditional designs.

    Original languageEnglish (US)
    Pages (from-to)42-47
    Number of pages6
    JournalJournal of Prosthetics and Orthotics
    Issue number1
    StatePublished - Jan 2013



    • acquired brain injury
    • Ankle-foot orthosis (AFO)
    • balance
    • gait
    • ground reaction
    • ground reaction AFO (GRAFO)
    • hemiparesis
    • stance limb instability
    • stroke

    ASJC Scopus subject areas

    • Biomedical Engineering
    • Rehabilitation
    • Orthopedics and Sports Medicine

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