The major finding of this study included: (1) the ToeOFF AFO was found to be consistent of the hypotheses, which improved the walking speed, cadence, step length, temporal symmetry, ankle push-off power generation, foot contact patterns, and energy cost; (2) the SAFO provided more improvement on the spatio-temporal parameters more; (3) in subjects of drop foot group, the power flow analysis showed different power delivery pathway on both AFO conditions. The ToeOFF AFO generated greater ankle power, but the transferring power did not bring on forward progression, which resulted in less improvement on spatio-temporal parameters than the SAFO.
Although some of the parameters discussed in this study did not reach the statistical significance, the improvement on the observational gait performance was revealed clinically. The two different configurations of AFOs indeed induced positive improvement clinically on subjects in this study, and the effectiveness was showed differently. For CVA patients, walk with an adequate AFO to compensate the deficit functions is a very important issue in rehabilitation work. Dissimilar configurations of AFOs provide different effectiveness for certain condition of patients. The results of this study supported that the SAFO provided better stability, and the ToeOFF AFO provided better power generation. The generated power could make use for propulsion in more stable patients, but for stabilizing in less stable patients. Accordingly, these
findings in the present study provided as a reference to choose an adequate AFO by considering what’s the majority of the patients need? The propulsion power or the stability is.
The most limited reason that the results did not showed statistically significant was the sample size and the high divergences of the subjects. Besides, the adaptation duration of the ToeOFF AFO and SAFO seemed to be less for subjects participated in this study. Future researches needed to investigate with fully accommodations with AFOs, and the sample size of subjects should be added more as well as the group of subjects should be select more specifically.
References
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correction by AFO. Clinical Orthopaedics and Related Research 1993; 288: 97-108.
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Appendix A
步驟為：
主動告知受試者。
（八）門諾會醫院的醫師及研究人員除了研究疾病的原因之外，也致力於改良診斷及發展 較佳的治療方法，本計畫是屬於人體試驗研究，因此無法保證一定有預期的效果，
為了讓您能決定是否參與本試驗計畫，我們希望您能瞭解試驗的內容及參與試驗的 益弊，希望您在完全瞭解而決定參與本試驗後簽下本同意書。
本人已詳閱上列各項資料，有關本試驗計畫之疑問業經計畫主持人詳細予以解釋，
本人瞭解在試驗期間可以隨時退出試驗，而且不會引起研究人員及醫師的成見，即 使本人中途退出計畫，也不會影響到本人在門諾會醫院應有而且完整的醫療照顧，
本人同意以自願受試者的身分參與本計畫。
自願受試者姓名： 身分字號：_________________________
簽名（或法定代理人）： 日期：______________________
見證人簽名： 日期：______________________
研究人員簽名： 日期：______________________
Appendix B
Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) Score Modified Ashworth Scale (1987) Modified Tardieu Scale (1954) (0) No increase in muscle tone No resistance throughout the course
of the passive movement
(1)
No increase in muscle tone,
manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or
extension.
Slight resistance throughout the course of passive movement, no clear catch at a precise angle
(2)
Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the reminder (less than half) of the ROM (range of movement).
Clear catch at a precise angle, interrupting the passive movement, followed
by release
(3)
More marked increase in muscle tone through most of the ROM, but
affected part(s) easily moved.
Fatigable clonus with less than 10 seconds when maintaining the pressure
and appearing at the precise angle
(4) Considerable increase in muscle tone passive, movement difficult.
Unfatigable clonus with more than 10 seconds when maintaining the
pressure and appearing at a precise angle
(5) Part(s) rigid in flexion or extension. Joint is immovable
Manual Muscle Test Scale (1950)
Grade 0 No contractile activity can be felt in the gravity eliminated position.
Grade 1 The muscle/muscles can be palpated while the patient is performing the action in the gravity eliminated position.
Grade 2 Patient has all or partial range of motion in the gravity eliminated position.
Grade 3 Patient can tolerate no resistance but can perform the movement through the full range of motion.
Grade 4 Patient can hold the position against strong to moderate resistance, has full range of motion.
Grade 5 Patient can hold the position against maximum resistance and through complete range of motion.
Brunnstrom stage
stage Upper extremity Lower extremity hand
Ⅰ flaccid flaccid flaccid
Ⅱ Spasticity is developing Spasticity is developing Little or no active finger flexion
(1)placing the hand behind the body
(2)elevation of the arm to a forward-horizontal
position
(3)pronation-supination, elbow at 90°
Spacticity↓
1. hip abducted(supine) 2. knee isolated
extended(sitting) 3. knee flexed(sitting) 4. ankle
2. arm-raising forward and overhead
3. pronation-supination, elbow extended
Spacticity↓
1. knee isolated flexed (standing)
2. ankle dorsiflexed (standing)
Ⅵ Isolated joint movements are now freely performed
Nearly normal All prehensile types under control