Evaluation of an ankle-foot orthosis effect on gait transitional stability during ramp ascent/descent.

Wearable ankle-foot orthoses (AFO) are widely prescribed clinically; however, their effect on balance control during ramp ascent/descent walk remains unknown. This study evaluates walking stability on a ramp during weight loading and unloading transitions of the stance phase with the effect of an adjustable AFO. An AFO is tuned firstly by tuning dorsiflexion only and then combining dorsi-plantarflexion adjustments. Gait stability is assessed from neuromotor input (centre-of-mass) and output (centre-of-pressure) responses obtained through motion-capture system and force platform. Stability margins are quantified from Nyquist and Bode methods illustrating the loading phase as stable and the unloading phase as unstable transition in all walking conditions. Further, a significant decrease in stability (p < 0.05) is observed by wearing AFO in its free mode which gets improved (p < 0.05) by tuning AFO. Results from neuromotor outputs also illustrated a strong interlimb correlation (p < 0.001), which implies a compensatory interaction between opposite limbs loading and unloading transitions. Neuromotor inputs illustrated unstable responses both in loading and unloading transitions and were observed to be greater in magnitudes compared with output margins. The overall results support the hypothesis that a wearable AFO affects gait stability during transitional phases, and by applying AFO adjustments, neuromotor balance control achieves stability margins closer to normal range.