The impact of ankle-foot orthoses on balance in older adults: A scoping review

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Layman’s Abstract

Falls are a serious cause of injury and death in older adults over age 65. Poor balance can lead to an increased number of falls in the older population.

The use of a brace, called an ankle-foot orthosis, can be prescribed to community living older adults to augment their balance. Ankle-foot orthoses can improve the stability and positioning of the ankle joint and foot to aid in balance during walking and standing, however ankle-foot orthoses have also been found to restrict natural movements and interrupt sensory feedback from the lower leg and foot.

The purpose of this article was to investigate how the balance of older adults living in the community is impacted by wearing ankle-foot orthoses.

Through conducting a database search to obtain appropriate literature on the topic, four trends were identified for how ankle-foot orthoses impact the balance of older adult wearers.

Based on the findings of this review, ankle-foot orthoses were found to improve stability and standing balance, decrease bodily sway, and increase the walking speed of older adult wearers.

These findings suggest that ankle-foot orthoses have a largely positive impact on the balance of older adults and can be considered to help improve balance in certain patient populations.

Background

Balance impairment is a contributing factor to falls. Falls are a leading cause of injury and death in older adults. An ankle-foot orthosis (AFO) is a device that can be prescribed as an intervention to help individuals with compromised balance to ambulate safely.

Objective

The purpose of this review was to investigate the role ankle-foot orthoses have in affecting balance in community-dwelling older adults.

Methodology

A scoping review was conducted searching MEDLINE, CINAHL, EMBASE, and REHABDATA databases to obtain the appropriate literature to meet the following criteria:

1) quantitative research design;
2) studies with participants over age 65;
3) studies with participants with drop-foot or sensory deficits in the lower extremity;
4) the treatment intervention was unilateral or bilateral AFOs;
5) the outcome measure was balance or stability.

The retrieved articles were assessed based on the internal validity, external validity, objectivity, and reliability of the study design and the interpretation of results.

Findings

11 articles were identified that met the inclusion criteria. Four major themes emerged in the analysis about the impact that ankle-foot orthoses have on balance in older adults:

1) AFOs improved lateral stability,
2) AFOs improved balance under static conditions,
3) AFOs provided a reduction in postural sway and
4) AFOs increased walking speed in community-dwelling older adults.

Conclusions

The evidence from the findings of the review indicate that ankle-foot orthoses have a generally positive affect on balance in older adults. Clinicians can consider the ankle-foot orthosis an effective intervention that can improve balance in some older adult patient populations.

References

The impact of ankle-foot orthoses on balance in older adults: A scoping review, Laidler J.L. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.1. https://doi.org/10.33137/cpoj.v4i1.35132