Replacing canes with an elasticated orthotic-garment in chronic stroke patients – The influence on gait and balance. A series of N-of-1 trials

Objective:To investigate the effect of replacing canes with an elasticated orthotic-garment on balanceand gait-function in chronic stroke survivors.Design:Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in ahome setting.Participants:Four cane using chronic stroke survivors (P1-4).Interventions:Phase A (9e12 weeks) cane-walking“as usual”to establish baseline values; Phase B (9e16weeks) intervention: orthotic-garment worn throughout the day with maximal cane-use reduction;Phase C (9e10 weeks) participant-determined follow-up: either no walking-aid, orthotic-garment orcane.Outcome measures:Primary: Functional-Gait-Assessment (FGA), Secondary: Trunk-sway during walkingmeasured as Total-Angle-Area (TAA�2) in frontal and sagittal-planes, both measured weekly.Results:Visual and statistical analysis of results showed significant improvements in FGA from phase Ato B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deterioratedin P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2&P4. Trunk-swayreduced during walking, indicating increased stability, in two participants from phase A to B and in threeparticipants from A to C but no TAA changes were statistically significant. In phase C participant-selectedwalking-aids were: P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4e5days.Conclusions:Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke.“Hands-free”assistive-devices may be more effective than canes in improving gait-function in somepatients