Variable gait training to improve gait stability in ankle-foot orthosis users with neuromuscular disorders: A pilot study

Background: Ankle-foot orthoses aim to improve walking in people with neuromuscular disorders with lower leg muscle weakness. However, clinical experience indicates that some ankle-foot orthosis users report limited gait stability improvements, suggesting suboptimal adaptation. Variable gait training may improve adaptation, and thereby gait stability. We aimed to investigate whether variable gait training improves gait stability in individuals with neuromuscular disorders who initially experienced stability problems when using ankle-foot orthoses. Methods: Three stiffness-optimized dorsal leaf ankle-foot orthosis users received three variable gait training sessions on an interactive treadmill with one session per week. Gait stability (variability in step time, step length, and step width), target-stepping accuracy (variable stepping error), balance performance, balance confidence, fear of falling, and perceived walking ability were assessed pre-training and one week post-training. Training experiences were also inventoried. Findings: Post-training, the variability in step time, step length, and step width decreased on average by 38 %, 26 %, and 22 % respectively. Anteroposterior target-stepping accuracy increased post-training by 24 % and mediolateral accuracy by 3 %. No clear differences in balance and fear of falling were observed. All participants perceived improvements in some aspects of walking ability and appreciated the training. Interpretation: Variable gait training may enhance gait stability and target-stepping accuracy in ankle-foot orthosis users who initially perceived little benefits. No improvements on balance outcomes and mixed outcomes on perceived walking ability were found. A larger study is needed to determine whether variable gait training following orthosis provision could lead to meaningful changes in gait stability, balance, and daily functioning.