Lauren DeMeyer, Marcie Brown, Ashley Adams
Rehabilitation Hospital, New Hanover Regional Medical Center, 2131 S. 17th Street, Wilmington, NC 28401, USA. E-mail: lauren.demeyer@nhrmc.org
DOI: 10.2340/16501977-2007

Objective: To investigate the effect of night positioning on ankle motion in patients after stroke or brain injury.
Design: Prospective randomized controlled pilot study with 3 groups: bivalve cast; pressure-relieving ankle–foot orthosis; and control.
Subjects/patients: Adults (n = 46) in inpatient rehabilitation with lower extremity paresis following stroke or brain injury.
Methods: Intervention group participants wore a custom bivalve cast or pre-fabricated orthosis 8–12 h/night. The primary outcome variable was passive ankle dorsiflexion. Muscle spasticity (Modified Ashworth Scale) and functional mobility (Functional Independence Measure) were also assessed.
Results: No significant differences were found between groups for all outcome measures at the pilot sample size (p > 0. 05). Control and pressure-relieving ankle–foot orthosis groups showed improvement in ankle dorsiflexion, and the bivalve cast group demonstrated a trend toward decreased spasticity. Positioning interventions were tolerated for approximately 11 h/night. Baseline range of motion was measured and a retrospective power analysis determined that a sample size of 234 is needed for 80% power to establish significance.
Conclusion: Future research with a larger sample size is re-commended to determine significance and whether a more specific subset of patients would benefit from night positioning to maximize treatment time during daytime therapy sessions.