Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy (original) (raw)
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Physical Therapy, 2019
Background People with cerebral palsy (CP) experience increased muscle stiffness, muscle weakness, and reduced joint range of motion. This can lead to an abnormal pattern of gait, which can increase the energy cost of walking and contribute to reduced participation in physical activity. Objective The aim of the study was to examine associations between lower-body joint angles, moments, power, and walking efficiency in adolescents with CP. Design This was a cross-sectional study. Methods Sixty-four adolescents aged 10 to 19 years with CP were recruited. Walking efficiency was measured as the net nondimensional oxygen cost (NNcost) during 6 minutes of overground walking at self-selected speed. Lower-body kinematics and kinetics during walking were collected with 3-dimensional motion analysis, synchronized with a treadmill with integrated force plates. The associations between the kinematics, kinetics, and NNcost were examined with multivariable linear regression. Results After adjusti...
Jpo Journal of Prosthetics and Orthotics, 2019
Study Design: Within-subjects design. Background: Children with cerebral palsy (CP) commonly expend two to three times as much energy to walk as typically developing children. Research shows that the effects of non-tuned ankle-foot orthoses (AFOs) on energy expenditure is inconclusive. Tuning of an ankle-foot orthosis-footwear combination (AFO-FC) has demonstrated an improvement in the kinetics and kinematics of pathological gait, particularly knee flexion during stance phase, which are key determinants of an energy efficient gait. Objective: To compare the submaximal energy expenditure via indirect calorimetry, speed and distance walked, of tuned and non-tuned AFO-FCs and barefoot gait, in children with cerebral palsy (CP). Methods: Performance assessment of four children aged between 7-10 years with a diagnosis of CP (one hemiplegic and three diplegic participants, two female, two male, with a Gross Motor Function Classification System (GMFCS) of 2) at a Gait Analysis Laboratory. Results: There was a reduction in gross submaximal energy expenditure and energy efficiency index (EEI) based on O2, in three out of the four participants tested when wearing tuned compared to a non-tuned AFO-FC, the reduction ranged from 9.2% to 33.7%. Speed and distance covered also showed improvement in the tuned condition. Conclusions: Tuning the AFO-FC of children with cerebral palsy has the potential to decrease energy expenditure and increase speed and distance compared to providing a nontuned AFO-FC. Clinical Relevance: There is a lack of research on the effect of using a tuned compared to a non-tuned AFO-FC on energy expenditure. This paper provides a comparison of energy expenditure in children with CP, during Barefoot, Non-tuned and Tuned AFO-FC walking, intending to inform clinical practice.
Prosthetics & Orthotics International, 2018
Background: To improve gait function in children with cerebral palsy, ankle-foot orthoses are often prescribed. However, until now, little attention has been devoted to the effect of ankle-foot orthoses on the postural control during walking in children with cerebral palsy. Objectives: The aim was to compare the differences in thorax, spine, and pelvis movements in children with cerebral palsy during walking barefoot and walking with ankle-foot orthoses. Study design: Clinical study with an intra subject design. Methods: A total of 15 children (12 boys and 3 girls; mean age, 8 ± 2 years) with bilateral spastic cerebral palsy (12 with Gross Motor Function Classification System I and 3 with Gross Motor Function Classification System II) performed a full-body three-dimensional gait analysis. Differences in the range of motion of the thorax, spine, and pelvis during walking barefoot and walking with bilateral ankle-foot orthoses were analyzed (SPSS v20, paired-samples t-test). Results: ...
Indian Journal of Physical Medicine and Rehabilitation
Objective: The aim of the study was to find the effect of ankle foot orthosis (AFO) on energy expenditure (EE) during walking in children with spastic diplegia (SD) due to cerebral palsy (CP). Materials and methods: Twenty-six subjects with SD CP who could ambulate with and without the help of orthosis were selected after screening with inclusion criteria. The EE of these patients during ambulation with and without orthoses was measured using the K4b 2 machine. Statistical analysis was performed with the help of Epi Info™ 3.5.3. t-test, chi-square test, and correlation tests were used to study the parameters of oxygen cost, oxygen pulse, heart rate, and EE. Results: The use of AFO resulted in decreased EE in 73% of patients in the first day itself. In the sequential assessment, these patients showed further decrease in EE with AFO use. The patients who initially showed an increase of EE also showed a decrease in the rise in EE during walking in their subsequent analysis. Oxygen cost also showed a positive correlation with EE. Heart rate was not much related to use of AFO; rather, it showed an increase in the assessment done second in the same day (among walking with and without the AFO). There was no linear relation or correlation between O 2 pulse and other parameters of the study. Conclusion: The AFOs are an important intervention in the treatment of SDs. It can help decrease the EE and improve the speed of walking in most patients when prescribed along with other needful therapies like exercises, antispastic medications, etc. O 2 cost showed positive correlation with EE analysis. In patients with increased EE with AFO use, the mean difference between EE with and without AFO decreases, suggesting long-term benefits that AFO could offer. A study of longer duration with more patients should be conducted to view the full benefits of AFO in children with SD CP.
BMC Pediatrics, 2013
Background: Ankle-Foot-Orthoses with a ventral shell, also known as Floor Reaction Orthoses (FROs), are often used to reduce gait-related problems in children with spastic cerebral palsy (SCP), walking with excessive knee flexion. However, current evidence for the effectiveness (e.g. in terms of walking energy cost) of FROs is both limited and inconclusive. Much of this ambiguity may be due to a mismatch between the FRO ankle stiffness and the patient's gait deviations. The primary aim of this study is to evaluate the effect of FROs optimised for ankle stiffness on the walking energy cost in children with SCP, compared to walking with shoes alone. In addition, effects on various secondary outcome measures will be evaluated in order to identify possible working mechanisms and potential predictors of FRO treatment success.
Analysis of Running Gait in Children with Cerebral Palsy: Barefoot vs. a New Ankle Foot Orthosis
International Journal of Environmental Research and Public Health
Running is an essential activity for children with cerebral palsy (CP). This study aims to characterize the locomotor pattern of running in hemiplegic children with new generation ankle foot orthosis (AFOs) conceived to foster intense motor activities such as running. A group of 18 children with spastic hemiplegia was recruited. A biomechanical multivariable comparison was made between barefoot and with AFO running trials. The focus was devoted to bilateral sagittal plane hip, knee, ankle kinematics and kinetics, and three-dimensional ground reaction forces. Wearing the orthoses, the children were found to reduce cadence and the duration of the stance phase as well as increase the step and stride length. The new AFO resulted in significant changes in kinematics of affected ankle both at initial contact 0–3% GC (p < 0.017) and during the entire swing phase 31–100%GC (p < 0.001) being the ankle more dorsiflexed with AFO compared to barefoot condition. Ankle power was found to di...
Clinical biomechanics (Bristol, Avon), 2016
Crouch gait results in an increase of the joint stress due to an excessive knee flexion. Daily walking exercises, even when performed at a self-selected speed, may result in a decrease of the extensor muscle strength which could lead to a more severe crouch gait pattern. The aim of this study was to assess the impact of a short walking exercise on gait kinematics in children with cerebral palsy who walk with a crouch gait. Seven children with cerebral palsy who walk with a crouch gait were asked to walk for 6min at a self-selected speed. The spatio-temporal and kinematic measures, as well as the center of mass position were compared before and after the exercise. There was no significant difference between walking speed before and after the walking exercise. Knee flexion and the maximal ankle dorsiflexion increased after the walking exercise. The vertical position of the center of mass decreased. No significant difference was found at the hip. Children with cerebral palsy who walk w...