The biomechanical optimisation (tuning) of the Ankle Foot Orthosis-Footwear Combination (AFO-FC) of children with Cerebral Palsy-the effects on sagittal gait … (original) (raw)

The current study aimed to investigate influences of rigid Ankle Foot Orthoses (AFOs) on gait in children with Cerebral Palsy (CP), immediate effects of tuning of AFO-FC (AFO-Footwear Combination) on gait of children with CP, short-term effects of tuning of AFO-FC on gait, muscle and joint characteristics and quality of life in children with CP, and the feasibility of conducting a larger trial. The study included 11 healthy children and 8 children with CP. Outcome measurements included sagittal plane kinematics and kinetics derived using 3D motion analysis, Gait Deviation Index (GDI), physical examination, and quality of life using the PedsQL™ questionnaire. Data from healthy children demonstrated influences of shoes on gait parameters and the role of the ankle joint in adapting to various wedges and rockers during gait. When studying children with CP, beneficial effects of rigid AFO-FC on gait parameters were evident; these were thought to relate to the appropriateness of the AFO-FC and familiarisation with the prescription. Immediate effects of tuning varied according to gait patterns previously demonstrated with non-tuned AFO-FC; benefits to knee kinematics and kinetics were largely seen in legs with extended knee gait, followed by jump knee gait, and with poorest responses in legs with crouch knee gait. Short-term effects of tuning were evident when comparing measurements taken before and after two-to-four months of wearing the tuned AFO-FC. Barefoot walking demonstrated significantly improved walking speed. Stride-length improved when comparing tuned AFO-FC at baseline with the tuned AFO-FC following the intervention period. No short-term changes were seen in PedsQL™ scores, muscle and joint characteristics, and GDI. Feasibility issues were also identified. Dr Marietta van der Linden: Thank you for your continuous support and mentoring. I really appreciate you giving me the time and space, and additional support, to get me up to speed during the initial stages of the PhD. I am also very thankful to you for your dedication and many hours of hard work that you have put into reading my thesis. Dr. Fiona Coutts: Thank you for continuous support as a line manager, supervisor and friend. I really appreciate you looking out for me all through my PhD, and supporting and guiding me at crucial moments of my career and life. I am very grateful for all your valuable feedback and advice. Dr Tom Mercer: Thank you for your valuable comments and support. I appreciate the way you have challenged my thinking and helped me streamline the thesis at crucial times. Jan Herman and Jacky Yirrel: Thank you for collaborating in this research through your valuable input in the original ideas, through individual data collection sessions and ongoing discussions that have been highly influencial in the project. Anderson's Gait Laboratory and Dr Alison Richardson: Thank you for allowing me to use the laboratory when it was needed the most, and collaborating with me on the project through assistance in participant recruitment and data collection sessions. Callum Ferguson, Lyndsay Forbes and Peacock's Medical group, Edinburgh: Thank you for collaboration in this research and your valuable input. I have appreciated your support through providing expertise and facilities for the design and production of orthotics and tuning materials. Robert Rush, Barry Meadows and Elaine Owen: Thank you for your valuable input and expert advice in the design and organisation of the study. Mr. James Robb: Thank you for the critical comments and questions which have challenged my thinking and helped to improve my thesis. Richard Wilson and Andrew Grainger: Thank you for all the technical support and advice. All my participants: My earnest thanks to all the children and their parents who participated in this study, for their patience, support and trust. I also thank all the adult participants in my study.