The effect of community-prescribed ankle–foot orthoses on gait parameters in children with spastic cerebral palsy (original) (raw)
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Background: Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. Methods: A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. Resu...
Ankle-foot orthoses: effect on gait in children with cerebral palsy
Disability & Rehabilitation, 2002
Purpose: In this study our aim was to evaluate the effectiveness of Ankle-Foot Orthoses (AFOs) on gait function in patients with spastic cerebral palsy for whom orthoses were indicated to control dynamic equines deformity. Method: Twenty-four spastic cerebral palsied patients with dynamic equines deformity were included in the study. Videotape recordings were performed to each patient on the same day with barefoot and AFOs. Temporal distance factors including velocity, cadence, stride length, stride width and Clinical Gait Assessment Score (CGAS) were compared across two conditions. Results: The use of AFOs during gait, produced a statistically significant increase in velocity (p=0.011) and stride length (p50.001), no significant difference in cadence (p=0,501), and stride width (p=0.796), and a significant decrease in CGAS (p50.001), compared to barefoot condition. Conclusions: Cerebral palsied children with dynamic equines deformities can benefit from AFOs for ambulation.
Clinical Rehabilitation, 2018
Objective: To determine the effects of ankle-foot orthoses (AFOs) on gait, balance, gross motor function and activities of daily living in children with cerebral palsy. Data sources: Five databases were searched (Pubmed, Psycinfo, Web of Science, Academic Search Premier and Cochrane Library) before January 2018. Review methods: Studies of the effect of AFOs on gait, balance, gross motor function and activities of daily living in children with cerebral palsy were included. Articles with a modified PEDRO score ≥ 5/9 were selected. Data regarding population, AFO, interventions and outcomes were extracted. When possible, standardized mean differences (SMDs) were calculated from the outcomes. Results: Thirty-two articles, corresponding to 56 studies (884 children) were included. Fifty-one studies included children with spastic cerebral palsy. AFOs increased stride length (SMD = 0.88, P < 0.001) and gait speed (SMD = 0.28, P < 0.001), and decreased cadence (SMD =-0.72, P < 0.001). Gross motor function scores improved (Gross Motor Function Measure (GMFM) D (SMD = 0.30, P = 0.004), E (SMD = 0.28, P = 0.02), Pediatric Evaluation of Disability Inventory (PEDI) (SMD = 0.57, P < 0.001)). Data relating to balance and activities of daily living were insufficient to conclude. Posterior AFOs (solid, hinged, supra-malleolar, dynamic) increased ankle dorsiflexion at initial contact (SMD = 1.65, P < 0.001) and during swing (SMD = 1.34, P < 0.001), and decreased ankle power generation in stance (SMD =-0.72, P < 0.001) in children with equinus gait. Conclusion: In children with spastic cerebral palsy, there is strong evidence that AFOs induce small improvements in gait speed and moderate evidence that AFOs have a small to moderate effect on gross motor function. In children with equinus gait, there is strong evidence that posterior AFOs induce large changes in distal kinematics.
Annals of Physical and Rehabilitation Medicine, 2018
Objective: To determine the effects of ankle-foot orthoses (AFOs) on gait, balance, gross motor function and activities of daily living in children with cerebral palsy. Data sources: Five databases were searched (Pubmed, Psycinfo, Web of Science, Academic Search Premier and Cochrane Library) before January 2018. Review methods: Studies of the effect of AFOs on gait, balance, gross motor function and activities of daily living in children with cerebral palsy were included. Articles with a modified PEDRO score ≥ 5/9 were selected. Data regarding population, AFO, interventions and outcomes were extracted. When possible, standardized mean differences (SMDs) were calculated from the outcomes. Results: Thirty-two articles, corresponding to 56 studies (884 children) were included. Fifty-one studies included children with spastic cerebral palsy. AFOs increased stride length (SMD = 0.88, P < 0.001) and gait speed (SMD = 0.28, P < 0.001), and decreased cadence (SMD =-0.72, P < 0.001). Gross motor function scores improved (Gross Motor Function Measure (GMFM) D (SMD = 0.30, P = 0.004), E (SMD = 0.28, P = 0.02), Pediatric Evaluation of Disability Inventory (PEDI) (SMD = 0.57, P < 0.001)). Data relating to balance and activities of daily living were insufficient to conclude. Posterior AFOs (solid, hinged, supra-malleolar, dynamic) increased ankle dorsiflexion at initial contact (SMD = 1.65, P < 0.001) and during swing (SMD = 1.34, P < 0.001), and decreased ankle power generation in stance (SMD =-0.72, P < 0.001) in children with equinus gait. Conclusion: In children with spastic cerebral palsy, there is strong evidence that AFOs induce small improvements in gait speed and moderate evidence that AFOs have a small to moderate effect on gross motor function. In children with equinus gait, there is strong evidence that posterior AFOs induce large changes in distal kinematics.
Pediatric Physical Therapy, 2008
This review assessed the efficacy of ankle-foot orthoses on the gait of children with cerebral palsy and concluded that there were positive effects for a range of outcomes. In light of the paucity of experimental studies, lack of good-quality data and small sample sizes the authors' conclusions should be interpreted with caution, as recommended by the reviewers themselves. Authors' objectives To assess the efficacy of ankle-foot orthoses on the gait of children with cerebral palsy. Searching PubMed, The Cochrane Library, PEDro, OTseeker, LILACS and SciELO were searched to January 2006; search terms were reported. Reference lists of retrieved articles were searched to identify additional articles. Data extraction Data on outcome measures related to gait were collected in all studies. Two reviewers independently extracted data. Disagreements were resolved through discussion with a third reviewer. Methods of synthesis Studies were combined in a narrative synthesis grouped by outcome. Results of the review A total of 20 studies was included in the review (n=446, range 6 to 115): 18 within-group studies and two betweengroup studies. Total quality scores ranged from 2 to 4, most studies (17) scored 3.
The effectiveness of ankle foot orthosis on gait in children with spastic diplegic cerebral palsy
Journal of Pediatrics & Neonatal Care, 2018
Introduction: Cerebral palsy is a life lasting disability and is one of the most expensive diseases. CP is defined as a non-progressive, chronic, involuntary movement disorder secondary to an injury or lesion of the immature brain. The lesion usually occurs prenatally on prenatally: only about 10 per cent of the lesions are of postnatal origin. In most patients, a specific cause is not identified. Orthotic management is a widely utilized method of treatment in children with CP due to its conservative nature. Orthosis continue to have an important role in many therapeutic regimens for children with CP. However; there have been differences in design variants of Orthosis prescribed for the common problem of Spastic Cerebral Palsy. Three AFO configurations frequently prescribed for children with spastic cerebral palsy they are Hinged AFO (HAFO), the Posterior leaf spring (PLS AFO), and the Solid AFO (SAFO). Methods: Thirty subjects with Spasticdieplegic Cerebral palsy aged from 5-15 yea...
Clinical biomechanics (Bristol, Avon), 2015
Ankle-foot orthoses can be prescribed to improve gait in children with cerebral palsy. Before evaluating the effects of ankle-foot orthoses on gait, a period to adapt or acclimatize is usually applied. It is however unknown whether an acclimatization period is actually needed to reliably evaluate the effect of a new orthosis on gait. This study aimed to investigate whether specific gait parameters in children with cerebral palsy would change within an acclimatization period after being provided with new ankle-foot orthoses. Ten children with cerebral palsy, walking with excessive knee flexion in midstance (8 boys; mean (SD) 10.2 (1.9) years; Gross Motor Function Classification System levels I-II) were provided with ventral shell ankle-foot orthoses. The orthoses were worn in combination with the child's own shoes and tuned, based on ground reaction force alignment with respect to the lower limb joints. Directly after tuning (T0) and four weeks later (T1), 3D-gait analysis was pe...
This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.
Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy
Journal of Rehabilitation Medicine, 2008
To determine the effect of ankle-foot orthoses on walking efficiency and gait in a heterogeneous group of children with cerebral palsy, using barefoot walking as the control condition. Design: A retrospective study. Methods: Barefoot and ankle-foot orthosis data for 172 children with spastic cerebral palsy (mean age 9 years; hemiplegia: 21, diplegia: 97, and quadriplegia: 54) were compared. These data consisted of non-dimensional speed, net nondimensional energy cost of walking (NN-cost), and NN-cost as a percentage of speed-matched controls (NN-cost pct ). For 80 of these children the Gillette Gait Index and data for 3D gait kinematics and kinetics were also analyzed. Results: Speed was 9% faster (p < 0.001), NN-cost was 6% lower (p = 0.007), and NN-cost pct was 9% lower (p = 0.022) when walking with an ankle-foot orthosis. The Gillette Gait Index remained unchanged (p = 0.607). Secondary subgroup analysis for involvement pattern showed a significant improvement in NN-cost pct only for quadriplegics (20%, p = 0.004), whereas it remained unchanged for patients with hemiplegia and diplegia. Changes in the minimum knee flexion angle in stance phase and in terminal swing were found to be significantly related to the change in NN-cost pct (p = 0.013 and p = 0.022, respectively). Conclusion: The use of an ankle-foot orthosis resulted in a significant decrease in the energy cost of walking of quadriplegic children with cerebral palsy, compared with barefoot walking, whereas it remained unchanged in hemiplegic and diplegic children with cerebral palsy. Energy cost reduction was related to both a faster and more efficient walking pattern. The improvements in efficiency were reflected in changes of stance and swing phase knee motion, i.e. those children whose knee flexion angle improved toward the typical normal range demonstrated a decrease in energy cost of walking, and vice versa.