Comparative analysis of the effect trunk-hip-knee-ankle foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy (case report)

Abstract

BACKGROUND: In children with spastic forms of cerebral palsy often prescribed difference type of trunk-hip-knee-ankle foot orthosis (THKAFO). At the same time, we have not found any significant reports in the world literature dedicated to the study of the influence of these orthosis on the gait biomechanical parameters.
 AIM: To demonstrate the results of a comparative analysis of the effect of trunk-hip-knee-ankle-foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy.
 MATERIALS AND METHODS: The study involved two 13-and 15-year-old children with a diagnosis of cerebral palsy, spastic diplegia, GMFCS 3, MACS 23, Ashworth Scale 23. Six studies were conducted ― three tests for each child (barefoot, in AFO and THKAFO) using the 3D video analysis system Qualisys (Sweden). The spatio-temporal and kinematic indicators of gait, as well as the gait index, were evaluated.
 RESULTS: Analysis of the results in patient D. demonstrated that using the THKAFO in comparison with AFO led to a slight improvement in spatio-temporal gait indicators (from 4.012.5%), but to a deterioration in hip kinematics and a deterioration in the gait index (2.528.1%). Whereas in patient A., it was noted that the use of the THKAFO in comparison with AFO had a negative effect on the spatio-temporal parameters of gait (4.097.6%), on the kinematics of the knee and ankle joints, and on the improvement of the hip kinematics in the sagittal plane, but the effect on the gait index was not unambiguous. According to the totality of the analyzed data, patient D. was recommended to wear AFO instead of the THKAFO. Patient A. was also recommended to wear an AFO instead of a THKAFO, even despite the ambiguous results of the biomechanical research, since the final decision on the choice of the orthosis design took into account not only accurate changes in biomechanical parameters, but also a number of other factors, in particular social and household ones.
 CONCLUSION: In patients with level GMFCS 3, for improve the biomechanical parameters of gait, it is advisable to give preference to shorter and functional orthoses before prescribing orthoses that capture two or more body segments.