Comparison of spatiotemporal parameters in the gait cycle in children with hemiplegia wearing AFO orthoses

Abstract

Cerebral palsy (CP) is a disorder usually caused by brain damage occurring at birth or earlier, up to the age of two years [1,2]. Spastic hemiplegia/hemiparesis is a type of CP that affects only one side of children's body. The types of treatment that can be used depend on the patient’s specific symptoms and range from physical and behavioural therapy, pharmacological treatments (with botulinum toxin and baclofen), surgical treatments (with rhizotomy) and the use of mechanical aids. Conservative treatment on children with CP includes prescribing the use of ankle-foot orthoses (AFOs). In children with hemiplegia, for example, AFOs are prescribed to correct ankle position and affect the pathologic plantarflexion- extension couple of the hyperextended affected knee. Thus, the aim of this study is to compare the spatiotemporal parameters between barefoot walking and with different types of AFOs. Eighteen children were recruited for the Polisocial Award 2019 research project GIFT- enGIneering For sporT for all (age: 8.0±1.5 years, height: 1.29±0.07 m, mass: 27.3±5.4 kg (mean±SD)). They were provided with a custom- designed AFO designed by ITOP Officine Ortopediche SpA. The parents or guarantors signed informed consent and the study was approved by the ethics committee of the IRCCS Eugenio Medea – Associazione La Nostra Famiglia where the gait analysis were performed. 22 reflective markers were applied following the Davis protocol. Children were asked to walk at self-selected pace along the walkway in order to obtain at least 5 trials per condition: (i) barefoot, (ii) with commonly used AFO, (ii) with new orthosis at t0 (the day of delivery of the brace) and (iv) with new orthosis at t1 (after about 30 days of conditioning). Kinematics was acquired by means of an optoelectronic system consisting of 8 cameras (Smart DX 700, BTS Bioengineering, Milano, Italy). The spatiotemporal parameters taken into consideration (velocity, cadence, step width, stride length, step length, stance and swing phase, double support, single support) were calculated using a protocol in SMART Analyzer (BTS Bioengineering, Milano, Italy). Three valid trials were selected for each patient, one full gait cycle (HS-HS) was segmented for each trial for both the affected and the less affected side. Then, the parameters were averaged for each condition (Fig. 1). To compare between the four conditions, after the data normality check, a two-way ANOVA repeated measures and a one-way ANOVA repeated measure (α = 0.05) were performed followed by post hoc tests with Bonferroni correction (ANOVA2rm on stride and step length, stance and swing phase, double and single support, ANOVA1rm on speed cadence and step width). See Fig. 1. With respect to the barefoot condition, wearing an AFOs (orthosis, AFO T0 and AFO T1) resulted in an increase in speed, a reduction in cadence, while stride width remained almost unchanged [3]. An asymmetry can be also observed between the affected and the less affected limb in relation to the temporal parameters (stance, swing, single and double support) that is not compensated even with the presence of the new device.