Effect of ankle-foot orthoses on gait, balance and gross motor functions in children with cerebral palsy: A systematic review and meta-analysis

Abstract

Ankle-foot orthoses are often prescribed to correct abnormal gait, facilitate gait training and reduce the impact on functional ability in children with cerebral palsy who present neuro-motor deficits of the lower limb. The aim of this study systematic review and meta-analysis was 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 (CP). Five databases were searched (Pubmed, Psycinfo, Web of Science, Academic Search Premier, Cochrane Library) before January 2018. Studies of the effect of AFOs on gait, balance, gross motor function and activities of daily living in children with CP 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. Thirty-two articles, corresponding to 56 studies (884 children) were included. In 51 studies, children with spastic CP were included. AFOs increased stride length (SMD = 0.88, P < 0.001) and gait speed (SMD = 0.28, P < 0.001), decreased cadence (SMD = −0.72, P < 0.001). Gross motor function scores improved GMFM D (SMD = 0.30, P = 0.004), E (SMD = 0.28, P = 0.02), PEDI (SMD = 0.57, P < 0.001). Data relating to balance and activities of daily living were insufficient to conclude. Posterior AFOs (solid, hinged, supramalleolar, dynamic) increased ankle dorsiflexion at initial contact (SMD = 1.52, P < 0.001) and during swing (SMD = 0.81, P < 0.001), and decreased ankle power generation in stance (SMD = −0.72, p < 0.001) in children with equinus gait. In children with spastic CP, 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.