Effects of Hinged versus Floor-Reaction Ankle-Foot Orthoses on Standing Stability and Sit-to-Stand Performance in Children with Spastic Diplegic Cerebral Palsy.

Yu-Lin Wang,Cheng-Hsieh Yang,Chiung-Ling Chen,Wen-Chou Chi,Kwok-Tak Yeung,Ya-Ling Teng

doi:10.3390/ijerph19010542

Abstract

Hinged ankle-foot orthoses (HAFOs) and floor reaction ankle-foot orthoses (FRAFOs) are frequently prescribed to improve gait performance in children with spastic diplegic cerebral palsy (CP). No study has investigated the effects of FRAFO on sit-to-stand (STS) performance nor scrutinized differences between the application of HAFOs and FRAFOs on postural control. This study compared the effects of HAFOs and FRAFOs on standing stability and STS performance in children with spastic diplegic CP. Nine children with spastic diplegic CP participated in this crossover repeated-measures design research. Kinematic and kinetic data were collected during static standing and STS performance using 3-D motion analysis and force plates. Wilcoxon signed ranks test was used to compare the differences in standing stability and STS performance between wearing HAFOs and FRAFOs. The results showed that during static standing, all center of pressure (COP) parameters (maximal anteroposterior/mediolateral displacement, maximal velocity, and sway area) were not significantly different between FRAFOs and HAFOs. During STS, the floor reaction force in the vertical direction was significantly higher with FRAFOs than with HAFOs (p = 0.018). There were no significant differences in the range of motion in the trunk, knee, and ankle, the maximal velocity of COP forward displacement, completion time, and the force of hip, knee, and ankle joints between the two orthoses. The results suggest both FRAFOs and HAFOs have a similar effect on standing stability, while FRAFOs may benefit STS performance more compared to HAFOs.

Highlights

Cerebral palsy (CP) is a neurological disorder caused by a nonprogressive brain lesion or malformation in the child’s developing brain
The results indicated that wearing the Hinged ankle-foot orthoses (HAFOs) significantly shortened the total duration of STS transfer when compared with that for the barefoot condition
We compared the effects of HAFOs and floor reaction ankle-foot orthoses (FRAFOs) on standing stability and STS performance in children with spastic diplegic CP

Summary

Introduction

Cerebral palsy (CP) is a neurological disorder caused by a nonprogressive brain lesion or malformation in the child’s developing brain. CP affects primarily motor function and is often accompanied by disturbances of sensation, perception, cognition, communication, behavior, and secondary musculoskeletal problems [1]. Individuals with cerebral palsy have been classified by motor type and topographical distribution. The tonal or movement abnormalities, include terms such as spastic, hypotonic, dyskinetic, ataxic, or mixed. The topographic classifications include the limbs that are affected, namely monoplegia, hemiplegia, triplegia, diplegia, or quadriplegia. Spastic diplegic motor disorders are most common in children with CP [2]. Children with spastic diplegic CP suffer from spasticity and have arm involvement of lesser severity than leg

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