Postoperative changes in vertical ground reaction forces, walking barefoot and with ankle-foot orthoses in children with Cerebral Palsy

Ingrid Skaaret,Harald Steen,Sanyalak Niratisairak,David Swanson,Inger Holm

doi:10.1016/j.clinbiomech.2021.105336

Abstract

BackgroundChildren with cerebral palsy often have problems to support the body centre of mass, seen as increased ratio between excessive vertical ground reaction forces during weight acceptance and decreased forces below bodyweight in late stance. We aimed to examine whether increasing ankle range of motion through surgery and restraining motion with ankle-foot orthoses postoperatively would have impact on the vertical ground reaction force in weight acceptance and late stance. MethodsGround reaction forces were recorded from 24 children with bilateral and 32 children with unilateral cerebral palsy, each measured walking barefoot before and after triceps surae lengthening. Postoperatively, the children were also measured walking with ankle-foot orthoses. Changes in vertical ground reaction forces between the three conditions were evaluated with functional curve and descriptive peak analyses; accounting for repeated measures and within-subject correlation. FindingsAfter surgery, there were decreased vertical ground reaction forces in weight acceptance and increased forces in late stance. Additional significant changes with ankle-foot orthoses involved increased vertical forces in weight acceptance, and in late stance corresponding to bodyweight (bilateral, from 92% to 98% bodyweight; unilateral, from 94% to 103% bodyweight) postoperatively. InterpretationOur findings confirmed that surgery affected vertical ground reaction forces to approach more normative patterns. Additional changes with ankle-foot orthoses indicated further improved ability to support bodyweight and decelerate centre of mass in late stance.

Highlights

Gait deviations are common in children with spastic unilateral cerebral palsy (SUCP)
Residual gait problems such as remaining crouch and dynamic ankle equinus/drop-foot were the main indications for continued use of ankle-foot orthoses (AFOs) one year postoperatively
We demonstrated the mechanical-functional efficacy of AFOs to further improve gait function one year postoperatively at activity, body functions and structures levels (9)

Summary

Introduction

Gait deviations are common in children with spastic unilateral cerebral palsy (SUCP). Residual gait problems, such as drop-foot in the swingphase are common.[2,8,9] Recurrent equinus has been reported in 38% to 62.5 % of patients with unilateral cerebral palsy (CP) five to ten years after triceps surae lengthening.[10,11] It is, not surprising that the one-year postoperative evaluation with 3DGA often results in recommendations regarding further treatment, such as prolonged use of orthoses, to prevent recurrent deformities.[8,12]. Children with cerebral palsy often have problems to support the body centre of mass, seen as increased ratio between excessive vertical ground reaction forces during weight acceptance and decreased forces below bodyweight in late stance. Additional significant changes with ankle-foot orthoses involved increased vertical forces in weight acceptance, and in late stance corresponding to bodyweight (bilateral, from 92% to 98% bodyweight; unilateral, from 94% to 103% bodyweight) postoperatively. Additional changes with ankle-foot orthoses indicated further improved ability to support bodyweight and decelerate centre of mass in late stance

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Conclusion