Abstract
To evaluate the efficacy of ankle foot orthoses (AFOs) prescribed in the community for children with cerebral palsy (CP). Fifty-six children (32 boys and 24 girls, mean age 8.9 years, range 4-17) who were diagnosed as having CP were enrolled. They were grouped according to the type of CP, diplegic (n = 38) and hemiplegic (n = 18). Three-dimensional gait analyses while patient were barefoot and with AFOs were obtained and analyzed. The spatio-temporal findings were the most significantly changed as a result of AFO use. In the hemiplegic group, stride length was 11.7% (p = 0.001) longer with AFOs in both affected (10.2%) and non-affected (12.4%) legs, and cadence was reduced by 9.7%; walking speed was not affected. In the diplegic group, stride length with AFOs was 17.4% longer compared to barefoot (p < 0.001) and walking velocity improved by 17.8% (p < 0.001); cadence was unchanged. AFOs also increased ankle dorsiflexion at initial contact in both groups. In the hemiplegic group, AFOs produced an average 9.4 degrees increase of dorsiflexion at initial contact (IC) on the affected side (p < 0.001) and 5.87 degrees on the unaffected side (p = 0.007), and an increase of 9.9 degrees (p < 0.001) dorsiflexion at swing, on the affected side. In the diplegic group, dorsiflexion at IC was increased by 13.4 degrees on the right side and 7.8 degrees on the left side (p = 0.05; p > 0.001, respectively) and an increase of 6 degrees (p = 0.005) at swing. In the hemiplegic group of patients, knee flexion at initial contact on the affected side was reduced by 8.5 degrees (p = 0.032) while in the diplegic group we found no influence. The number of patients that reached symmetry at initial double support tripled (from 5.6 to 16.7%) with the use of AFOs. Our results showed that the use of AFOs improves spatio-temporal gait parameters and gait stability in children with spastic cerebral palsy. It has a lesser effect on proximal joint kinematics. Children with spastic hemiplegia display greater improvement than those with spastic diplegia.
Highlights
Equinus gait, the most common deformity in children with cerebral palsy (CP), is usually accompanied by additional abnormalities at the upper segments of the lower extremities [1, 2]
In the hemiplegic group of patients, knee flexion at initial contact on the affected side was reduced by 8.5° (p = 0.032) while in the diplegic group we found no influence
Our results showed that the use of ankle–foot orthoses (AFOs) improves spatio-temporal gait parameters and gait stability in children with spastic cerebral palsy
Summary
The most common deformity in children with cerebral palsy (CP), is usually accompanied by additional abnormalities at the upper segments of the lower extremities [1, 2]. The use of ankle–foot orthoses (AFOs) is widely recommended to prevent the development or progression of this deformity and to improve the dynamic efficiency of the child’s gait [3]. Physicians usually prescribe AFOs following clinical examinations and observation of the child’s walking patterns [4]. Most of the children referred to our gait analysis laboratory were using an AFO that had been prescribed for them by various health care practitioners. The purpose of the current study was to evaluate the efficacy of AFOs prescribed in the community to children with CP. We assessed the AFOs’ contribution to these children in our gait laboratory, using the parameters of time–distance, stride analysis, foot prepositioning, and response to loading
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