Use Of Ankle-foot Orthoses Research Articles

Efficacy of hinged and carbon fiber ankle-foot orthoses in children with unilateral spastic cerebral palsy and drop-foot gait pattern.

In children with unilateral spastic cerebral palsy (USCP), ankle-foot orthoses (AFOs) are widely used to correct common gait deviations such as a drop-foot pattern. Most studies on this topic have investigated specific time points while omitting other parts of the gait cycle. This study investigated the separate effects of prefabricated carbon fiber AFOs and custom-made hinged AFOs compared with barefoot walking in children with USCP with a drop-foot gait pattern using statistical parametric mapping. Retrospective, cross-sectional, repeated measures study. Twenty ambulatory children (9.9 ± 2.5 years) with USCP and a drop-foot gait pattern were included. Kinematics, kinetics, and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking. Statistical parametric mapping was used to compare joint angles and moment waveforms. Kinematics, kinetics and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking for each AFO type but not between the 2 AFO types. Compared with barefoot walking, there was a steeper sole angle at initial contact, corresponding to a heel strike pattern, and an increased ankle dorsiflexion in swing with the use of both AFOs. The ankle plantar flexion moment during loading response increased. Ankle power generation during pre-swing decreased in the carbon fiber AFO group when walking with AFOs. Both AFOs were beneficial for improving a drop-foot gait pattern in these small patient groups and can, therefore, be recommended to treat this gait deviation in patients with unilateral cerebral palsy. However, the reduction in ankle power generation during push-off and additional goals targeted by AFOs, such as correction of structural or flexible foot deformities, should be considered for prescription.

Efficacy of Lower Limb Orthoses in the Rehabilitation of Children Affected by Cerebral Palsy: A Systematic Review.

Lower limb orthoses are frequently used in children suffering from cerebral palsy (CP) alongside rehabilitation. The aim of this study was to analyze the effectiveness of ankle-foot orthosis (AFO) and knee-ankle-foot orthosis (KAFO) in walking, balance maintenance, spasticity, and quality of life improvement during rehabilitation in children affected by CP. The hypothesis was that the use of orthoses could improve the parameters compared to non-use. A systematic review was conducted in the main databases, including English language RCTs published about the use of AFO and KAFO in combination or not with rehabilitation methods in children affected by CP and studies mentioning walking, balance, muscle length, and quality of life as outcomes. From an initial number of 1484 results, a final number of 11 RCTs were included, comprising a total number of 442 participants and showing an overall high risk of bias in 10 studies and some concerns in one study. Six studies investigated the domain of walking, four studies investigated the domain of balance, and two studies investigated how KAFO and AFO orthoses could improve and prevent muscle contractures. Using highly heterogeneous study designs, different kinds of orthoses and different assessment tools were used. Further studies conducted with higher methodological quality are needed to establish whether AFO and KAFO are useful or not in combination with rehabilitation in improving the investigated domains.

Órtese tornozelo-pé em pacientes com distrofia muscular de Duchenne: um estudo retrospectivo

Abstract Introduction: Duchenne muscular dystrophy (DMD) is a recessive genetic disease linked to the X chromosome, leading to progressive muscle tissue loss. Initially, there is difficulty getting up from the floor and an increased frequency of falls. Maintaining ambulation as long as possible is essential, and the use of ankle-foot orthosis (AFO) has been investigated as an ally in this process. Objective: To verify the prescription and use of an AFO for ambulant boys with DMD. Methods: Information was collected using the medical records of 181 patients with DMD from the Neuropediatric Service of the Instituto de Puericultura e Pediatria Martagão Gesteira of the Universidade Federal do Rio de Janeiro. Variables used were: age at the first medical appointment, age at first symptoms, age at loss of independent gait, time between the first symptoms and loss of gait, prescription of orthosis, time of use, and surgical intervention in the lower limbs. Results: The orthosis was prescribed for 63.5% of patients and used by 38.1%. The range of orthosis time was 2 to 4 years (62.3%). The night sleep period was the most prescribed for orthosis use, with 67.2%. Patients who used the orthosis for a longer time were older at gait loss. However, the children who arrived earlier for the first appointment had a higher frequency of orthosis prescriptions and later loss of gait. Conclusion: The use of AFO can help maintain ambulation for longer in boys with DMD.

Use, tolerability, benefits and side effects of orthotic devices in Charcot-Marie-Tooth disease

BackgroundShoe inserts, orthopaedic shoes, ankle-foot orthoses (AFOs) are important devices in Charcot-Marie-Tooth disease (CMT) management, but data about use, benefits and tolerance are scanty.MethodsWe administered to Italian CMT Registry patients...

Do lower limb motor-evoked potentials predict walking outcomes post-stroke?

BackgroundThis observational study examined whether lower limb (LL) motor-evoked potentials (MEPs) 1 week post-stroke predict recovery of independent walking, use of ankle-foot orthosis (AFO) or walking aid, at 3 and...

Effects of ankle-foot orthosis on gait pattern and spatiotemporal indices during treadmill walking in hemiparetic stroke.

Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in post-stroke gait, a three-dimensional motion analysis of gait pattern was conducted. Forty patients with hemiparesis were enrolled. A three-dimensional motion analysis system was used to analyze patients' treadmill walking with/without an AFO. Outcome measures were 12 abnormal gait indices (forefoot contact, knee extensor thrust, retropulsion of the hip, flexed-knee gait, medial whip in the stance phase, circumduction gait, hip hiking, insufficient knee flexion during the swing phase, excessive lateral shifting of the trunk, contralateral vaulting, excessive hip external rotation, and posterior pelvic tilt), calculated using kinematic data and spatiotemporal indices, and the symmetry index of double-stance and single-stance time and step length. Forefoot contact (without AFO vs. with AFO: 71.0 vs. 65.8, P < 0.001), circumduction gait (65.0 vs. 57.9, P < 0.001), and contralateral vaulting (78.2 vs. 72.2, P = 0.003) were significantly reduced, whereas excessive hip external rotation (53.7 vs. 62.8, P = 0.003) significantly increased during walking with an AFO. Hip hiking (77.1 vs. 71.7) showed marginal reduction with the use of AFO ( P = 0.096). The absolute symmetry index of double-stance time (21.9 vs. 16.1, P = 0.014) significantly decreased during walking with an AFO. AFO effectively mitigates abnormal gait patterns typical of hemiparetic gait. A 3D motion analysis system with clinically oriented indices can help assess intervention efficacy for gait abnormalities.

Gait and Muscle Activity Changes in Patients in the Recovery Phase of Stroke with Continuous Use of Ankle-Foot Orthosis with Plantarflexion Resistance

Gait and Muscle Activity Changes in Patients in the Recovery Phase of Stroke with Continuous Use of Ankle-Foot Orthosis with Plantarflexion Resistance

Kinesiology taping and ankle foot orthosis equivalent therapeutic effects on gait function in stroke patients with foot drop: A preliminary study.

An ankle foot orthosis (AFO) is a standard type of orthosis applied to immediately treat foot drop symptoms. Kinesiology taping (KT) is a therapeutic method used in patients with neurological diseases, such as stroke, as well as in patients after orthopedic and sports injuries. This study aimed to compare outcomes of AFO treatment with those of KT to investigate the effect on gait ability in patients with foot drop after stroke. We recruited 18 patients exhibiting foot drop from stroke. Gait ability was assessed under 2 conditions: treatment with KT and that with AFO using the GAITRite system according to the following parameters: cadence, velocity, swing time, stance time, step length, and stride length. As a result, gait ability after treatment with KT and that after treatment with AFO showed no significant differences in cadence (P = .851), velocity (P = .865), swing time (P = .289 and .123), stance time (P = .255 and .711), step length (P = .955 and .975), and stride length (P = .711 and .690) of the affected and less-affected limbs. This study demonstrated that KT and AFO use have similar effects on gait function in patients with foot drop after stroke. Thus, treatment of foot drop with KT may be an alternative in patients for whom AFO use is contraindicated.

Ankle-foot orthoses among children with cerebral palsy: a cross-sectional population-based register study of 8,928 children living in Northern Europe

BackgroundCerebral palsy (CP) is an umbrella term where an injury to the immature brain affects muscle tone and motor control, posture, and at times, the ability to walk and stand. Orthoses can be used to improve or maintain function. Ankle-foot orthoses (AFOs) are the most frequently used orthoses in children with CP. However, how commonly AFOs are used by children and adolescents with CP is still unknown. The aims of this study were to investigate and describe the use of AFOs in children with CP in Sweden, Norway, Finland, Iceland, Scotland, and Denmark, and compare AFO use between countries and by gross motor function classification system (GMFCS) level, CP subtype, sex, and age.MethodAggregated data on 8,928 participants in the national follow-up programs for CP for the respective countries were used. Finland does not have a national follow-up program for individuals with CP and therefore a study cohort was used instead. Use of AFOs were presented as percentages. Logistic regression models were used to compare the use of AFOs among countries adjusted for age, CP subtype, GMFCS level, and sex.ResultsThe proportion of AFO use was highest in Scotland (57%; CI 54–59%) and lowest in Denmark (35%; CI 33–38%). After adjusting for GMFCS level, children in Denmark, Finland, and Iceland had statistically significantly lower odds of using AFOs whereas children in Norway and Scotland reported statistically significantly higher usage than Sweden.ConclusionIn this study, the use of AFOs in children with CP in countries with relatively similar healthcare systems, differed between countries, age, GMFCS level, and CP subtype. This indicates a lack of consensus as to which individuals benefit from using AFOs. Our findings present an important baseline for the future research and development of practical guidelines in terms of who stands to benefit from using AFOs.

Does use of ankle foot orthoses affect the dynamic motor control index during walking in cerebral palsy and idiopathic toe walking populations?

BackgroundThe dynamic motor control (walk-DMC) index during walking is a measure of the complexity of muscle activation pattern. Ankle Foot Orthoses (AFO) are frequently used to improve the gait of children with Cerebral Palsy (CP) and Idiopathic Toe Walking (ITW). The purpose of this study was to assess the change in walk-DMC index secondary to AFO use. Research QuestionDoes the change in walk-DMC reflect the change in walking kinematics with the use of AFO. MethodsIndividuals with diagnosis of CP or ITW with gait analysis data available for barefoot and AFO condition were retrospectively identified. For each individual, the walk-DMC index, Gait Deviation Index (GDI) and Gait Variable Scores (GVS) of knee and ankle kinematics were computed for BF and AFO conditions. Paired t-tests were used to compare key variables between BF and AFO conditions. Multi-variate stepwise regression analysis was performed to identify variables that may predict the increase in walk-DMC between BF and AFO condition. Results253 individuals were included in the study. For CP individuals (n = 208), statistically significant but quantitatively minimal improvement was observed in walk-DMC (1 ± 9), GDI (2 ± 9) and ankle GVS (2 ± 7). For ITW individuals (n = 45), larger improvements were observed in walk-DMC (11 ± 13), GDI (9 ± 11) and ankle GVS (6 ± 7).Diagnosis of ITW, use of Solid-AFO and Posterior Leaf Spring-AFO were the significant predictor of increase in walk-DMC with AFO. Higher ankle GVS at BF condition (larger deviation from TD) led to larger increase in walk-DMC. Higher knee GVS (larger deviation from TD) led to smaller increase in walk-DMC. SignificanceUse of AFO can lead to improvement in walking kinematics that is reflected in increase in walk-DMC with AFO compared to BF for ITW individuals. The change in kinematics and walk-DMC with use of AFO was minimal for CP individuals.

The effect of a modified elastic band orthosis on gait and balance in stroke survivors.

Gait is crucial for independent living for stroke survivors and assistive devices have been developed to support gait performance. Ankle foot orthosis (AFOs) are commonly provided to stroke survivors to prevent foot drop during walking. However, previous studies have reported limitations of AFOs including them being too heavy, creating skin irritation, and being a stigma of disability. The purpose was to compare the gait and balance improvement between elastic band orthosis (EBOs) and AFOs. Experimental study design. The AFOs and EBOs were provided to 17 stroke survivors, and changes in gait and balance were assessed compared to barefoot (control). Gait spatiotemporal parameters were measured using the zebris-FDM-Rehawalk® system, and balance ability was evaluated using the time up and go test (TUG). Satisfaction with the EBOs was determined using the Quebec user evaluation of satisfaction with assistive technology (QUEST2.0) questionnaire. The EBO showed significant differences in; gait speed, cadence, stride length, stride time, step length unaffected side, stance phase and swing phase on the affected side, and pre-swing on the unaffected side, and balance performance (TUG) (p<0.05) when compared to the AFO and control conditions. The participants were quite satisfied with the EBOs with QUEST2.0 scores greater than 4 out of 5. EBOs could be provided to stroke survivors given their acceptability and properties to improve gait and balance. The EBO used in this study offered clinically important improvements in gait and balance when compare to AFO and control conditions, and could mitigate against some of the limitations reported in the use of AFOs in stroke survivors.

AFOs Improve Stride Length and Gait Velocity but Not Motor Function for Most with Mild Cerebral Palsy

Ankle-foot orthoses (AFOs) are prescribed to children with cerebral palsy (CP) in hopes of improving their gait and gross motor activities. The purpose of this retrospective study was to examine if clinically significant changes in gross motor function occur with the use of AFOs in children and adolescents diagnosed with CP (Gross Motor Function Classification System levels I and II). Data from 124 clinical assessments were analyzed. Based on minimum clinically important difference (MCID), 77% of subjects demonstrated an increase in stride length, 45% of subjects demonstrated an increase in walking velocity, and 30% demonstrated a decrease in cadence. Additionally, 27% of the subjects demonstrated increase in gait deviation index (GDI). Deterioration in gait was evident by decreases in walking speed (5% of subjects), increases in cadence (11% of subjects), and 15% of subjects demonstrated decreases in gait deviation index. Twenty-two percent of subjects demonstrated no change in stride lengths and one participant demonstrated a decrease in stride length. However, AFOs improved Gross Motor Function Measure (GMFM) scores for a minority (10%) of children with mild CP (GMFCS level I and II), with 82-85% of subjects demonstrating no change in GMFM scores and 5-7% demonstrating decrease in GMFM scores.

A Survey of Clinical Practice Patterns of Physical Therapists for the Use of Ankle-Foot Orthoses or Functional Electrical Stimulation Poststroke

ABSTRACT Objective The aims of this study were (1) to understand the practice patterns and decision-making factors of physical therapists (PTs) when choosing ankle-foot orthoses (AFOs) or functional electrical stimulation (FES) for patients with mobility deficits secondary to poststroke hemiplegia and (2) to explore perceived gaps in knowledge to inform development of a clinical practice guideline (CPG). Methods A mixed-methods web-based survey collected quantitative and qualitative data from practicing PTs. Descriptive analysis of quantitative data and thematic content analysis of the qualitative data were completed. Results The 103 PTs were practicing clinicians with a doctoral degree and specialized board certification. A higher level of confidence with AFOs compared with FES was reported, along with increased inclusion of AFOs compared with FES for assessments and treatments. The PTs considered outcomes across the International Classification of Functioning, Disability and Health (ICF) when choosing devices, noting barriers in access and reimbursement as influential factors in clinical decision making. Fewer than 50% participated in continuing education on AFO or FES. Perceived knowledge gaps and educational needs included assessment and intervention strategies to support clinical decision making. The PTs considered themselves influential in the decision-making process and more than 95% of the respondents replied that a CPG on AFO and FES poststroke would impact clinical practice. Conclusion Themes related to education, clinical decision-making, access, and reimbursement were identified. A CPG may provide valuable information to address gaps in knowledge to improve clinical practice and decision-making. Clinical Relevance This research aims to inform the development of a CPG to address needs and gaps in knowledge identified by practicing clinicians. The information gained will inform knowledge translation strategies to promote best practices when implementing AFO and FES to improve activity and participation levels of individuals poststroke.

The Effectiveness of Using AFO with Stroke in Developing Functional Performance

The study goal is to find out the impact of using AFO on balance, gait, and daily life activity of chronic stroke patients. Single case experimental design study. The case study focuses on patients who have a chronic CVA, one patient will undergo the AFO, then be assessed by measurement and tests regarding balance by the Berg Balance Scale, gait by Wisconsin Gait Scale and ADL by Barthel Index for two weeks before dressing AFO and after dressing it. The findings show that there is a clear significance in scores which resulted for the patient pre and post using AFO, the balance score for the patient before using AFO was 26/56 but after it shows a better result it was 40/56 ,and the ADL score for the patient before wearing AFO was 40/100 , after using AFO it becomes 75/100, also the gait improve clearly in stance phase and swings as measurement shows, therefore it was concluded that the AFO is very good for stroke patients to improve their balance , gait, and ADLs. The study concluded that the use of orthotics has a good effect on balance, gait, and ADLs.&#x0D; Originality/value: This single-case experimental design study explores the impact of ankle-foot orthosis (AFO) on balance, gait, and activities of daily living (ADLs) in chronic stroke patients. Findings indicate significant improvements in balance, gait, and ADL scores after two weeks of AFO use. The study underscores the effectiveness of AFO in enhancing functional outcomes and highlights its value in stroke rehabilitation.

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

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.

Therapeutic effect of gait training with two types of ankle-foot orthoses on the gait of the stroke patients in the recovery phase.

Objectives This study aimed to demonstrate the therapeutic effect of gait training using ankle-foot orthoses (AFOs) on the gait of stroke patients when not wearing AFOs with two different types of AFO, an AFO with an oil damper (AFO-OD) that resists plantarflexion and an AFO with a plantarflexion stop (AFO-PS), and to display the possible differences between the AFO types. Patients and methods Forty-two patients (38 males, 4 males, mean age: 59.7±10.9; range, 38 to 81 years) with subacute stroke were randomized to either an AFO-PS or an AFO-OD group. Participants were given gait training in a two-week period by physiotherapists wearing their allocated AFO. Nineteen patients were assigned to the AFO-PS group and 20 to the AFO-OD group. Patients' gait without an AFO before gait training and then after two weeks of training wearing allocated AFOs was recorded through a three-dimensional movement capture system. Results A therapeutic effect through two weeks of continuous use of AFOs and gait training was found in both AFO groups (main effect of time) in the spatiotemporal factors, ankle joint moments, ankle power generation, shank-to-vertical angle, and center of gravity velocity throughout the stance phase, pre-swing knee angular velocity, and hip flexion moment in pre-swing. The results did not show a large interaction between two AFOs group. Conclusion These findings reveal that both AFOs had significant therapeutic effects on stroke gait. There was no significant difference between the two AFO groups. Further studies with a control group representing the effects of gait training without wearing an AFO are needed.

Effect of Custom Carbon Ankle–Foot Orthosis Use on Energetic Demands of Walking and Comparisons With Individuals With Amputation

ObjectiveTo compare the metabolic demands of walking in individuals with lower limb injury with and without ankle–foot orthosis (AFO) use. A secondary aim was to compare these results with those from individuals with unilateral transtibial amputation (TTA) and able-bodied controls. DesignCross-sectional study. SettingTwo clinical research centers. ParticipantsThirteen individuals (N=13) with lower limb injury who used a passive-dynamic AFO underwent metabolic analysis at 3 standardized speeds with and without their AFO. Results were compared with individuals with unilateral TTA who used a passive prosthetic foot and able-bodied controls with no musculoskeletal, neurologic, or cardiovascular deficits. Main Outcome MeasuresOxygen consumption, heart rate, and rating of perceived exertion. ResultsThe use of the passive-dynamic AFO did not significantly change energetic demand (oxygen consumption, heart rate, perceived exertion) in participants with a lower limb [LL] injury. Heart rate (P<.037) was significantly greater than able-bodied controls, but perceived exertion was significantly lower (P≤.031). There were no significant differences between participants with an LL injury (with or without the AFO) and individuals with TTA. ConclusionsMany individuals with LL injuries may expect to use passive-dynamic AFOs with little to no metabolic consequence. The stabilizing and assistive benefits of the AFO likely balance with its well-known range of motion limitations and power reductions. Passive-dynamic AFO use can sometimes be an alternative for individuals considering TTA. These results support that AFO users may be able to achieve similar energetic demands as those with amputation.

Classification of Ankle Joint Stiffness during Walking to Determine the Use of Ankle Foot Orthosis after Stroke

Categorization based on quasi-joint stiffness (QJS) may help clinicians select appropriate ankle foot orthoses (AFOs). The objectives of the present study were to classify the gait pattern based on ankle joint stiffness, also called QJS, of the gait in patients after stroke and to clarify differences in the type of AFO among 72 patients after stroke. Hierarchical cluster analysis was used to classify gait patterns based on QJS at least one month before the study, which revealed three distinct subgroups (SGs 1, 2, and 3). The proportion of use of AFOs, articulated AFOs, and non-articulated AFOs were significantly different among SGs 1–3. In SG1, with a higher QJS in the early and middle stance, the proportion of the patients using articulated AFOs was higher, whereas in SG3, with a lower QJS in both stances, the proportion of patients using non-articulated AFOs was higher. In SG2, with a lower QJS in the early stance and higher QJS in the middle stance, the proportion of patients using AFOs was lower. These findings indicate that classification of gait patterns based on QJS in patients after stroke may be helpful in selecting AFO. However, large sample sizes are required to confirm these results.

Effects of Ankle Foot Orthoses on the Gait Patterns in Children with Spastic Bilateral Cerebral Palsy: A Scoping Review.

Background: Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. Methods: A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. Results: We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO. Conclusions: Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.

Effects of Ankle-Foot Orthoses on acceleration and energy cost of walking in children and adolescents with cerebral palsy.

Impaired postural control is a key feature of cerebral palsy that affects daily living. Measures of trunk movement and acceleration have been used to assess dynamic postural control previously. In many children with cerebral palsy, ankle-foot orthoses are used to provide a stable base of support, but their effect on postural control is not yet understood. The objectives of the current study were to investigate the effects of ankle-foot orthoses on postural control and energy cost of walking in children with cerebral palsy. Clinical study with controls. Trunk accelerometry (amplitude and structure) and energy cost of walking (J/kg/m) were recorded from five-minute walking trials with and without ankle-foot orthoses for children with cerebral palsy and without orthoses for the reference group. Nineteen children with unilateral spastic cerebral palsy and fourteen typically developed children participated. The use of ankle-foot orthoses increased structure complexity of trunk acceleration in mediolateral and anterior-posterior directions. The use of ankle-foot orthoses changed mediolateral-structure toward values found in typically developed children. This change was not associated with a change in energy cost during walking. The use of ankle-foot orthoses does affect trunk acceleration that may indicate a beneficial effect on postural control. Using measures of trunk acceleration may contribute to clinical understanding on how the use of orthoses affect postural control.