Orthosis Research Articles

The Kinetic and Kinematic Efficacy of Posterior Leaf Spring Ankle-foot Orthosis in Patients with Drop foot

Background: Dorsi flexor weakness is one of the common consequences of stroke with a negative impact on normal walking. Posterior leaf spring (PLS) Ankle Foot Orthosis (AFO) is the most frequent prescription to assist foot clearance and leg propulsion in these patients. However, the real efficacy of this AFO needs more attention. This study aimed to investigate the efficacy of PLS AFO on gait outcomes as the most common AFO in drop foot post-stroke patients. Methods: The study design was a pre–post-test experiments in which twenty drop foot patients with a mean age of 65 years with a mean age of 58.45 (±5.23) years who were 4/5 years post-stroke. They walked at self-selected walking speed on a 10 meters walk away in two conditions of with their own shoes and PLS AFO. The 3D motion capture gait analysis system including 6 vicon cameras and a Kistler force plate were used in order to measure gait kinetic and kinematic variables. For each trial, each joints (ankle, knee and hip) angle, moment and power were averaged over one-minute walking. Results: Walking with PLS showed a statistically significant improve kinetic and kinematic variables in hip, knee and ankle joints included power, moments and angles at entire gait cycle. P<0.05. Conclusions: In our study of stroke patients who were fitted with a PLS AFO, immediate significant improvements occurred in most kinetic and kinematic than shoes only in sacrifice some others.

Effect of Ankle Foot Orthosis (AFO) on kinematics in Children with Cerebral Palsy (CP)

Introduction: Children with cerebral palsy have impaired motor control, caused by prenatal and postnatal causes that affect the developing brain which leads to Muscle weakness, sensory loss, and stiffness Objective: To assess the efficacy of floor reaction orthoses (FRO) and solid ankle foot orthoses (AFO) with gait's temporospatial factors. Methodology: It was experimental based with custom molded Floor reaction orthosis and Solid ankle foot orthosis, the sampling technique was Non-probability Convenience sampling the targeted population was CP patients, and trials were taken from the patient. Results: FRAFO significantly improved patient cadence, velocity, stride time, stance, and swing phases compared to SAFO, with better improvement in kinetic dynamics and a decrease in stance and swing phases. Conclusion: FRAFO is more effective than SAFO.

HALO VEST IMMOBILIZATION: IS IT STILL A VALID TREATMENT FOR THE ATLANTO-AXIAL FRACTURES?

IntroductionAtlanto-axial injuries pose a significant threat to morbidity and mortality. This retrospective study aims to analyze clinical and radiological results, failure rates, and complications in a series of patients treated with a halo vest, validating the effectiveness of this device through long-term follow-up. Materials and methodsThis study reviewed adult patients with acute upper cervical spine injuries treated with halo vest immobilization from 1994 to 2022. Fracture types were classified based on Computed Tomography (CT) characteristics. Clinical and radiological follow-ups were performed at the end of treatment and at 3 months after the removal of the system. ResultsMost treated patients were males (70%) with a mean age of 38 years. Car accidents were the primary cause of injury (63%). Among 161 patients, 134 had a C2 fracture, 20 had a C1 fracture, 5 had a C1-C2 rotational dislocation, and 2 had other unclassified combined C1/C2 fractures. Patients without additional injuries or neurological deficits had significantly shorter hospitalization (8 vs. 16 days and 12 vs. 22 days, respectively) compared to those with additional injuries (p value<.00001) or neurological deficits (p value=0.00164). At the 6-month follow-up, radiological and clinical outcomes were available for 147 patients. X-rays in 139 cases showed fracture fusion (94.6%). Clinical follow-up revealed normal or slightly reduced range of motion in 144 cases (98%). Pain was absent or episodic in all the patients except one. In 131 cases (89%), an excellent or good clinical result was achieved. Complications did not impact treatment. ConclusionsBased on our results, the halo vest is a valid treatment for atlanto-axial injuries in selected patients. This includes young and middle-aged individuals (up to 65 years old) with C1 and/or C2 fractures. Halo vest treatment is associated with minor complications and yields a high percentage of excellent/good clinical results.

The Direct Impact Effect of Different Foot Orthotic Designs on the Plantar Loading of Patients with Structural Hallux Limitus: A Quasi-Experimental Study

Background: This study examines the effect of two types of custom-made foot orthoses (CFOs) in patients with structural hallux limitus (SHL). Methods: In this quasi-experimental, repeated measures study, 24 participants with SHL were sampled. Two CFOs—cut-out CFO and anterior stabilizer element (AFSE) CFO—were compared using minimalist SAGURO neoprene shoes: no foot orthoses (FO), cut-out CFO, and AFSE CFO. Plantar pressures and center of pressure (CoP) displacement were measured using a Podoprint® platform. Results: Both CFOs shifted the CoP medially during midstance (p &lt; 0.001 with AFSE CFO and p = 0.0036 with cut-out CFO). The AFSE CFO showed a more anterior CoP in midstance, while the cut-out CFO affected anterior CoP in midstance and pre-swing. The AFSE CFO significantly increased pressure in the second toe, lesser metatarsal heads (MTH), midfoot, and rearfoot. In contrast, the cut-out CFO decreased pressure in the second MTH and lesser toe regions, increasing pressure in the midfoot and heel. Both CFOs lowered the hallux/first MTH ratio compared to shod without CFO. Conclusions: The cut-out CFO led to medial and anterior CoP displacement, reducing lateral foot and hallux pressure while transferring loads to the first MTH. The AFSE CFO caused a similar shift by increasing loads on the first MTH.

Mobility Assistive Technology (AT) for Children with Cerebral Palsy (CP): A Literature Review

This paper comprehensively reviews the use of mobility Assistive Technology (MAT) in children with Cerebral Palsy (CP). Currently, 9 million people are severely affected by CP, the most serious form of movement disability, characterized by deficits in movement, posture, and more, alongside cognitive and sensory deficits. These impairments restrict the child’s functionality in self-care, performing tasks associated with daily living, and socialization. The main purpose of this paper is to establish the role of MAT in supporting children with CP and assess its impact on their lives. This review describes a range of devices that enhance mobility in motor-disabled patients such as powered wheelchairs, robotic exoskeletons, ankle-foot orthoses (AFO), and gait trainers, and examines their effects on the psychosocial well-being and physical growth of children with CP. A methodical search performed within the PRISMA framework enabled us to analyze papers from 2010 to 2024, discussing the advantages and disadvantages of assistive technology (AT). It was noted that although ATs can improve independence, social involvement, and mobility, challenges remain such as high costs, poor design, and unavailability of these resources in underprivileged regions. New information technologies, including intelligent systems and virtual reality (VR) training tools, are effective in addressing health-related issues; however, the optimization of these techniques over a long period needs further study. This paper underscores the importance of a more child-centred design of AT devices and additional policy adjustments to enhance accessibility across different socio-economic strata. Through this review, we seek to advance the emerging understanding of the role of mobility AT in enhancing the lives of children with CP, focusing on identifying weaknesses in the existing research and suggesting possible advancements.

Evaluation of the Working Mechanism of a Newly Developed Powered Ankle–Foot Orthosis

Ankle–foot orthoses (AFOs) are commonly prescribed to children with cerebral palsy (CP). The conventional AFO successfully controls the first and second ankle rocker, but it fails to correct the third ankle rocker, which negatively effects push-off power. The current study evaluated a new powered AFO (PAFO) design, developed to address the shortcomings of the conventional AFO. Eight children with spastic CP (12.4 ± 3.4 years; GMFCS I-III; 4/4-♂/♀; 3/5-bi/unilateral) were included. Sagittal kinematic and kinetic data were collected from 20 steps during barefoot walking, with conventional AFOs and PAFOs. In the PAFO-condition, an actuation unit was attached to a hinged AFO and through push–pull cables to a backpack that was carried by the child and provided patient-specific assistance-as-needed. SnPM-analysis indicated gait cycle sections that differed significantly between conditions. For the total group, differences between the three conditions were found in ankle kinematics (49.6–66.1%, p = 0.006; 88.0–100%, p = 0.011) and angular velocity (0.0–6.0%, p = 0.001; 45.1–51.1%, p = 0.006; 62.2–73.0%, p = 0.001; 81.2–93.0%, p = 0.001). Individual SnPM-analysis revealed a greater number of significant gait cycle sections for kinematics and kinetics of the ankle, knee, and hip. These individual results were heterogeneous and specific per gait pattern. In conclusion, the new PAFO improved the ankle range-of-motion, angular velocity, and power during push-off in comparison to the conventional AFO.

Impact of Serial Casting on Autonomic Nervous System Responses during Virtual Reality Tasks in Children with Cerebral Palsy: A Pilot Study Comparing Orthoses and Barefoot Conditions.

Cerebral palsy (CP) is a group of movement disorders that impair posture and mobility, often leading to spasticity and joint contractures. Interventions like serial casting are commonly used to improve joint mobility and manage spasticity in children with CP. However, its effects on the autonomic nervous system (ANS) remain unclear. This study aimed to evaluate the effects of serial casting and ankle-foot orthoses (AFOs) on ANS responses during a virtual reality (VR) standing task, comparing these interventions with a barefoot condition. Thirty children with CP were randomized into three groups (n = 10 per group): serial casting, AFOs, and barefoot. Heart rate variability (HRV) was used to assess ANS responses across three phases: seated rest, VR task, and recovery. The results showed that the serial casting group exhibited higher sympathetic activity during rest compared to the other groups, but had a reduced sympathetic response during the VR task. Additionally, the serial casting group displayed a more pronounced parasympathetic rebound during recovery, similar to the orthoses and barefoot groups. While serial casting provides essential joint stability, it alters ANS response patterns, leading to heightened sympathetic activation at rest, without providing significant improvements in ANS behavior during physical activity.

“Everyone has a role in Rehabilitation” - Delivering staff education on rehabilitation skills in a post-acute rehabilitation unit

Abstract Background Due to a combination of disrupted services, it was observed that there was a gap in nursing and HCA knowledge of their crucial role within the rehabilitation process for the patients in an older person's post-acute rehabilitation unit. The purpose of this study was to highlight the importance of delivering nursing and healthcare assistant care (HCA) through the lens of goal specific rehabilitation. Methods A staff education programme was designed covering topics of rehabilitation including interdisciplinary team working, therapy group interventions, role of HCA in rehabilitation, personal care, toileting, continence, pressure areas, manual handling, weight bearing status, pain management, mobility aids, equipment, orthopaedic braces and physical activity recommendations in the older adult. A pre and post knowledge-based questionnaire was completed specific to each topic with maximum score 100% indicating full knowledge of the topic. Handouts and resources were created and provided at each session. Education was facilitated by an OT and PT, on a weekly basis. Participants were given the opportunity to provide feedback on the education session. An analysis of the pre/post questionnaire scores was completed using Microsoft Excel. Results Of the 26 staff (HCA and nurses) on the unit, 23 completed the education. Staff scored an average of 45% on the pre-education questionnaire and 76% on the post-education questionnaire. There was a significant increase in the post education session score (p&amp;lt;0.0001). Participants reported benefited from education session (87% strongly agreed n=20, 13% agreed n=3). Conclusion Peer to peer staff educations within the MDT improved knowledge in core aspects of rehabilitation care. To enhance patient experience and outcome the full MDT should feel part of the rehabilitation programme and be aware of the individuals' goals and their role to achieve the goal. This education initiative was beneficial in reinforcing the rehabilitation ethos of the ward and addressing gaps in ward staff’s knowledge.

A Portable Passive Ankle-Foot Orthosis for Walking Propulsion and Drop-Foot Prevention

Abstract Individuals with a drop-foot generally have issues of foot-slap and toe-drag, and ankle-foot orthoses (AFOs) have been developed for them to address the drop-foot gait. However, the currently available active AFOs usually have heavier mass, larger volume, and additional power sources, and almost all of the passive AFOs can achieve dorsiflexion assistance at the cost of making plantarflexion more difficult, which increases the wearer's metabolic cost of walking. This paper illustrates the development and validation of a passive AFO for walking propulsion and drop-foot prevention of individuals with a drop-foot gait. The AFO is primarily composed of a propulsion module, a drop-foot prevention module, and a support module. The propulsion module can detect the wearer's gait stages, and it can control the energy storage and release of an energy storage spring-A by switching the state of a clutch-A mechanism. The drop-foot prevention module is designed to correct the abnormal gait of individuals with a drop-foot gait during the swing phase. Experiments are conducted to evaluate the performance of the developed AFO. The experimental results demonstrate that during a gait cycle, reductions of 7.74%, 6.72%, and 16.36% of the average muscle activities of the gastrocnemius, soleus, and tibialis anterior are observed, respectively. The significance of this study is the development of a portable passive AFO that has the potential to provide plantarflexion assistance and dorsiflexion assistance for the wearers during the late stance phase and swing phase, respectively.

Odontoid fractures in the pediatric population: a systematic review and management algorithm.

The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm. A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0-18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated. In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach. Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures.

The efficacy of the Novel Hybrid Passive Spring Damper Ankle Foot Orthosis regard to kinetic and kinematic parameters of patients with Multiple Sclerosis: An intervention study

ABSTRACT Drop foot is a common consequence of Multiple Sclerosis (MS), which may be improved somewhat by an ankle-foot orthosis (AFO). This study aimed to examine the immediate effect of using the recently developed Novel Hybrid Passive Spring Damper AFO (the novel HPSDAFO) on the kinetic and kinematic parameters of patients with MS (PwMS) in the sagittal plane. Twelve PwMS who suffered a unilateral drop foot participated in this study and fitted with the novel HPSDAFO. They walked with the novel HPSDAFO on the affected side and shoe on the affected side at a self-selected speed. Walking by the novel HPSDAFO, the symmetry of all of the evaluated sagittal kinetic and kinematic parameters improved noticeably. The range of ankle plantarflexion and knee flexion increased significantly at the stance phase. Power generation increased at all three joints. The peak of ankle dorsiflexion at early stances and the first peak of knee extension moments increased significantly but decreased at the hip joint. Changes in sagittal ROM, moment, and power generation in the plane and the improved symmetry revealed a more normal walking by using the novel HPSDAFO on the affected limb of PwMS.

Articulated ankle-foot orthoses associated with home-based task-specific training improve functional mobility in patients with stroke: a randomized clinical trial

ABSTRACT Introduction We compared fixed and articulated ankle-foot orthoses (AFOs) in home-based mobility tasks to assess short-term mobility, dynamic balance, quality of life, anxiety/depression, disability level, stroke severity, autonomy, human functioning, and patient satisfaction. Methods This was a two-arm, parallel-group, randomized controlled trial with concealed allocation, assessor blinding, and a complete case analysis involving patients with chronic stroke. The participants were randomized into two groups: fixed (n = 24) and articulated (n = 23) AFOs. The AFOs were custom-fabricated, and both groups performed four-week home-based mobility tasks five days weekly. Primary outcome measures included changes in balance and mobility assessed using the Tinetti Performance-Oriented Mobility Assessment (POMA), Timed Up and Go (TUG) test, and Functional Ambulation Category (FAC). Secondary outcomes included quality of life, anxiety/depression, disability, stroke severity, autonomy, human functioning, and patient satisfaction. Results In a between-group comparison, after adjusting for age, sex, stroke severity, and thrombolysis, the articulated AFO group showed better performance in the TUG test (p = 0.020; d = 0.93), POMA-Gait (p = 0.001; d = 0.53), POMA-Total (p = 0.048; d = 0.98), and FAC (p = 0.003; d = 1.03) than the fixed AFO group. Moreover, significant difference was noted in human functioning (moving around using equipment)between the groups (p = 0.047; d = 92). Conclusion A program involving home-based mobility tasks and articulated AFOs improved functional mobility after stroke.

Material Performance Evaluation for Customized Orthoses: Compression, Flexural, and Tensile Tests Combined with Finite Element Analysis.

Orthoses are commonly used for treating injuries to improve the quality of life of patients, with customized orthoses offering significant benefits. Additive manufacturing, especially fused deposition modelling, enhances these benefits by providing faster, more precise, and more comfortable orthoses. The present study evaluates nine polymeric materials printed in horizontal and vertical directions by assessing their performance through compressive, flexural, and tensile tests. Among all materials, polycarbonate, polylactic acid, and ULTEMTM 1010 showed the most promising results, not only because they had the highest mechanical values, but also due to their minimal or no difference in performance between printing directions, making them advantageous in orthoses fabrication. Based on this, a finite element model of an ankle-foot orthosis was developed to simulate the deformation, strain, and stress fields under static conditions. The findings aim to optimize material selection for orthotic fabrication, where ULTEMTM 1010 is presented as the material with improved performance and durability.

The experiences of podiatrists prescribing custom foot orthoses and patients using custom foot orthoses for foot pain management in the United Kingdom: A focus group study.

Foot pain can be a significant burden for patients. Custom foot orthoses (CFOs) have been a mainstay in podiatry treatment for foot pain management and improving foot function. However, little is known about podiatrists' experience of prescribing CFOs or patient experience of using foot orthoses (FOs), including CFOs, for foot pain. A focus group (FG) discussion with three FOs users (Female=2 and Male=1) was conducted in November 2022 within a private podiatry practice. This group represented non-experts from the general local population of individuals with existing or previous foot pain who have personally experienced using either over-the-counter FOs or CFOs. An online FG discussion with five musculoskeletal (MSK) specialist podiatrists (Female=2 and Male=3) was also conducted in December 2022. This group represented podiatrists with specialist knowledge in foot biomechanics and clinical experience in CFO provision. The FG discussions were recorded and lasted 49 and 57min respectively. Transcribed data was manually coded, and a thematic analysis was undertaken to identify patterns within the collected data. The participants in the patient FG detailed mixed experiences of the prescription process and CFOs received, with reports of limited involvement/input in their prescription, the need for frequent adjustments and high costs. The impact on footwear choices, replicability and transferability of CFOs into different types of shoes and technologies to aid design were also highlighted. In the podiatrist FG, lack of confidence in design and manufacture processes, prescription form language, relationship and communication building with manufacturers, variability in the CFOs issued and the need for better student education in CFO provision emerged as key themes. Patients and podiatrists shared similar views on CFO provision, namely poorcommunication with manufacturers leading to dissatisfaction with the CFOs prescribed causing negative impacts on patient experiences. Podiatrists called for greater education at registration level to increase new graduate podiatrist knowledge in CFO design and manufacture and better collaboration with manufacturing companies.

The effect of ankle-foot orthoses on gait characteristics in people with Charcot-Marie-Tooth disease: A systematic review and meta-analysis.

Ankle-foot orthoses (AFOs) are commonly prescribed for people with Charcot-Marie-Tooth disease (CMT) to improve gait efficiency and reduce the occurrence of tripping and falls. The aim of this study was to systematically review evidence on the effects of AFOs on gait kinematics and kinetics and postural stability/balance in people with CMT. Studies were identified from electronic databases and screened for inclusion online using Rayyan. Data from all eligible studies were extracted into a standardised Excel spreadsheet. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Where available, continuous outcomes were pooled to estimate standardised mean differences in random-effects meta-analyses. A total of 15 studies were included with variable methodological quality. Sample sizes ranged from 1 to 32 with significant variability in participant characteristics, AFO designs and testing procedures. Data from eight studies were available for meta-analysis. Although AFOs impacted walking velocity, stride length, step length, cadence, ankle dorsiflexion, plantarflexion, knee and hip flexion and ankle plantarflexion and dorsiflexion moments, the effect sizes were small-to-moderate and non-significant. There were insufficient data available for pooled analyses of outcomes related to postural stability/balance. Although AFOs positively affect a number of gait and balance parameters, the small participant numbers, variability in participant characteristics, AFO designs and testing procedures adopted by the available studies resulted in the absence of statistically significant effects when data were pooled. The results from this review also highlight the importance of device customisation based on the individual needs of people with CMT and their degree of gait impairment.

Comparison of accuracy and speed between plaster casting, high-cost and low-cost 3D scanners to capture foot, ankle and lower leg morphology of children requiring ankle-foot orthoses.

Traditional plaster-cast fabrication of an ankle-foot orthosis (AFO), although robust, is time-consuming and cumbersome. 3D scanning is quickly gaining attention as an alternative to plaster casting the foot and ankle region for AFO fabrication. The aim of this study was to assess the accuracy and speed of two high-performing 3D scanners compared with plaster casting in pediatric patients requiring an AFO. Ten participants (mean age 10.0±3.9years) prescribed AFOs for a movement disorder were 3D scanned with the high-cost Artec Eva (Eva) and low-cost Structure Sensor II (SSII) using one-person (1p) and two-person (2p) protocols. Accuracy and speed for both 3D scanners were compared with corresponding plaster cast measures (≤5% acceptable difference). Bland and Altman plots were generated to show mean bias and limits of agreement. Overall, Eva and SSII were accurate for foot, ankle, and lower leg key clinical landmarks (Eva-1p: 4.4±7.3%; Eva-2p: 3.2±7.5%; SSII-1p: 0.6±7.4%; SSII-2p: 0.7±8.2%). Bland and Altman plots for the SSII demonstrated lower biases for 1p (bias 0.5mm, LoA: -12.4-13.5mm) and 2p (0.4mm, LoA: -11.4-12.2mm) protocols compared with Eva for 1p (bias 2.3mm, LoA: -8.0-12.7mm) and 2p (1.8mm, LoA: -10.7-14.3mm) protocols. The SSII 2p protocol was the fastest 3D scanning method (26.4±11.1s). The high-cost Eva and low-cost SSII 3D scanners using the 1p and 2p protocols produced comparable accuracy and faster capture of key clinical landmarks compared with plaster cast measures for the fabrication of AFOs in pediatric patients.

Markerless capture of gait kinematics while walking with ankle-foot orthoses

Markerless capture of gait kinematics while walking with ankle-foot orthoses

Effects of Ankle-foot orthoses on gait in children with cerebral palsy investigated with a gait classification system

Effects of Ankle-foot orthoses on gait in children with cerebral palsy investigated with a gait classification system

Repeatability of gait of children with spastic cerebral palsy in different walking conditions

Three-dimensional gait analysis is the ‘gold standard’ for measurement and description of gait. Gait variability can arise from intrinsic and extrinsic factors and may vary between walking conditions. This study aimed to define the inter-trial and inter-session repeatability in gait analysis data of children with cerebral palsy (CP) who were walking in four conditions, namely barefoot or with ankle–foot orthosis (AFO), and overground or treadmill. Ten children with spastic CP (7♀; 9.9y ± 3.5y; GMFCS-level I-III) were included in this study. Overall, we found good to excellent intra-class correlation (ICC)-values and favourable standard error of measurement (SEM)-values for the inter-session Gait Profile Score (ICC = 0.85–0.98, SEM = 0.45–0.91°) and Gait Variable Scores (ICC = 0.85–0.99, SEM = 0.22–1.11°) for the lower-limb joints. Taking the total joint-range-of-motion into account, the knee joint showed the most repeatable motion (%SEM = 0.5–1.8 %), while ankle motions showed the lowest repeatability (%SEM = 0.8 %–3.0 %). For the continuous waveform data, only the ankle joint showed repeatability differences between walking conditions, namely, smaller SEM-values for the AFO-condition (mean inter-trial = 0.14°; mean inter-session = 1.121°) in comparison to the barefoot-condition (mean inter-trial = 0.55°; mean inter-session = 2.22°). For all the kinetic parameters, the treadmill conditions showed smaller SEM-values in comparison to the overground condition. In conclusion three-dimensional gait analysis was found to be reliable in all four walking conditions for children with CP. The resulting measurement errors can be used as a reference during clinical interpretations of gait analyses.Clinical trial registration number: Trial ID from an internationally recognized trial registry (ClinicalTrials.gov): NCT06355869

The impact of ankle-foot orthotics on selective motor control during gait in children and adolescents with cerebral palsy

BackgroundChildren with cerebral palsy (CP) often exhibit altered selective motor control during gait (SMCg). Ankle-foot-orthoses (AFOs) are used in this population to improve gait, by reducing the degrees of freedom at the ankle joint. However, the specific impact of AFOs on SMCg and whether this effect is more related to gait deviations or motor development remains unclear. Research questionDo AFOs impact SMCg, and is the change related to joint kinematics or age? MethodsGait analysis data from 53 children and adolescents with spastic CP, walking both barefoot and with AFOs, were included. Electromyography data from six lower-limb muscles, and lower limb joint kinematics were analyzed for both walking conditions. SMCg was quantified by the total variance in electromyography activity accounted for by one synergy (tVAF1), where an increase in tVAF1 indicates a decrease in SMCg. Kinematic gait deviation was assessed using the Gait-Profile-Score (GPS) and sagittal plane ankle Gait-Variable-Score (ankle-GVS). All analyses were performed for the more clinically involved leg only. ResultsWalking with AFOs resulted in a mean increase in tVAF1 of 0.02±0.07 (p=0.015) and a median increase in ankle-GVS of 3.4º (p>0.001). No significant changes were observed in GPS, and no correlation was found between the changes in tVAF1 and ankle-GVS. A significant positive moderate correlation was found between the change in tVAF1 and age, even with ankle-GVS as a covariate (r=0.45; p>0.001). SignificanceWalking with an AFO resulted in a small decrease in SMCg, with large inter-participant variability. Younger participants showed a greater decrease in SMCg, which may indicate greater neuromuscular plasticity in early developmental stages.