The Efficacy of Ankle-Foot Orthoses on Improving the Gait of Children With Diplegic Cerebral Palsy: A Multiple Outcome Analysis.

Ankle-foot orthosis (AFO) prescriptions are common for patients diagnosed with cerebral palsy (CP). Typical treatment objectives are to improve ankle-foot function and enhance general gait quality. To determine the effectiveness of AFOs for improving the gait of children with diplegic CP. Retrospective analysis. Primary clinical care facility. Data were used from 601 visits for 378 individuals (age at visit: 9.8 ± 3.8 years [mean ± standard deviation]) who wore either a solid, hinged, or posterior leaf spring AFO design. Participants had a diagnosis of diplegic CP, wore the same AFO design bilaterally, and had 3-dimensional gait analysis data collected while walking both barefoot and with AFOs during a single session. Differences between walking with AFOs and walking barefoot were used as outcome measures. Statistical analysis consisted of paired t-tests and multivariate analysis of variance scores to determine significance, main effects, and interactions of AFO design, ambulation type (walking with/without assistive devices), and barefoot level on each outcome. Minimal clinically important differences from the literature determined clinical significance. Gait Deviation Index (GDI), ankle Gait Variable Score, knee Gait Variable Score, nondimensional speed, and nondimensional step length. Only step length exhibited clinically meaningful improvements for the average AFO user. Changes in step length, speed, and GDI all were statistically significant (P < .001). Barefoot outcome levels were the most consistent influence on outcome changes. AFO design was shown to effect changes in speed and ankle function, whereas ambulation type was shown to affect GDI change. Current AFO prescription methodologies for children with CP result in consistent gait improvements for step length only. This study emphasizes the need to develop more effective AFO prescription algorithms in an effort to improve the efficacy of AFOs on general gait quality via optimizing patient selection or AFO design.

Ries AJ ，Novacheck TF ，Schwartz MH 《-》

Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review.

Ankle foot orthoses (AFOs) are orthotic devices that can be used to normalize the walking pattern of children with cerebral palsy (CP). One of the aims of orthotic management is to produce a more normal gait pattern by positioning joints in the proper position to reduce pathological reflex or spasticity. To conduct a systematic review of the literature and establish the effect of treatment with various types of AFOs on gait patterns of children with CP. PubMed, Scopus, ISI Web of knowledge, Cochrane Library, EMBASE and Google Scholar were searched for articles published between 2007 and 2015 of studies of children with CP wearing the following AFOs: hinged (HAFO), solid (SAFO), floor reaction (FRO), posterior leaf spring (PLS) and dynamic (DAFO). Studies that combined treatment options were excluded. Outcomes investigated were a change in gait pattern and subsequent walking ability. The PEDro scale used to assess the methodological quality of relevant studies. We included 17 studies investigating a total of 1139 children with CP. The PEDro score was poor for most studies (3/10). Only 4 studies, of 209 children in total, were randomized controlled trials, for a good PEDro score (5, 7, 9/10) and an appropriate level of evidence. One study used a case-based series and the remainder a cross-sectional design. In general, the use of AFOs improved speed and stride length. The HAFO was effective for improving gait parameters and decreasing energy expenditure with hemiplegic CP as compared with the barefoot condition. It also improved stride length, speed of walking, single limb support and gait symmetry with hemiplegic CP. The plastic SAFO and FRO were effective in reducing energy expenditure with diplegic CP. With diplegic CP, the HAFO and SAFO improved gross motor function. For children with CP, use of specific types of AFOs improved gait parameters, including ankle and knee range of motion, walking speed and stride length. AFOs reduced energy expenditure in children with spastic CP. However, further studies with good PEDro scores are required for more conclusive evidence regarding the effectiveness of AFOs in children with CP.

Aboutorabi A ，Arazpour M ，Ahmadi Bani M ，Saeedi H ，Head JS ... -  《-》

Long-Term Effects of Orthoses Use on the Changes of Foot and Ankle Joint Motions of Children With Spastic Cerebral Palsy.

Orthoses commonly are prescribed to children with cerebral palsy (CP) to provide foot correction and to improve ambulatory function. Immediate effects of ankle foot orthosis (AFOs) have been investigated, but long-term kinematic effects are lacking clinical evidence. To determine changes in 3-dimensional ankle and foot segment motion in pediatric patients with CP between initial and follow-up visits (18-month average time differences) in both barefoot gait and gait with their AFO. We also investigated intravisit changes between barefoot and AFO gait. A prospective cohort study. Children's Hospital of Wisconsin, Department of Orthopaedic Surgery, Medical College of Wisconsin. A total of 23 children with CP, mean age 10.5 years (6.2-18.1 years) were clinically prescribed either a solid ankle foot orthotic (SAFO), hinged ankle foot orthotic (HAFO), or supramalleolar orthotic. Holes were cut in the study orthoses so that electromagnetic markers could be directly placed on the skin. A 6-foot segment model was used. Kinematic and kinetic data were recorded for each patient's initial and follow-up visit (18-month follow-up average, 15-20 months range). For the SAFO group (gait with AFO), a significant decrease in dorsiflexion was found between the initial and third visit (P = .008). Furthermore, the SAFO group (barefoot gait) had an increased eversion at the midfoot for most of the gait cycle (P < .008). Sagittal forefoot range of motion was reduced for all 3 groups between the barefoot and AFO groups. The use of AFOs long term either maintained or improved foot deformities or dysfunction. Level II.

Liu XC ，Embrey D ，Tassone C ，Zvara K ，Brandsma B ，Lyon R ，Goodfriend K ，Tarima S ，Thometz J ... -  《-》

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.

Dobler F ，Mayr R ，Lengnick H ，Federolf P ，Alexander N ... -  《-》

A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy.

Radtka SA ，Skinner SR ，Johanson ME 《GAIT & POSTURE》