Ground reaction and solid ankle-foot orthoses are equivalent for the correction of crouch gait in children with cerebral palsy.

To investigate any performance differences between the solid ankle-foot orthosis (SAFO) and ground reaction ankle-foot orthosis (GRAFO) designs for correcting crouch gait in children diagnosed with cerebral palsy (CP). We retrospectively analyzed 147 individuals seen at our center who: (1) were diagnosed with diplegic CP, (2) walked with crouch gait, (3) had bilateral SAFO or GRAFO prescription, and (4) had three-dimensional gait analysis collected for both barefoot and orthosis walking conditions. Overall, no performance gap was identified between the SAFO and GRAFO groups (p=0.828). A series of bootstrapped stepwise regression analyses indicated that ankle-foot orthosis (AFO) design was not predictive of crouch gait improvements. Improvements in crouch gait were instead shown to be predicted by AFO neutral angle and four patient factors: amount of dorsiflexion in stance, level of knee flexion contracture, age, and severity of crouch. Our results show that the SAFO and GRAFO designs are equally effective at correcting crouch gait for individuals diagnosed with CP. No performance difference was detected between solid ankle-foot orthoses and ground reaction ankle-foot orthoses designs for crouch gait correction. Crouch gait improvement from ankle-foot orthoses (AFO) is influenced by AFO neutral angle. Other factors of influence include: dorsiflexion in stance, level of knee flexion contracture, age, and severity of crouch.

Ries AJ ，Schwartz MH 《-》

Effect of floor reaction ankle-foot orthosis on crouch gait in patients with cerebral palsy: What can be expected?

Böhm H ，Matthias H ，Braatz F ，Döderlein L ... -  《-》

The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy.

Rogozinski BM ，Davids JR ，Davis RB 3rd ，Jameson GG ，Blackhurst DW ... -  《-》

Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy.

Skaaret I ，Steen H ，Terjesen T ，Holm I ... -  《-》

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 《-》