scholarly journals Comparison of gait with and without ankle-foot orthoses after lower limb surgery in children with unilateral cerebral palsy

2019 ◽  
Vol 13 (2) ◽  
pp. 180-189 ◽  
Author(s):  
I. Skaaret ◽  
H. Steen ◽  
A. B. Huse ◽  
I. Holm
Keyword(s):  
Cerebral Palsy ◽  
Lower Limb ◽  
Fixed Effects ◽  
Initial Contact ◽  
Foot Orthoses ◽  
Level Of Evidence ◽  
Ankle Foot Orthoses ◽  
Lower Limb Surgery ◽  
Unilateral Cerebral Palsy ◽  
One Year

Purpose Children with spastic unilateral cerebral palsy (SUCP) frequently undergo lower limb surgery to improve gait. Postoperatively, ankle-foot orthoses (AFOs) are used to maintain the surgical corrections and provide adequate mechanical support. Our aim was to evaluate changes in gait and impacts of AFOs one-year postoperatively Methods In all, 33 children with SUCP, 17 girls and 16 boys, mean age 9.2 years (5 to 16.5) were measured by 3D gait analysis walking barefoot preoperatively and walking barefoot and with AFOs one-year postoperatively. Changes in Gait Profile Scores (GPS), kinematic, kinetic and temporal spatial variables were examined using linear mixed models, with gender, gross motor function and AFO type as fixed effects. Results The results confirm significant gait improvements in the GPS, kinematics and kinetics walking barefoot one year after surgery. Comparing AFOs with barefoot walking postoperatively, there was additionally reduced ankle plantarflexion by an average of 5.1° and knee flexion by 4.7° at initial contact, enhanced ankle moments during loading response, increased velocity, longer steps and inhibited push-off power generation. Stance and swing phase dorsiflexion increased in children walking with hinged AFOs versus children walking with ground reaction AFOs. Changes in the non-affected limbs indicated less compensatory gait postoperatively. Conclusion Major changes were found between pre- and postoperative barefoot conditions. The main impact of AFOs was correction of residual drop foot and improved prepositioning for initial contact, which could be considered as indications for continued use after the one-year follow-up. Level of Evidence Level II - Therapeutic

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

2018 ◽  
Vol 43 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Ingrid Skaaret ◽  
Harald Steen ◽  
Terje Terjesen ◽  
Inger Holm
Keyword(s):  
Cerebral Palsy ◽  
Gait Analysis ◽  
Lower Limb ◽  
Three Dimensional ◽  
Foot Orthoses ◽  
Important Improvement ◽  
Gait Dysfunction ◽  
Ankle Foot Orthoses ◽  
Profile Score ◽  
Lower Limb Surgery

Background: Different types of ankle-foot orthoses are commonly used following lower limb surgery in children with bilateral spastic cerebral palsy. After three-dimensional gait analysis 1 year postoperatively, many children are recommended continued use of ankle-foot orthoses. Objectives: Our aims were to quantify the impact of ankle-foot orthoses on gait 1 year postoperatively and evaluate predictors for clinically important improvement. Study design: Prospective cohort study. Methods: A total of 34 ambulating children with bilateral cerebral palsy, with mean age 11 years (range 6–17), comprising 12 girls and 22 boys, were measured with three-dimensional gait analysis preoperatively (barefoot) and 1 year postoperatively (barefoot and with ankle-foot orthoses). Outcome was evaluated using gait profile score, key kinematic, kinetic and temporal–spatial variables in paired sample comparisons. Logistic regression was used to evaluate predictors for clinically important improvement with orthoses (⩾1.6° change in gait profile score). Results: Walking barefoot 1 year postoperatively, major improvements were seen in gait profile score and key variables. With ankle-foot orthoses, there were significantly improved step length and velocity, additional moderate reduction/improvement in gait profile score and knee moments and decreased stance ankle dorsiflexion compared to barefoot. Children using ground reaction ankle-foot orthoses ( n = 14) decreased stance knee flexion from 13.9° walking barefoot to 8.2° with orthoses. High gait profile score and more gait dysfunction preoperatively were significant predictors of clinically important improvement walking with orthoses. Conclusion: The results indicate improved gait function walking with ankle-foot orthoses versus barefoot 1 year after lower limb surgery. Stronger impact of ankle-foot orthoses was found in children with more pronounced gait dysfunction preoperatively. Clinical relevance The 1-year postoperative three-dimensional gait analysis is a useful method to assess treatment outcome after lower limb surgery in children with bilateral cerebral palsy and could also guide clinicians whether further treatment with ankle-foot orthoses is indicated, using clinically important differences as thresholds to evaluate their impact on gait.

Effect of ankle-foot orthoses on trunk sway and lower limb intersegmental coordination in children with bilateral cerebral palsy

2012 ◽  
Vol 5 (3) ◽  
pp. 171-179 ◽  
Author(s):  
Marc Degelean ◽  
Ludo De Borre ◽  
Patrick Salvia ◽  
Karine Pelc ◽  
Eric Kerckhofs ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Lower Limb ◽  
Foot Orthoses ◽  
Intersegmental Coordination ◽  
Ankle Foot Orthoses ◽  
Trunk Sway

The impact of ankle-foot orthoses one year post orthopaedic surgery in children with cerebral palsy

2013 ◽  
Vol 38 ◽  
pp. S19-S20
Author(s):  
Ingrid Skaaret ◽  
Merete Aa Fosdahl ◽  
Bjorn Lofterod ◽  
Inger Holm
Keyword(s):  
Cerebral Palsy ◽  
Orthopaedic Surgery ◽  
Foot Orthoses ◽  
Ankle Foot Orthoses ◽  
Children With Cerebral Palsy ◽  
One Year ◽  
The Impact

Ankle-foot orthoses: effect on gait in children with cerebral palsy

2002 ◽  
Vol 24 (7) ◽  
pp. 345-347 ◽  
Author(s):  
Erbil Dursun ◽  
Nigar Dursun ◽  
Duygu Alican
Keyword(s):  
Cerebral Palsy ◽  
Foot Orthoses ◽  
Ankle Foot Orthoses ◽  
Children With Cerebral Palsy

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

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 903
Author(s):  
Diogo Ricardo ◽  
Maria Raposo ◽  
Eduardo Cruz ◽  
Raul Oliveira ◽  
Filomena Carnide ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Scientific Data ◽  
Cochrane Library ◽  
Leaf Spring ◽  
Foot Orthoses ◽  
Gait Patterns ◽  
Functional Scores ◽  
Ankle Foot Orthoses ◽  
Pathological Gait ◽  
The Impact

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

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tobias Goihl ◽  
Espen Alexander F. Ihlen ◽  
Ellen Marie Bardal ◽  
Karin Roeleveld ◽  
Astrid Ustad ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Children And Adolescents ◽  
Energy Cost ◽  
Foot Orthoses ◽  
Ankle Foot Orthoses ◽  
Energy Cost Of Walking

scholarly journals Studies Examining the Efficacy of Ankle Foot Orthoses should Report Activity Level and Mechanical Evidence

2010 ◽  
Vol 34 (3) ◽  
pp. 327-335 ◽  
Author(s):  
Jaap Harlaar ◽  
Merel Brehm ◽  
Jules G. Becher ◽  
Daan J. J. Bregman ◽  
Jaap Buurke ◽  
...  
Keyword(s):  
Treatment Algorithm ◽  
Relevant Information ◽  
Current Treatment ◽  
Activity Level ◽  
Walking Ability ◽  
Foot Orthoses ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Ankle Foot Orthoses

Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.

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