Using the Edinburgh Visual Gait Score to Compare Ankle-Foot Orthoses, Sensorimotor Orthoses and Barefoot Gait Pattern in Children with Cerebral Palsy

Gait analysis is one aspect of evaluation in ambulatory children with cerebral palsy (CP). Ankle-foot orthoses (AFOs) improve gait and alignment through providing support. An alternative and under-researched orthosis are sensomotoric orthoses (SMotOs). The Edinburgh Visual Gait Score (EVGS) is a valid observational gait analysis scale to measure gait quality. The aim of this study was to use the EVGS to determine what effect AFOs and SMotOs have on gait in children with CP. The inclusion criteria were: mobilizing children with a CP diagnosis, no surgery in the past six weeks, and currently using SMotOs and AFOs. Eleven participants were videoed walking 5 m (any order) barefoot, in SMotOs and AFOs. Of the participants (age range 3–13 years, mean 5.5 ± 2.9), two were female and six used assistive devices. Seven could walk barefoot. Participants had spastic diplegia (4), spastic quadriplegia (6), and spastic dystonic quadriplegia (1). Gross Motor Functional Classification System (GMFCS) levels ranged I–IV. The total score for SMotOs (7.62) and AFOs (14.18) demonstrated improved gait when wearing SMotOs (no significant differences between barefoot and AFOs). SMotOs may be a viable option to improve gait in this population. Additional study is required but SMotOs may be useful in clinical settings.

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Using the Edinburgh Visual Gait Score to Compare Ankle-Foot Orthoses, Sensorimotor Orthoses and Barefoot on Gait Pattern in Children with Cerebral Palsy: A Cross-Sectional Cohort Study

10.21203/rs.2.10645/v1 ◽

2019 ◽

Author(s):

Clare MacFarlane ◽

Wayne Hing ◽

Rob Orr

Keyword(s):

Cerebral Palsy ◽

Cohort Study ◽

Gait Pattern ◽

Foot Orthoses ◽

Cross Sectional ◽

Gait Quality ◽

Ankle Foot Orthoses ◽

Children With Cerebral Palsy ◽

Gait Score ◽

One Way Anova

Abstract Background: Gait analysis is one of the important aspects of evaluation in ambulatory children with cerebral palsy (CP). Typically prescribed for children with CP, ankle-foot orthoses (AFOs) improve gait and alignment through providing support and stability to the ankle complex. An alternative and under-researched orthosis being used in this population is the Sensomotoric orthotic (SMotO), which uses a different approach to correct alignment and improve gait. The Edinburgh Visual Gait Score (EVGS) is a valid, robust, reliable and easy-to-use observational gait analysis scale to measure of gait quality in CP. Improvements to gait could then be attributed to intervention, or regression of gait could be attributed to poor intervention or physical changes. Therefore, the aim of this study was to use the EVGS to determine the effect of SMotOs, AFOs and barefoot on gait pattern in children with CP. Methods: This cross-sectional cohort study investigated the differences in gait quality in children with CP between wearing SMotOs and AFOs through using the EVGS. Video imagery was taken when walking barefoot (where appropriate), in SMotOs and in AFOs for at least 5m at a self-directed pace. Individual scores and averages across the population were recorded. Data was analysed through SPSS statistics software (Version 20) and the Microsoft Office Excel 2007. A one-way ANOVA and post hoc Bonferroni were completed to identify significant differences with the alpha level set at p<.05. Results: One-way ANOVA analyses revealed significant differences between total left (p=0.011) and right (p=0.014) scores between SMotO and AFOs. Overall, results demonstrate improved gait in favour of SMotO vs AFO and that there are no significant differences between being barefoot and wearing AFOs. Conclusions: SMotOs are a viable orthotic option to improve gait in children with CP, but due to small yield of participants, a larger scale, blinded study should be performed to further determine results.

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Improved motor function in a pre-ambulatory child with spastic bilateral cerebral palsy, using a custom rigid ankle-foot orthosis–footwear combination: A case report

Prosthetics and Orthotics International ◽

10.1177/0309364619852239 ◽

2019 ◽

Vol 43 (4) ◽

pp. 453-458 ◽

Cited By ~ 1

Author(s):

Joshua Young ◽

Sally Jackson

Keyword(s):

Cerebral Palsy ◽

Case Report ◽

Gait Speed ◽

Foot Orthoses ◽

Ankle Foot Orthosis ◽

Ankle Foot Orthoses ◽

Children With Cerebral Palsy ◽

Gait Score ◽

The Subject ◽

Foot Orthosis

Background: Ankle-foot orthoses may be used in pre-ambulatory children with cerebral palsy; however, their effect on the acquisition of walking is unknown. This case report aims to evaluate the effect of an ankle-foot orthosis–footwear combination on the acquisition of walking in a single subject with cerebral palsy. Case Description and Methods: This study reports the orthotic management of a single child with spastic bilateral cerebral palsy over a 15-month period, during which time the ability to independently stand and walk was acquired. Custom rigid ankle-foot orthoses were prescribed. Gait speed and Edinburgh Visual Gait Score were assessed with and without the orthoses. Findings and Outcomes: The subject developed the ability to stand and walk using an ankle-foot orthosis–footwear combination with a walker frame, and to a limited extent without a walker frame. The subject remained unable to take independent steps unless wearing the ankle-foot orthosis–footwear combination. Clinically significant differences in gait speed and Edinburgh Visual Gait Score were observed. Conclusion: An ankle-foot orthosis–footwear combination may aid the development of independent walking in some children with cerebral palsy. Further research on the effects of orthoses on the acquisition of walking ability in children with cerebral palsy is needed. Clinical relevance Custom rigid ankle-foot orthoses combined with footwear may aid the development of independent standing and walking in some children with bilateral spastic cerebral palsy. This intervention may be considered in clinical practice and future research in this patient group.

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Sensomotoric Orthoses, Ankle–Foot Orthoses, and Children with Cerebral Palsy: The Bigger Picture

Children ◽

10.3390/children7080082 ◽

2020 ◽

Vol 7 (8) ◽

pp. 82

Author(s):

Clare MacFarlane ◽

Robin Orr ◽

Wayne Hing

Keyword(s):

Quality Of Life ◽

Cerebral Palsy ◽

Well Being ◽

Foot Orthoses ◽

Timed Up And Go ◽

Gross Motor ◽

Ankle Foot Orthoses ◽

Children With Cerebral Palsy ◽

Gait Score

Ankle–foot orthoses (AFOs) and sensomotoric orthoses (SMotOs) are two—clinically relevant, yet under researched—types of lower limb orthoses used in children with cerebral palsy (CP). Quality of life is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Evaluating the effect of these two types of orthoses on quality of life in children with CP has not been reported on. The aim of this case study series was to synthesise and enrich the volume of evidence reported to inform real world applications of SMotO use in children with CP. Participants recruited were children with CP who performed the Berg Balance Scale, Timed Up-and-Go, the Gross Motor Function Measure and/or the Edinburgh Visual Gait Score in AFOs, SMotOs and barefoot where able. Qualitative data included videos of gait, a questionnaire and pedographs. Eight participants completed 39 quantitative and six qualitative measures, with the Edinburgh Visual Gait Score (EVGS) reporting the highest response. A general improvement was seen in gross motor skills and gait when wearing the SMotOs compared to AFOs and some parents reported that SMotOs were preferred. The reader is able to correlate the quantitative results with the qualitative evidence presented.

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

Disability and Rehabilitation ◽

10.1080/0963820110090724 ◽

2002 ◽

Vol 24 (7) ◽

pp. 345-347 ◽

Cited By ~ 35

Author(s):

Erbil Dursun ◽

Nigar Dursun ◽

Duygu Alican

Keyword(s):

Cerebral Palsy ◽

Foot Orthoses ◽

Ankle Foot Orthoses ◽

Children With Cerebral Palsy

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Prefabricated ankle-foot orthoses for children with cerebral palsy to overcome spastic drop-foot

Prosthetics and Orthotics International ◽

10.1097/pxr.0000000000000050 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Harald Böhm ◽

Chakravarthy U. Dussa

Keyword(s):

Cerebral Palsy ◽

Foot Orthoses ◽

Drop Foot ◽

Ankle Foot Orthoses ◽

Children With Cerebral Palsy

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

Prosthetics and Orthotics International ◽

10.1177/0309364618791615 ◽

2018 ◽

Vol 43 (1) ◽

pp. 12-20 ◽

Cited By ~ 1

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.

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