Effects of Hinged versus Floor-Reaction Ankle-Foot Orthoses on Standing Stability and Sit-to-Stand Performance in Children with Spastic Diplegic Cerebral Palsy

Hinged ankle-foot orthoses (HAFOs) and floor reaction ankle-foot orthoses (FRAFOs) are frequently prescribed to improve gait performance in children with spastic diplegic cerebral palsy (CP). No study has investigated the effects of FRAFO on sit-to-stand (STS) performance nor scrutinized differences between the application of HAFOs and FRAFOs on postural control. This study compared the effects of HAFOs and FRAFOs on standing stability and STS performance in children with spastic diplegic CP. Nine children with spastic diplegic CP participated in this crossover repeated-measures design research. Kinematic and kinetic data were collected during static standing and STS performance using 3-D motion analysis and force plates. Wilcoxon signed ranks test was used to compare the differences in standing stability and STS performance between wearing HAFOs and FRAFOs. The results showed that during static standing, all center of pressure (COP) parameters (maximal anteroposterior/mediolateral displacement, maximal velocity, and sway area) were not significantly different between FRAFOs and HAFOs. During STS, the floor reaction force in the vertical direction was significantly higher with FRAFOs than with HAFOs (p = 0.018). There were no significant differences in the range of motion in the trunk, knee, and ankle, the maximal velocity of COP forward displacement, completion time, and the force of hip, knee, and ankle joints between the two orthoses. The results suggest both FRAFOs and HAFOs have a similar effect on standing stability, while FRAFOs may benefit STS performance more compared to HAFOs.

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The effect of hinged ankle-foot orthoses on sit-to-stand transfer in children with spastic cerebral palsy

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2004.05.008 ◽

2004 ◽

Vol 85 (12) ◽

pp. 2053-2057 ◽

Cited By ~ 25

Author(s):

Eun Sook Park ◽

Chang Il Park ◽

Hyun Jung Chang ◽

Jong Eun Choi ◽

Don Shin Lee

Keyword(s):

Cerebral Palsy ◽

Spastic Cerebral Palsy ◽

Foot Orthoses ◽

Sit To Stand ◽

Ankle Foot Orthoses

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The role of rigid and hinged polypropylene ankle-foot-orthoses in the management of cerebral palsy: a case study

Prosthetics and Orthotics International ◽

10.3109/03093648809079396 ◽

1988 ◽

Vol 12 (3) ◽

pp. 129-135 ◽

Cited By ~ 39

Author(s):

E. A. Middleton ◽

G. R. B. Hurley ◽

J. S. McIlwain

Keyword(s):

Cerebral Palsy ◽

Reaction Force ◽

Force Plate ◽

Spastic Cerebral Palsy ◽

Foot Orthoses ◽

Ankle Motion ◽

Ankle Foot Orthosis ◽

Ankle Foot Orthoses ◽

The Subject ◽

Foot Orthosis

Ankle-foot orthoses are commonly used in the treatment of spastic cerebral palsy to hold the foot in a position conducive to a more functional gait. This study, utilizing quantitative biomechanical techniques, evaluates the effects of a rigid ankle-foot orthosis and a hinged ankle-foot orthosis on spastic cerebral palsy gait. The subject was a 4.5 year old female diagnosed as spastic diplegic cerebral palsied shortly after birth. Testing involved collection of kinematic coordinate data employing a WATSMART video system and ground reaction force' data using a Kistler force plate. Jensen's (1978) photogrammetric method was used to estimate body segment inertial parameters. The hinged ankle-foot orthosis was found to be more effective than the rigid ankle-foot orthosis. The subject exhibited a more natural ankle motion during the stance phase of gait, greater symmetry of segmental lower extremity motion, and decreased knee moments during stance while wearing a hinged ankle-foot orthosis.

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Influence of modified solid ankle-foot orthosis to be used with and without shoe on dynamic balance and gait characteristic in asymptomatic people

Prosthetics and Orthotics International ◽

10.1177/0309364612454159 ◽

2012 ◽

Vol 37 (2) ◽

pp. 145-151

Author(s):

Mina Arvin ◽

Mojtaba Kamyab ◽

Vahideh Moradi ◽

Behnam Hajiaghaei ◽

Nader Maroufi

Keyword(s):

Reaction Force ◽

Center Of Gravity ◽

Neutral Position ◽

Foot Orthoses ◽

Balance Performance ◽

Ankle Foot Orthosis ◽

Sit To Stand ◽

Gait Characteristic ◽

Ankle Foot Orthoses ◽

Foot Orthosis

Background: Ankle-foot orthoses are usually used in combination with footwear. Shoe design can have a significant effect on kinematics of the lower limb joints and line of action of the ground reaction force during walking. But, ankle-foot orthosis–footwear combination is not appropriate for indoor barefoot walking in some Asian cultures. In this study, we have modified a solid ankle-foot orthosis in order to set it in the same position as a solid ankle-foot orthosis–footwear combination. Objective: To investigate the effect of a modified solid ankle-foot orthosis; a solid ankle-foot orthosis which can be locked in different positions on gait and balance performance in comparison with a conventional solid ankle-foot orthosis, a common solid ankle-foot orthosis–shoe combination in asymptomatic adults. Study Design: Cross sectional. Methods: Two standard solid ankle-foot orthoses were manufactured with the ankle joint in neutral position. Then, one of these solid ankle-foot orthoses was modified in order to allow locking in a different alignment. Walk across, limit of stability, and sit-to-stand tests of the balance master system were performed while participants wore the modified solid ankle-foot orthosis aligned in 5°–7° anterior inclination without a shoe and a conventional solid ankle-foot orthosis–shoe combination. Results: There was no significant change in walking speed, step length, and step width with the conventional and modified solid ankle-foot orthoses. In addition, movement velocity and maximum excursion of the center of gravity during the limit of stability test were not different, although the maximal forward excursion of the center of gravity was longer when wearing the modified solid ankle-foot orthosis compared to the conventional solid ankle-foot orthosis–shoe combination ( P = 0.000). Sway velocity of the center of gravity did not change during the sit-to-stand test. Conclusion: The results demonstrated that the modified solid ankle-foot orthosis had the same effects as the conventional solid ankle-foot orthosis–shoe combination on the gait and balance performance of asymptomatic adults. Clinical relevance The findings of the present study can be used as the basis for further investigations on the efficacy of the modified solid ankle-foot orthoses in different neuromuscular populations in order to help people who do not wear shoes at home, as is the custom in some Asian cultures.

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

Children ◽

10.3390/children8100903 ◽

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.

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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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