Changes in Joint Kinematics in Children With Cerebral Palsy While Walking With and Without a Floor Reaction Ankle–foot Orthosis

Abstract

INTRODUCTION: The floor reaction ankle-foot orthosis is commonly prescribed in the attempt to decrease knee flexion during the stance phase in the cerebral palsy (CP) gait. Reported information about this type of orthosis is insufficient. PURPOSE: The purpose of this study was to determine the effect of clinically prescribed floor reaction ankle-foot orthosis on kinematic parameters of the hip, knee and ankle in the stance phase of the gait cycle, compared to barefoot walking on children with cerebral palsy. METHODS: A retrospective chart review of 2200 patients revealed that 71 patients (142 limbs) had a diagnosis of diplegia, with no contractures in hip, knee or ankle flexion. Their average age was 12.2 ± 3.9. All of them were wearing clinically prescribed hinged floor reaction ankle-foot orthosis undergoing a three dimensional gait analysis. We divided the patients in three groups: Group I, with limited extension (maximum knee extension less than 15°); Group II, with moderate limited extension (maximum knee extension between 15° and 30°) and Group III Crouch (maximum knee extension in stance more than 30°). RESULTS: Results indicate the parameters maximum knee extension and ankle dorsiflexion were significant in Group II e III; no change was observed in Group I. The maximum hip extension was not significant in all three groups. Conclusion: when indicated to improve the extension of the knees and ankle in the stance of the CP patients floor reaction ankle-foot orthosis was effective.

A Systematic Review to Determine Best Practice Reporting Guidelines for AFO Interventions in Studies Involving Children with Cerebral Palsy

“…31,32,35 Several other studies ensured homogeneity by describing knee and ankle posture either with 29,36,37,39 or without 38 reference to published gait classification systems. …”

The effect of floor reaction ankle foot orthosis on postural control in children with spastic cerebral palsy

“…This position refers to increased knee and hip flexion and ankle dorsiflexion 8 and is due to insufficient plantar flexion/knee extension. [8][9][10] The crouch position may result in decreased postural control and increased muscle weakness in children with CP. 4,11 Various interventions, such as orthotic management, surgery and physical training, are employed to overcome the crouch position in these children.…”

Effect of Kinesiologic Taping of Feet and Ankles on Static and Dynamic Balance in Children with Cerebral Palsy

“…With the purpose of treating these balance problems seen among children with CP and treating gait disorders, which are also commonly seen problems, various treatment modalities are used in rehabilitations [30,31]. Among these treatments, kinesio taping has begun to find more approval in the field of paediatric rehabilitation in the recent years [16,32,33].…”