Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking

Abstract

In children with cerebral palsy (CP), rigid ventral shell ankle-foot orthoses (vAFOs) are often prescribed to reduce excessive knee flexion in stance and lower the energy cost of walking (ECW). However, how vAFOs affect ECW is a complex issue, as vAFOs may have an impact on lower limb biomechanics, upper body movements, and balance. Besides, the vAFO's biomechanical effect have been shown to be dependent on its stiffness around the ankle joint. We examined whether vAFO stiffness influences trunk movements and gait stability in CP, and whether there is a relationship between these factors and ECW. Fifteen children with spastic CP were prescribed vAFOs. Stiffness was varied into a rigid, stiff and flexible configuration. At baseline (shoes-only) and for each vAFO stiffness configuration, 3D-gait analyses and ECW-tests were performed. From the gait analyses, we derived trunk tilt, lateroflexion, and rotation range of motion (RoM) and the mediolateral and anteroposterior Margins of Stability (MoS) and their variability as measures of gait stability. With the ECW-test we determined the netEC. We found that wearing vAFOs significantly increased trunk lateroflexion (Wald c2 ¼ 33.7, p < 0.001), rotation RoM (Wald c2 ¼ 20.5, p < 0.001) and mediolateral gait instability (Wald c2 ¼ 10.4, p ¼ 0.016). The extent of these effects partly depended on the stiffness of the vAFO. Significant relations between trunk movements, gait stability and ECW were found r ¼ 0.57e0.81, p < 0.05), which indicates that trunk movements and gait stability should be taken into account when prescribing vAFOs to improve gait in children with CP walking with excessive knee flexion.

Individual stiffness optimization of dorsal leaf spring ankle–foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations

“…In unilateral affected patients, increased ankle power related with energy cost reduction and increased speed, which may be more favored by patients than reductions in hip compensations. However, in bilateral affected subjects, such relation was absent and improvements in energy cost and speed are potentially likely due to positive effects on other factors less directly affected by AFO stiffness, such as trunk rotations, stability and knee flexion angles and moments during stance [ 22 ]. It needs to be assessed if indeed these measures are affected to a larger extent in bilateral affected patients in order to better understand how AFO stiffness affects energy cost in these subjects.…”

The Interzonal Distribution of the Load on the Plantar Surface of the Foot During Walking in the Patients with Cerebral Palsy as an Objective Criterion of Functional Impairment Severity

“…Основным направлением реабилитации при ДЦП являются, как минимум, сохранение, а жела-тельно -повышение имеющегося уровня функциональных возможностей ребенка. Почти за двухсотлетнюю историю изучения ДЦП разработан значительный арсенал методов лечения: медикаментозных, включая ботулинотерапию, хирургических, технических, реабилитационных [1,13,14,15].…”

The Effects of Combining High-Top Shoes with Twister Wrap Orthoses on Balance Parameters of Children with Spastic Diplegic Cerebral Palsy

“…Occupational therapy, physical therapy, and orthoses are the most common non-surgical treatments for children with mild to moderate deformities [9]. High-top shoes and ankle-foot orthosis are frequently prescribed to enhance ankle joint stability in CP patients [10,11]. Using twister cables or twister wrap orthosis (TWO) attached to waistbands proximally and the feet distally [12] aims to control the abnormal femoral/tibial rotations with in-toeing in children with spastic diplegic CP [13,14].…”