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

Abstract

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

Three-Dimensional Gait Analysis in Children Undergoing Gastrocsoleus Lengthening for Equinus Secondary to Cerebral Palsy

“…Eleven studies [ 9 , 11 , 14 , 16 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] specified the inclusion of fixed equinus, but not all used the widely used Silfverskiold test. Seventeen [ 9 , 11 , 12 , 14 , 16 , 18 , 19 , 20 , 24 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] studies specified the CP subtype as spastic CP.…”

“…Fourteen studies reported swing phase kinematics [ 4 , 9 , 10 , 12 , 14 , 18 , 21 , 23 , 24 , 25 , 26 , 33 , 35 , 36 ]. All studies reported significant increases in maximum or mean swing phase ankle dorsiflexion.…”

“…Eight studies [ 16 , 19 , 20 , 23 , 29 , 30 , 32 , 33 ] reported Gait Profile Scores (GPS). The GPS measures the difference between patients and people with no gait pathology across nine kinematic variables [ 8 ].…”

Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

“…For the non-paretic side (see Figure 5b), the main affectations were the H-R and F-R movements related to the device's weight compensation. As GDI, different studies used GPS to analyze the effects on people with cerebral palsy [40,41]. Although, in protocols that include patients with stroke in assisted gait with AAFO, the score was not reported.…”

Effects of Virtual Reality Horse Riding Simulator Training Using a Head-Mounted Display on Balance and Gait Functions in Children with Cerebral Palsy: A Preliminary Pilot Study

“…2 These primary conditions additionally generate secondary deficits such as muscle contracture and alignment deformities of children with cerebral palsy, leading to a reduction in the level of functional activity and difficulty in balance control and walking necessary for performing activities of daily living. 3,4 Various therapeutic approaches, such as virtual reality, treadmill training, robot-supported therapy and horseback riding simulator, have been used to improve balance and gait in children with cerebral palsy. [5][6][7][8][9][10] Among diverse therapeutic approaches, hippotherapy is a training method employing the natural gait of the horse to provide motor and sensory input to children with cerebral palsy.…”