Defining the Mechanical Properties of a Spring-hinged Ankle Foot Orthosis to Assess its Potential Use in Children With Spastic Cerebral Palsy

Kerkum, Yvette L.; Brehm, Merel-Anne; Buizer, Annemieke I.; Noort, Josien C. van den; Becher, Jules G.; Harlaar, Jaap

doi:10.1123/jab.2014-0046

Cited by 19 publications

(24 citation statements)

References 15 publications

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“…The effect of those assistive AFOs have been shown to be beneficial for cerebral palsy patients (Eddison and Chockalingam, 2013; Kerkum et al, 2014) and hemiplegic patients following a stroke (Kim et al, 2015). In addition, Bregman et al (2011) have shown that wearing a spring-assisted AFO decreases the energy cost of gait in stroke patients by about 10%.…”

Section: Discussionmentioning

confidence: 99%

“…The current modern design of AFOs include articulated devices capable of assisting plantarflexion during stance. Whereas some studies confirmed the benefits of assistive AFOs (Guillebastre et al, 2009; Bregman et al, 2011; Eddison and Chockalingam, 2013; Petrucci et al, 2013; Kerkum et al, 2014; Kim et al, 2015), other studies have asserted a minimal effect of traditional AFOs on global gait kinematics in hemiplegic patients (Yamamoto et al, 1997; Mulroy et al, 2010). Therefore, taken into consideration the economic cost and the bulkiness of some articulated AFOs, the standard rigid model is still commonly used in rehabilitation practices.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rigid Ankle Foot Orthosis Deteriorates Mediolateral Balance Control and Vertical Braking during Gait Initiation

Delafontaine

Gagey

Colnaghi

et al. 2017

Front. Hum. Neurosci.

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Rigid ankle-foot orthoses (AFO) are commonly used for impeding foot drop during the swing phase of gait. They also reduce pain and improve gait kinematics in patients with weakness or loss of integrity of ankle-foot complex structures due to various pathological conditions. However, this comes at the price of constraining ankle joint mobility, which might affect propulsive force generation and balance control. The present study examined the effects of wearing an AFO on biomechanical variables and electromyographic activity of tibialis anterior (TA) and soleus muscles during gait initiation (GI). Nineteen healthy adults participated in the study. They initiated gait at a self-paced speed with no ankle constraint as well as wearing an AFO on the stance leg, or bilaterally. Constraining the stance leg ankle decreased TA activity ipsilaterally during the anticipatory postural adjustment (APA) of GI, and ipsilateral soleus activity during step execution. In the sagittal plane, the decrease in the stance leg TA activity reduced the backward displacement of the center of pressure (CoP) resulting in a reduction of the forward velocity of the center of mass (CoM) measured at foot contact (FC). In the frontal plane, wearing the AFO reduced the displacement of the CoP in the direction of the swing leg during the APA phase. The mediolateral velocity of the CoM increased during single-stance prompting a larger step width to recover balance. During step execution, the CoM vertical downward velocity is normally reduced in order to lessen the impact of the swing leg with the floor and facilitates the rise of the CoM that occurs during the subsequent double-support phase. The reduction in stance leg soleus activity caused by constraining the ankle weakened the vertical braking of the CoM during step execution. This caused the absolute instantaneous vertical velocity of the CoM at FC to be greater in the constrained conditions with respect to the control condition. From a rehabilitation perspective, passively- or actively-powered assistive AFOs could correct for the reduction in muscle activity and enhance balance control during GI of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rigid Ankle Foot Orthosis Deteriorates Mediolateral Balance Control and Vertical Braking during Gait Initiation

Delafontaine

Gagey

Colnaghi

et al. 2017

Front. Hum. Neurosci.

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show abstract

“…AFOs were manufactured using prepeg carbon, with an integrated ankle hinge (NeuroSwing®, Fior & Gentz, Lüneburg, Germany), which allows mechanical properties to be adjusted within the same orthosis by applying springs with different degrees of stiffness (Kerkum et al, 2014). The AFO was worn in combination with the child's own shoes, referred to as the AFO-footwear combination (AFO-FC).…”

Section: Methodsmentioning

confidence: 99%

Acclimatization of the gait pattern to wearing an ankle–foot orthosis in children with spastic cerebral palsy

Kerkum

Brehm

Hutten

et al. 2015

Clinical Biomechanics

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“…A careful evaluation of the literature, showed how clinicians and technicians tried to demonstrate in the last years the perceptive value and rehabilitative usefulness of DAFOs to in luence the gait pro ile of adults and children affected by central or peripheral nervous system damages [7][8][9][10][11][12]. The original aspect of this study was to investigate, for the irst time, the in luence of a personalized rehabilitative model on the functional response of different ankle foot orthoses in a cohort of patients affected by neurological gait pattern.…”

Section: Discussionmentioning

confidence: 99%

“…The current modern design of AFOs includes articulated devices capable of assisting plantar lexion during stance. Whereas some studies con irmed the bene its of assistive AFOs [12,13], other studies demonstrated a minimal effect of traditional AFOs on global gait kinematics in hemiplegic patients [14]. For this reason, taken into consideration the economic cost and the bulkiness of some articulated AFOs, often the clinical attitude is to use standard rigid model in the daily rehabilitation practices.…”

Section: Introductionmentioning

confidence: 99%

How does a Personalized Rehabilitative Model influence the Functional Response of Different Ankle Foot Orthoses in a Cohort of Patients Affected by Neurological Gait Pattern?

Falso¹,

Cattaneo²,

Foglia³

et al. 2017

J Nov Physiother Rehabil

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Background: Orthoses need to support physiotherapy as well as surgical treatment. Related to patient's rehabilitative goals and pathological gait pattern, orthotists have to produce an orthoses that using an adjustable ankle joint system with preloaded disc springs can store the energy brought in by the body weight and produce a tuning effect on patient's gait and sense of balance. The purpose of this study was to establish how a personalized proprioceptive individualized rehabilitative treatment could infl uence the functional response of different AFOs (Ankle Foot Orthoses) in a cohort of patients affected by neurological gait pattern. Methods:Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: 1) without AFO or free-walk (FW); 2) wearing a Codivilla spring, 3) wearing a carbon unjointed AFO ("Toe-Off"); 4) wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3=time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: a. G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; b. clinical/functional outcome measures (Modifi ed Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS).Findings: A comparative analysis of clinical and instrumental data, performed in the pre-defi ned four investigational conditions, showed:√ a statistical insignifi cant change of MRC and MAS scales at time T4, with a signifi cance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test √ a statistical signifi cant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off √ a statistical signifi cant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2 √ a statistical signifi cant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4 √ a statistical signifi cant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4 √ in a comparative post-treatment visual gait analysis a modifi cation of each patient's static and dynamic postural assessment by using 3 different types of orthoses Interpretation:In line with our study design we noted at the end of the proposed rehabilitative treatment an amelioration of gait quality with th...

show abstract

Defining the Mechanical Properties of a Spring-hinged Ankle Foot Orthosis to Assess its Potential Use in Children With Spastic Cerebral Palsy

Cited by 19 publications

References 15 publications

Rigid Ankle Foot Orthosis Deteriorates Mediolateral Balance Control and Vertical Braking during Gait Initiation

Rigid Ankle Foot Orthosis Deteriorates Mediolateral Balance Control and Vertical Braking during Gait Initiation

Acclimatization of the gait pattern to wearing an ankle–foot orthosis in children with spastic cerebral palsy

How does a Personalized Rehabilitative Model influence the Functional Response of Different Ankle Foot Orthoses in a Cohort of Patients Affected by Neurological Gait Pattern?

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