Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy

Skaaret, Ingrid; Steen, Harald; Terjesen, Terje; Holm, Inger

doi:10.1177/0309364618791615

Cited by 13 publications

(12 citation statements)

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“…AFO users have different ages, anatomy, gender, and lifestyles, and can be found at various stages of the disease or disability. Stroke [ 41 , 42 ], multiple sclerosis [ 43 ], cerebral palsy [ 3 , 44 , 45 ], foot drop [ 2 , 8 , 46 ], Charcot-Marie tooth [ 47 ], neck or spinal cord injury [ 48 ], sciatica [ 44 ], muscular dystrophy [ 49 ], or peroneal nerve injury [ 46 ] are the most common diseases that need an AFO to improve the kinematics and kinetics of the patients. Among the AFO functionality, the patient’s comfort, pain, and disability reduction should be an essential factor to consider.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, ankle-foot orthoses (AFO) are prescribed to improve the patient’s quality of life for several walking difficulties. It is well documented that these devices may help in lower limb impairments such as stride length [ 2 ]; gait speed and walking confidence [ 3 , 4 , 5 , 6 , 7 ]; equinus ankle correction [ 2 , 8 ]; energy expenditure index [ 6 ]; hip extension, dorsiflexion in the swing phase and knee extension [ 2 , 3 ]; correction of knee hyperextension [ 9 ]; correction of foot drop [ 10 ]; correction of the crouch gait [ 8 ]; increased solear muscle activity [ 11 ]; and increased resistive moment in plantar flexion [ 9 ]. An AFO can support weak muscles or restrain spastic muscles, leading to smoother and more stable locomotion.…”

Section: Introductionmentioning

confidence: 99%

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A Review of Additive Manufacturing Studies for Producing Customized Ankle-Foot Orthoses

et al. 2022

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Ankle-foot orthoses (AFO) are prescribed to improve the patient’s quality of life. Supporting weak muscles or restraining spastic muscles leads to smoother and more stable locomotion. Commonly, AFO are made using thermoplastic vacuum forming, which requires a long time for production and has limited design options. Additive manufacturing (AM) can solve this problem, leading to a faster and cheaper solution. This review aimed to investigate what is the state-of-art using AM for AFO. Evaluating the used manufacturing processes, customization steps, mechanical properties, and biomechanical features in humans would provide significant insights for further research. The database searches combined AM and AFO with no year or publication type restrictions. Studies must have examined outcomes on human participants with the orthoses built by AM. Other types of orthotic devices or different manufacturing techniques were excluded. Nineteen studies met the inclusion criteria. As stated by having all studies conducted in the last nine years, this is a very recent domain. Different AM processes have been used, with the majority relying on Fused Deposition Modeling. Overall, the manuscripts’ quality is deficient, which is critical to promoting further studies with higher samples. Except for one paper, AM-printed AFO was comparable or superior to the thermoplastic vacuum forming AFO in mechanical tests, kinematics, kinetics, and participant feedback.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Review of Additive Manufacturing Studies for Producing Customized Ankle-Foot Orthoses

et al. 2022

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“…According to the literature, the method of Clinical Gait Analysis (CGA) has a significant impact on orthopedic decision-making [16,17,18] and modifies surgical planning in more than half of cases [19,20,21], revealing clinically significant differences in the quality of threshold values [22]. When CGA data are used for planning the operations, early relapses (up to 21 months after surgery) were reported in 15 % of cases.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the causes of pathological patterns of the kinematic locomotor profile based on the findings of computer gait analysis in children with spastic CP types

Chibirov¹,

Долганова²,

Долганов³

et al. 2019

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To interpret the clinical gait analysis (CGA), it is necessary to associate changes in gait with clinical impairment and differentiate the primary deviations in the gait stereotype from compensatory adaptive changes. Purpose To assess the pathological elements of the locomotor profile according to video gait analysis and clinical examination of patients; to compare the abnormalities identified in gait kinematics with the probable clinical causes of these abnormalities. Materials and methods Clinical examination and assessment of the locomotor profile with video gait analysis (CGA) were performed in 46 children (92 limbs) with bilateral spastic types of cerebral palsy (25 boys, 21 girls). We used 6 Qualisys Oqus cameras and one AMTI dynamometric platform (Advanced Mechanical Technology Inc., Watertown, MA, USA) with passive marker video capture technology. The IOR model was used for installing markers. The patterns of the locomotor profile adopted by the Delphic Convention were analyzed. The assessment of diagnostic coincidences or discrepancies was evaluated as percentage rates. Results The portion of the pathological elements of the locomotor profile identified according to the video gait analysis and clinical examination of patients is presented in the tables. The positive ratio of the pathological elements of the locomotor profile identified according to the video gait analysis and clinical examination of patients averaged 66.7 %. The lowest error rate: when assessing the limitation of the range of motion of the ankle joint and hip joint there were 82.6% and 81.8% of positive results, respectively. Discussion Clinical gait analysis (CGA) is crucial in controversial situations regarding detorsion osteotomies in multilevel operations. Conclusions Muscle retraction is the main (primary) clinical sign leading to positional kinematic deviations in joints and segments. The limitation of the range of motion in the knee and ankle joints due to muscle retraction results in secondary contractures of these joints.

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“…The study was based on three repeated measures in a cohort of children with preoperative baseline data, who were initially part of two other studies (Skaaret et al, 2018;Skaaret et al, 2019) to compare walking with AFOs versus barefoot after lower limb surgery. The study was approved by the Regional Committee for Medical Research Ethics -South East Norway (REC; 2013/1242).…”

Section: Participantsmentioning

confidence: 99%

“…(Borton et al, 2001) Ankle-foot orthoses (AFOs) are routinely used after lower limb surgery to provide adequate mechanical support during the rehabilitation period and prevent recurrence of deformities. (Skaaret et al, 2018;Skaaret et al, 2019;Vuillermin et al, 2011) Reviewing the prerequisites of normal gait, an important purpose of AFOs in ambulating children with CP is to provide stability in stance. (Gage, 2004) Adequately aligned AFOs have been advocated to reduce CoM deceleration deficiency, (Williams et al, 2011) and walking with AFOs has previously been associated with increased FZ 2 in spastic CP.…”

Section: Introductionmentioning

confidence: 99%

Postoperative changes in vertical ground reaction forces, walking barefoot and with ankle-foot orthoses in children with Cerebral Palsy

Skaaret

Steen

Niratisairak

et al. 2021

Clinical Biomechanics

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Background: Children with cerebral palsy often have problems to support the body centre of mass, seen as increased ratio between excessive vertical ground reaction forces during weight acceptance and decreased forces below bodyweight in late stance. We aimed to examine whether increasing ankle range of motion through surgery and restraining motion with ankle-foot orthoses postoperatively would have impact on the vertical ground reaction force in weight acceptance and late stance. Methods: Ground reaction forces were recorded from 24 children with bilateral and 32 children with unilateral cerebral palsy, each measured walking barefoot before and after triceps surae lengthening. Postoperatively, the children were also measured walking with ankle-foot orthoses. Changes in vertical ground reaction forces between the three conditions were evaluated with functional curve and descriptive peak analyses; accounting for repeated measures and within-subject correlation. Findings: After surgery, there were decreased vertical ground reaction forces in weight acceptance and increased forces in late stance. Additional significant changes with ankle-foot orthoses involved increased vertical forces in weight acceptance, and in late stance corresponding to bodyweight (bilateral, from 92% to 98% bodyweight; unilateral, from 94% to 103% bodyweight) postoperatively. Interpretation: Our findings confirmed that surgery affected vertical ground reaction forces to approach more normative patterns. Additional changes with ankle-foot orthoses indicated further improved ability to support bodyweight and decelerate centre of mass in late stance.

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Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy

Cited by 13 publications

References 35 publications

A Review of Additive Manufacturing Studies for Producing Customized Ankle-Foot Orthoses

A Review of Additive Manufacturing Studies for Producing Customized Ankle-Foot Orthoses

Analysis of the causes of pathological patterns of the kinematic locomotor profile based on the findings of computer gait analysis in children with spastic CP types

Postoperative changes in vertical ground reaction forces, walking barefoot and with ankle-foot orthoses in children with Cerebral Palsy

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