Impact of Ankle-Foot Orthosis on Gait Efficiency in Ambulatory Children With Cerebral Palsy

Abstract

Objective Children with cerebral palsy experience functional limitations because of excessive muscle weakness, spasticity, and impaired motor control. They are prescribed ankle-foot orthoses to assist with ambulation. Our objective was to analyze stride length and dorsiflexion data comparing the effectiveness of “ankle-foot orthoses” with “barefoot or shoes only” on ambulatory children with cerebral palsy. Design An electronic literature search was conducted. Studies were screened by two reviewers based on our inclusion criteria: prospective cohort study or randomized clinical trial, participants younger than 18 yrs with a primary diagnosis of cerebral palsy, ankle-foot orthoses with a control group, 20 combined participants in the experimental and control groups for cohort studies, and 10 participants for randomized clinical trials. Results Seventeen studies were selected. Pooled results of the meta-analyses showed that stride length was significantly better in the ankle-foot orthoses group as compared with the control group (mean difference between groups = 0.05 m (95% confidence interval = 0.04–0.06). The dorsiflexion angle (5 studies, 124 participants) was improved in patients with ankle-foot orthoses as compared with barefoot or shoes only (mean difference between groups = 8.62 degrees (95% confidence interval = 8.05–9.2). Conclusions Children with cerebral palsy using ankle-foot orthoses had improved stride length and dorsiflexion angle during gait in a pooled meta-analyses of cohort studies and clinical trials.

Effects of Ankle Foot Orthoses on the Gait Patterns in Children with Spastic Bilateral Cerebral Palsy: A Scoping Review

“…Even though an AFO is a frequently prescribed intervention for children with CP, rigorous evidence of their efficacy is limited [52], mainly because of the heterogeneity of outcome measures among researchers, which limits comparison between studies [53]. Although previous reviews have reported similar results and identified some of the limitations described above, still none have reported consistent guidelines for future studies [10,[21][22][23][24].…”

“…Many studies involving orthotic use with CP patients present a wide variety of discrepancies in inclusion criteria or baseline assessments; missing information about orthosis design and construction, and how they are used; and different types of outcomes that can bias the indicated results. Previous systematic reviews have not focused on specific CP subgroups or referred to gait pattern classifications, thereby including a wide range of gait abnormalities, or have included the information of lower quality studies [21][22][23][24].…”

A Review on Recent Advances of Cerebral Palsy

“…The reduced energy expenditure was found to be effective in improving stride length, speed of walking, single limb support, and gait symmetry; it also helped in decreasing energy expenditure of hemiplegic CP as compared with the barefoot condition. Further studies are required for better evidence regarding this [71].…”

Kinematic Comparison of Orthopedic Shoes and Ankle-Foot Orthoses in Children With Cerebral Palsy

“…Одним из важных составляющих комплексного биомеханического обследования пациентов с ДЦП является оценка пространственно-временных показателей ходьбы, что особенно актуально при оценке эффективности ортезирования. В частности, по данным ряда исследователей, использование ортеза на ГСС увеличивает скорость ходьбы [22,23,24] и длину шага [25,26,27]. По нашим данным, статистически значимое различие при использовании ортопедической обуви и ортезов на ГСС по сравнению с ходьбой босиком наблюдалось только по переменной длины шага правой нижней конечности.…”

“…Исходя из вышесказанного, обсуждение построено на основании указанных результатов. Так, данные, представленные в таблице 3, показали, что ношение AFO по сравнению с ходьбой босиком положительно влияет на пространственно-временные характеристики походки (длину и скорость шага) с различиями средних значений в диапазоне от 5,5 до 26,0%, в этом наши результаты согласуются с данными литературы [22,23,24,25,26,27]. Примечательно, что эти различия тем больше, чем тяжелее уровень нарушения глобальных моторных функций.…”