The Effect of Hinged Ankle-Foot Orthosis on Walking Function in Children With Spastic Diplegic Cerebral Palsy: A Cross-Sectional Pilot Study

Abstract

Purpose:The aim of the current study was to examine the effects of hinged ankle-foot orthosis (HAFO) on walking function in children with spastic diplegic cerebral palsy (CP). Methods: Thirty-two children (mean age: 6.79±0.35 years, age range: 5-7 years) who were diagnosed with spastic diplegic cerebral palsy participated in the study. Each subject typically walked through 10 meters of a gait platform with markers on the subject's proper body segments and underwent 3-D motion analysis system with and without hinged ankle-foot orthosis. The HAFOs were all custom-made for individual CP children and had plantarflexion stop at 0° with no dorsiflexion stop. The interventions were conducted over three trials in each group, and measurements were performed on each subject by one examiner in three trials. 3-D motion analysis system was used to measure gait parameters such as walking velocity, cadence, step-length, step-width, stride-length, and double support period in two conditions. Results: The walking velocity, cadence, step-length, and stride-length were significantly greater for the HAFO condition as compared to the no HAFO condition (p<0.05). However, no significant difference in step-width and double support period was observed between two conditions. Conclusion: These findings suggest that using the HAFO during walking would suggest positive evidence for improving the spatiotemporal parameters of gait in children with spastic diplegic cerebral palsy. This is an Open Access article distribute under the terms of the Creative Commons Attribution Non-commercial License (Http:// creativecommons.org/license/by-nc/3.0.) which permits unrestricted non-commercial use, distribution,and reproduction in any medium, provided the original work is properly cited.

Multidimensional Effects of Solid and Hinged Ankle-Foot Orthosis in Children With Cerebral Palsy

“…Our finding that stride length was greater when wearing a HAFO compared with walking barefoot is consistent with previous studies. 5,7,8,11 Perhaps a HAFO improves stability and allows ankle dorsiflexion progression in stance phase, contributing to a longer footstep. However, in our study, velocity was not faster when children wore their orthosis compared with walking barefoot.…”

“…Many studies7,8,10–15 support the benefits of walking with AFOs for children with spastic diplegic CP when compared with barefoot walking or walking with shoes only. These benefits include greater dorsiflexion of the ankle during stance, increase in stride length, increase in velocity, and increase in single limb support 5–8,10,11.…”

“…Many studies7,8,10–15 support the benefits of walking with AFOs for children with spastic diplegic CP when compared with barefoot walking or walking with shoes only. These benefits include greater dorsiflexion of the ankle during stance, increase in stride length, increase in velocity, and increase in single limb support 5–8,10,11. Buckon et al16 found that the energy expenditure index (EEI) of children with spastic diplegic CP when wearing a SAFO or HAFO was less than when walking barefoot.…”

“…These benefits include greater dorsiflexion of the ankle during stance, increase in stride length, increase in velocity, and increase in single limb support. [5][6][7][8]10,11 Buckon et al 16 found that the energy expenditure index (EEI) of children with spastic diplegic CP when wearing a SAFO or HAFO was less than when walking barefoot. Dalvand et al 13 found that scores on the Gross Motor Function Measure (GMFM) improved when children with spastic diplegic CP wore HAFOs compared with walking barefoot.…”