Use of orthoses lowers the O2 cost of walking in children with spastic cerebral palsy

Maltais, Désirée B.; Bar‐Or, Oded; Galea, Victoria; Pierrynowski, M.R.

doi:10.1097/00005768-200102000-00023

Cited by 81 publications

(74 citation statements)

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“…A observação mais detalhada de componentes qualitativos da marcha, através da PRS modificada, revelou que o uso das órteses suropodálicas influenciou, principalmente, o posicionamento do pé no contato inicial, assim como a progressão da distribuição de peso durante a fase de apoio, com redução do eqüinismo dinâmico observado neste grupo clínico. Esses achados confirmam os de outros estudos que utilizaram sistemas de análise de movimentos para verificar os benefícios do uso de órteses suropodálicas na marcha de crianças com PC 7,21,22 . A precisão da informação fornecida por esses sofisticados sistemas de análise de movimento é bastante superior à fornecida pela PRS modificada, entretanto, a utilização desses sistemas na avaliação clínica no Brasil ainda apresenta-se como uma realidade distante, devido ao alto custo de aquisição e de manutenção.…”

Section: Discussionunclassified

“…Maltais et al 22 compararam o desempenho de dez crianças portadoras de diplegia com idade média de 9 anos, nas condições com e sem órtese, utilizando os itens das dimensões de pé e andando/correndo/pulando do teste GMFM. Nove crianças participantes desse estudo apresentavam grau leve de gravidade da condição de PC (níveis 1 e 2 da classificação GMFCS).…”

Section: Discussionunclassified

“…Entretanto, o GMFM apresenta menor sensibilidade para detectar mudanças em crianças com idades superiores a seis anos e inferiores a três anos e, também, naquelas que apresentam escores nos limites superiores ou inferiores do mesmo (categorias extremas de comprometimento motor) 19 . A justificativa para os resultados não significativos encontrados por Maltais et al 22 pode estar relacionada às características da amostra utilizada, incluindo crianças com média de idade superior a seis anos e gravidade leve da condição de PC (níveis 1 e 2 da GMFCS). Tais características ilustram, provavelmente, o efeito teto do teste, conforme ressaltado pelos autores do GMFM 18 .…”

Section: Discussionunclassified

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Efeitos do uso de órtese na mobilidade funcional de crianças com paralisia cerebral

Cury¹,

Mc²,

Melo³

et al. 2006

Rev. bras. fisioter.

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RESUMOObjetivo: Comparar o desempenho motor de crianças com paralisia cerebral (PC) em duas condições: com órtese e sem órtese. Métodos: Vinte crianças PC foram avaliadas utilizando-se o teste Gross Motor Function Measure (GMFM), a versão modificada da avaliação da marcha Physicians Rating Scale (PRS) e entrevista com os pais para avaliar o uso de órteses na rotina diária. Resultados: O teste ANOVA que foi utilizado para avaliar o efeito do uso órtese na mobilidade das crianças revelou médias significantemente superiores na condição com órtese durante o desempenho motor grosso e na marcha. Entrevistas informaram que o uso de órteses estava inserido na rotina diária e os pais demonstraram percepção positiva com relação ao uso desse dispositivo. Conclusão: As órteses promoveram o desempenho de tarefas motoras da rotina diária de crianças com PC, podendo orientar os processos de avaliação e de intervenção dos profissionais que trabalham com essa clientela.Palavras-chave: paralisia cerebral, órtese, mobilidade. ABSTRACT The Effects of the Use of Orthoses on the Functional Mobility of Children with Cerebral PalsyObjective: To compare the motor performance of children with cerebral palsy (CP) under two conditions: with and without orthoses. Method: Twenty children with CP were evaluated using the Gross Motor Function Measure test (GMFM), a modified version of the Physicians Rating Scale (PRS) locomotion assessment, and an interview with their parents to evaluate the use of orthoses in their daily routine. Results: The ANOVA test was used to evaluate the effect of orthosis use on the children's mobility, and it revealed that, when orthosis was used, the means for gross motor function and gait assessments were significantly higher. The interviews confirmed that the use of orthoses was included in the daily routine, and the parents demonstrated positive perceptions regarding the use of such devices. Conclusion: Orthoses improved the performance of routine daily motor tasks among the children with CP, and this finding may serve to guide the assessment and intervention processes of professionals who work with this clientele.

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Efeitos do uso de órtese na mobilidade funcional de crianças com paralisia cerebral

Cury¹,

Mc²,

Melo³

et al. 2006

Rev. bras. fisioter.

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“…We wish to thank Drs Maltais and Bar-Or for pointing out an error in our paper 1 where we incorrectly commented that the participants in their study 2 showed no significant changes in GMFM goal total scores (Standing; and Walking, Running, Jumping) between 'AFO plus shoes' versus 'barefoot' function. In fact they reported no significant difference in GMFM goal total scores between 'AFO plus shoes' versus 'shoes only'.…”

Section: 'Russell and Gorter Reply'mentioning

confidence: 97%

‘Assessing functional differences in gross motor skills in children with cerebral palsy who use an ambulatory aid or orthoses: can the GMFM‐88 help?’

Maltais

Bar‐Or

2006

Develop Med Child Neuro

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'Assessing functional differences in gross motor skills in children with cerebral palsy who use an ambulatory aid or orthoses: can the GMFM-88 help?' SIR-We read with interest the article by Russell and Gorter 1 recently published in this journal. The authors reported on the sensitivity of the 88-item Gross Motor Function Measure (GMFM-88) to detect within-child changes in function between aided (walking aids and orthoses) and barefoot walking conditions. In the introductory section of their article, Russell and Gorter reviewed one of our studies 2 with children with cerebral palsy where we looked at the effect of wearing hinged ankle-foot orthoses (AFOs) on gross motor function related to walking (the Standing and the Walking, Running and Jumping dimensions of the GMFM-88) and on the oxygen cost of treadmill walking. Russell and Gorter rightly stated that we found that wearing AFOs resulted in a decrease in the oxygen cost of walking but did not affect GMFM scores. We collected data when participants wore their AFOs and shoes and when they wore shoes only. Russell and Gorter, however, incorrectly described our second condition as barefoot. We wish to bring this error to the attention of the readers of this journal for two reasons. First, our results show that oxygen uptake (at least during treadmill walking), is sensitive to changes related to wearing AFOs compared with wearing shoes. This is in contrast to studies on the effects of AFOs on gait biomechanics. As Russell and Gorter point out, such studies have found that biomechanic changes are 'less discernible' when the control condition is walking in shoes compared with when it is walking barefoot. Indeed, in some cases there is no change in biomechanic variables when children wear their AFOs and shoes compared with when they wear their shoes alone. 3 Second, although not made explicit by Russell and Gorter, it would be inappropriate to conclude that our finding of no AFO-related differences in the GMFM scores for the Walking, Running and Jumping dimension directly contrasts their results. While they did find that for their participants at Gross Motor Function Classification System Level I (similar in function to our own participants) wearing AFOs resulted in an increase in GMFM scores for this same dimension, their participants were barefoot for the control condition unlike in our study, where the participants wore their shoes.

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“…8 Correlations have been reported between gait velocity and a number of measures of functional status, such as the Gross Motor Function Measure, the Clinical Gait Assessment Scores, and the Pediatric Outcomes Data Collection Instrument. [9][10][11][12][13] A related meta-analysis examined the effect of various therapeutic exercise protocols on gait velocity of the elderly living in the community. 14 In this related meta-analysis it was found that high-intensity exercise had a significant effect on increasing habitual gait velocity.…”

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confidence: 99%

Evaluating interventions to improve gait in cerebral palsy: a meta‐analysis of spatiotemporal measures

Paul

Siegel

Malley

et al. 2007

Develop Med Child Neuro

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A number of interventions to improve gait in individuals with cerebral palsy (CP) have been reported in the literature. The aim of this study was to perform a meta‐analysis of these studies to determine the overall efficacy of these interventions. Effect sizes (Hedge's g) for spatiotemporal measures of gait (velocity, cadence, stride length) pre‐ and postintervention were analyzed. Sixty‐three studies were included, and the overall effect size was statistically significant for both fixed effects and random models. Types of interventions were grouped into spasticity treatments, orthopedic (bony and soft tissue) surgery, lower extremity orthoses, or ‘other’. When the data were analyzed in subgroups by type of intervention, each intervention had a statistically significant effect size with the exception of the ‘other’. More importantly, the present study indicates the need to address participant inclusion criteria and power analysis more adequately in future research studies of interventions to improve gait in CP.

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Use of orthoses lowers the O2 cost of walking in children with spastic cerebral palsy

Abstract: Use of hinged AFO reduces the oxygen and ventilatory cost of walking in children with spastic diplegic CP.

Cited by 81 publications

References 0 publications

Efeitos do uso de órtese na mobilidade funcional de crianças com paralisia cerebral

Efeitos do uso de órtese na mobilidade funcional de crianças com paralisia cerebral

‘Assessing functional differences in gross motor skills in children with cerebral palsy who use an ambulatory aid or orthoses: can the GMFM‐88 help?’

Evaluating interventions to improve gait in cerebral palsy: a meta‐analysis of spatiotemporal measures

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