Clinical Rehabilitation published research on 28 (15 experimental and 13 control group) ambulatory children, ages 4-16, with spastic diplegia to determine if a knee-ankle-foot orthosis (KAFO) helps maintain ankle-foot dorsiflexion range of motion over time. The intervention group was required to wear the KAFOs for 6 hours every other night for one year. Measurements were recorded 5 times over the course of the year. The results were the following:
1. No significant difference was found in the decrease of ankle-foot dorsiflexion range of motion between the experimental and control groups.
2. secondary outcome measures did not show differences between groups.
3. Even with good motivation, knee-ankle-foot orthosis wearing time was limited to a mean±SD of 3.2±1.9 hours per prescribed night due to discomfort.
The researchers occluded that KAFOs with dynamic ankle and fixed knee are poorly tolerated and are not beneficial in preventing a reduction in ankle-foot dorsiflexion range of motion in children with spastic cerebral palsy, at least with limited use.
I have seen similar results based on my experience with KAFOs and children with cerebral palsy. Many times the children did not tolerate the orthotics frequently complaining of pain or they were at risk of skin breakdown. One child who exhibited excessive knee hyperextension did very well with KAFOs (but his primary issue was excessive knee hyperextension not decreased ankle foot range of motion). What has your experience been with KAFOs and children?
Reference: Maas, JC et. al. A randomized controlled trial studying efficacy and tolerance of a knee-ankle-foot orthosis used to prevent equinus in children with spastic cerebral palsy. Published online before print July 31, 2014, doi: 10.1177/0269215514542355 Clin Rehabil October 2014 vol. 28 no. 10 1025-1038