AFOs, Walking and Cerebral Palsy

The Annals of Physical Medicine and Rehabilitation published a systemic review on ankle foot orthotics AFOs, walking and cerebral palsy. The purpose of the study was to complete a systematic review of the literature to determine if AFOs produce a more normal gait pattern by positioning joints in the proper position to reduce pathological reflex or spasticity in children with cerebral palsy.

An article search was performed from 2007 to 2015 of studies of children with CP wearing the following AFOs: hinged (HAFO), solid (SAFO), floor reaction (FRO), posterior leaf spring (PLS) and dynamic (DAFO) to determine if there was a change in gait pattern and walking ability.

Seventeen studies were included with a total of 1139 children with CP. The PEDro score was poor for most studies (3/10) with only 4 randomized controlled studies with an appropriate level of evidence.

The results indicated the following:

• overall the use of AFOs improved speed and stride length.
• the HAFO was effective for improving stride length, speed of walking, single limb support and gait symmetry and decreasing energy expenditure with hemiplegic CP as compared with the barefoot condition.
• the plastic SAFO and FRO were effective in reducing energy expenditure with diplegic CP.
• for children with diplegic CP, the HAFO and SAFO improved gross motor function.

The researchers concluded that for children with hemiplegic CP, certain AFOs improved gait parameters, including ankle and knee range of motion, walking speed and stride length. AFOs reduced energy expenditure in children with spastic and hemiplegic CP. The researchers recommend further studies with improved PEDro scores for more conclusive evidence regarding the effectiveness of AFOs in children with CP.

Reference:  Aboutorabi, A., Arazpour, M., Bani, M. A., Saeedi, H., & Head, J. S. (2017). Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review. Annals of Physical and Rehabilitation Medicine.

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Sensory Processing Styles and Mindfulness

Mindfulness is the ability to live in the moment with an open mind and attention to the present.   In order to  live in the moment, one must be able to bring attention and awareness to all of the sensory, cognitive, and emotional aspects of the current experience.   Focused breathing, meditation and yoga are a few examples of how one can practice mindfulness.

The British Journal of Occupational Therapy published research examining the relationship between mindfulness and sensory processing
styles.   Since mindfulness involves paying attention to the sensory components of daily experiences, it would be expected to vary across sensory processing styles. For example, sensory styles characterized by reduced awareness of sensory inputs would be expected to be associated with less mindfulness during daily experiences.  The study included 151 healthy individuals ranging in age from 18-60.  Each participant completed the Mindful Attention Awareness Scale (MAAS), Cognitive and Affective Mindfulness Scale – Revised (CAMS-R) and the Adolescent/Adult Sensory Profile (AASP).  The results indicated the following:

1. low registration sensory processing style was negatively correlated with both measures of mindfulness.
2. sensory sensitivity and sensory avoiding processing styles were also negatively correlated with mindfulness, but only in the frequency of mind wandering episodes.
3. sensory seeking style did not significantly correlate with either mindfulness measure.
4. increased low registration, sensory sensitivity and sensory avoiding scores significantly predicted mind wandering and distraction.

In summary, “aspects of mindfulness associated with attention and awareness were significantly negatively related to sensory processing
patterns associated with passive behavioral strategies (low registration and sensory sensitivity)”.

Reference:  Karen R Hebert. The association between sensory processing styles and mindfulness. British Journal of Occupational Therapy 0308022616656872, first published on July 18, 2016 doi:10.1177/0308022616656872

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