AFO's and Gait in Children with Cerebral Palsy

The Journal of Physical Medicine and Rehabilitation published a retrospective analysis on the effects of ankle-foot orthoses (AFO) on the gait of children with diplegic cerebral palsy.  Data was analyzed from 601 visits of 378 children with a diagnosis of diplegic cerebral palsy.  The children either wore a solid AFO, hinged AFO or posterior leaf spring AFO design.  Each child had a three dimensional gait analysis when walking barefoot and with AFOs.  Data was recorded for Gait Deviation Index (GDI), ankle Gait Variable Score (GVS), knee GVS,
nondimensional (ND) speed, and ND step length.

The results indicated the following:

1.  Only step length exhibited clinically meaningful improvements for the average AFO user.

2.  Changes in step length, speed, and GDI all were statistically significant

3.  Barefoot outcome levels were the most consistent influence on outcome changes.

4.  AFO design was shown to effect changes in speed and ankle function while ambulation type was shown to affect GDI change.

The researchers concluded that current AFO prescription methodologies for children with CP result in consistent gait improvements for step length only.

Reference:  Ries AJ, Novacheck TF, Schwartz MH. The efficacy of ankle-foot orthoses on improving the gait of children with diplegic cerebral palsy: a multiple
outcome analysis. PM R. 2015 Mar 11. pii: S1934-1482(15)00127-6. doi: 10.1016/j.pmrj.2015.03.005. [Epub ahead of print]

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Postural Control and Ankle Foot Orthotics

Recent research studied the effects of ankle foot orthotics on trunk postural control and lower limb coordination in 20 children (ages 4-12) with and without cerebral palsy.  The results of tridimensional trunk kinematics and thigh, shank, and foot elevation angles while walking barefoot and with ankle foot orthotics indicated the following:

• significantly greater trunk excursions in children with cerebral palsy compared to
  typically developing children in both conditions
• when wearing ankle foot orthotics, increased trunk frontal angular velocity was seen in children with cerebral palsy whereas typically developing children showed increased trunk frontal displacement
• no significant changes in trunk displacement and angular velocity were recorded in the sagittal plane in either group
• significant changes in shank and foot elevation was seen in both groups when wearing the ankle foot orthotics

Reference: Degelean M, De Borre L, Salvia P, Pelc K, Kerckhofs E, De Meirleir L, Cheron G, Dan B. Effect of ankle-foot orthoses on trunk sway and lower limb intersegmental coordination in children with bilateral cerebral palsy. J Pediatr Rehabil Med. 2012 Jan 1;5(3):171-9.