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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