An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion

Kerkum, Yvette L.; Harlaar, Jaap; Buizer, Annemieke I.; Noort, Josien C. van den; Becher, Jules G.; Brehm, Merel-Anne

doi:10.1016/j.gaitpost.2016.03.001

Cited by 33 publications

(52 citation statements)

References 31 publications

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“…Further, the results from this study highlight the importance of optimizing AFOs across multiple parameters to minimize muscle demand during walking. Passive AFO optimization protocols have been proposed, but typically select between only a few different AFO stiffness values or designs [39, 40], possibly limiting the “optimality” of selected AFO properties.…”

Section: Discussionmentioning

confidence: 99%

Simulated impacts of ankle foot orthoses on muscle demand and recruitment in typically-developing children and children with cerebral palsy and crouch gait

Rosenberg

Steele

2017

PLoS ONE

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Passive ankle foot orthoses (AFOs) are often prescribed for children with cerebral palsy (CP) to assist locomotion, but predicting how specific device designs will impact energetic demand during gait remains challenging. Powered AFOs have been shown to reduce energy costs of walking in unimpaired adults more than passive AFOs, but have not been tested in children with CP. The goal of this study was to investigate the potential impact of powered and passive AFOs on muscle demand and recruitment in children with CP and crouch gait. We simulated gait for nine children with crouch gait and three typically-developing children with powered and passive AFOs. For each AFO design, we computed reductions in muscle demand compared to unassisted gait. Powered AFOs reduced muscle demand 15–44% compared to unassisted walking, 1–14% more than passive AFOs. A slower walking speed was associated with smaller reductions in absolute muscle demand for all AFOs (r2 = 0.60–0.70). However, reductions in muscle demand were only moderately correlated with crouch severity (r2 = 0.40–0.43). The ankle plantarflexor muscles were most heavily impacted by the AFOs, with gastrocnemius recruitment decreasing 13–73% and correlating with increasing knee flexor moments (r2 = 0.29–0.91). These findings support the potential use of powered AFOs for children with crouch gait, and highlight how subject-specific kinematics and kinetics may influence muscle demand and recruitment to inform AFO design.

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Section: Discussionmentioning

confidence: 99%

Simulated impacts of ankle foot orthoses on muscle demand and recruitment in typically-developing children and children with cerebral palsy and crouch gait

Rosenberg

Steele

2017

PLoS ONE

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“…Given the fact that the studies poorly identified the characteristics of the orthosis, it is not surprising that the instrumentation and materials involved in the fabrication of the orthosis wasn't exposed [16,18,20]. Although, a few studies [3,4,7,17] revealed that the custom made AFO was from prepreg carbon fibers. The majority of studies used a costume made AFO build by an orthotist [1,8,6,19] in cooperation with a physical therapy [8,6,13,19].…”

Section: Information Relating the Afo Interventionmentioning

confidence: 99%

“…Kerkum et al [7] in a study with 15 children with CP prescribed with a hinged ventral shell AFO (vAFO) with adjustable stiffness realize that a decrease in net EC was found for walking with the optimized vAFO compared to shoes-only, daily activity remained unchanged and knee flexion I stance was reduced.…”

Section: Applied Mechanics and Materials Vol 890 305mentioning

confidence: 99%

“…For example, controlling crouched gait with increased hip and knee flexion and ankle dorsiflexion in stance phase in children is better done using an ankle foot orthoses in ambulatory. It is suggested that this system is a commonly intervention in children with CP, and can improve joint stability, posture, and gait skills [6,7]. Therefore, studies have shown that to improve gait and reduce walking limitations, children with CP might use ankle foot orthoses (AFOs) [1,3,4,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…It is suggested that this system is a commonly intervention in children with CP, and can improve joint stability, posture, and gait skills [6,7]. Therefore, studies have shown that to improve gait and reduce walking limitations, children with CP might use ankle foot orthoses (AFOs) [1,3,4,6,7]. Some studies on the literature evaluating the effects of AFOs on gait in children with CP generally report improvement in gait parameters, like spatiotemporal parameters, joint kinematics and kinetics, and knee extension [3,6].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Outcomes Related with Gait in Children with Cerebral Palsy Using Ankle-Foot Orthotic - A Systematic Review

Gordo

Pascoal‐Faria

Mateus

et al. 2019

AMM

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Gait in children with cerebral palsy (CP) is often affected by motor impairments which limit the patient's ability to walk. To improve gait and reduce walking limitations, children with CP need to use ankle foot orthoses. An orthosis is an externally applied device that is designed and fitted to the body to achieve one or more of the following goals: a) Control biomechanical alignment. b) Correct or accommodate deformity, and 3) Protect and support an injury. This systematic review aims to describe research evidence supporting the use of ankle-foot orthoses to improve gait biomechanical outcomes among individuals with CP. Literature search was pursued from PubMed database. Studies were included if (1) they evaluated an outcome measure related with gait using ankle-foot orthotic (AFO) in children (2) considered children with a diagnosis of CP and have a (3) GMFCS classification of I, II or III. Papers were excluded if they evaluated (1) other population besides CP, (2) the use of orthoses other than AFOs and (3) gait analysis procedure was not presented. All the included studies have analyzed spatiotemporal parameters, the step length (m), stride length (m) and cadence (steps/minute) were the most frequently reported. Our findings showed that several studies have investigated the effects of AFOs, all of which have reported positive influences on at least one gait parameter, as well as positive changes in joint kinematics and kinetic in children with CP.

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State of the Prescription Process for Dynamic Ankle-Foot Orthoses

Koller

Arch

2018

Curr Phys Med Rehabil Rep

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An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion

Cited by 33 publications

References 31 publications

Simulated impacts of ankle foot orthoses on muscle demand and recruitment in typically-developing children and children with cerebral palsy and crouch gait

Simulated impacts of ankle foot orthoses on muscle demand and recruitment in typically-developing children and children with cerebral palsy and crouch gait

Biomechanical Outcomes Related with Gait in Children with Cerebral Palsy Using Ankle-Foot Orthotic - A Systematic Review

State of the Prescription Process for Dynamic Ankle-Foot Orthoses

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