Analysis of type and frequency dynamics of rehabilitation assistive devices in children with cerebral palsy

Aksenov

Traumatology and Orthopedics of Russia

2022

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Introduction Cerebral palsy (CP) patients may have additional complications such as deformities of lower limbs which significantly change the gait pattern. Various treatments have been used to correct the walking gait and among them are orthotic devices. According to the data based on literature research the ankle-foot orthoses (AFOs) are the most widely used in clinical practice for CP patients. However, orthopedic shoes are more widely used in Russia and there is a lack of gait comparison research has been done up to date. Aim. Kinematic data comparison of walking gait between orthopedic shoes and AFOs in children with CP. Materials and methods. Eighteen CP children with GMFCS 2 and GMFCS 3 were recruited for this research. Three test comparisons were conducted for barefoot, orthopedic shoes, and AFOs walking for each children being tested. Twelve Miqus M5 Qualisys cameras were used for kinematic data collection with 100 Hz frequency. Visual3D (C-Motion), Clinical Gait PAF (Qualisys), Statistica 10, and Excel were used for data analysis. Results. The results demonstrated that wearing AFOs versus barefoot improved spatial-temporal parameters as well as ankle and knee joint kinematics without significant changes in hip joint angles for both GMFCS 2 and GMFCS 3 levels. As a result, the Gait Profile Score (GPS) showed significant improvement in AFOs as well. The use of orthopedic footwear in patients with gross motor function levels GMFCS 2 and GMFCS 3 led to improvement of ankle and knee joints kinematics when compared to barefoot walking. However, the group with GMFCS 2 demonstrated less improvement of the ankle and knee joint angles in orthopedic shoes but the GPS showed significantly better overall values when compared to GMFCS 3 group. Therefore, this study showed that orthopedic footwear and AFOs almost equally corrected the walking gait in GMFCS 2 group but AFOs were significantly better for GMFCS 3 group.

Kinematic Comparison of Orthopedic Shoes and Ankle-Foot Orthoses in Children With Cerebral Palsy

Aksenov

Traumatology and Orthopedics of Russia

2022

Self Cite

Orthotics lower limbs in children with spastic forms of cerebral palsy: (literature review)

Исфандиярович²,

Medical and Social Expert Evaluation and Rehabilitation

et al. 2021

Background. Cerebral palsy (CP) is an important medical and social problem due to the high frequency of childhood disability and a significant prevalence of the disease. One of the features of cerebral palsy is the formation of secondary orthopedic complications, for the correction of which, along with surgery and botulinum therapy, technical rehabilitation devices and orthoses in particular are used. Aim: To analyze world experience in orthotics in children with cerebral palsy. World literature review in open electronic databases PubMed and Elibrary for the last 30 years. The most of publications focuses on ankle-foot orthoses as the most commonly used in foreign clinical practice. A minimal number of papers cover the problem of orthopedic footwear, despite on its prevalence in Russia. There are no works analyzing the frequency characteristics of orthoses used, including the likelihood of their reuse and rejection. There is no unified, generally accepted terminology and classification of orthoses. We found no articles covering the effectiveness of combined use of several types of orthoses. To date, no clinical guidelines for orthotics in children with cerebral palsy have been developed; therefore, in many cases, orthoses are prescribed empirically. Conclusion. Thus, further research of the role of orthotics in the medical rehabilitation of children with cerebral palsy appears to be an urgent task.

Comparative analysis of the effect trunk-hip-knee-ankle foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy (case report)

Aksenov²,

Medical and Social Expert Evaluation and Rehabilitation

2021

BACKGROUND: In children with spastic forms of cerebral palsy often prescribed difference type of trunk-hip-knee-ankle foot orthosis (THKAFO). At the same time, we have not found any significant reports in the world literature dedicated to the study of the influence of these orthosis on the gait biomechanical parameters. AIM: To demonstrate the results of a comparative analysis of the effect of trunk-hip-knee-ankle-foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy. MATERIALS AND METHODS: The study involved two 13-and 15-year-old children with a diagnosis of cerebral palsy, spastic diplegia, GMFCS 3, MACS 23, Ashworth Scale 23. Six studies were conducted ― three tests for each child (barefoot, in AFO and THKAFO) using the 3D video analysis system Qualisys (Sweden). The spatio-temporal and kinematic indicators of gait, as well as the gait index, were evaluated. RESULTS: Analysis of the results in patient D. demonstrated that using the THKAFO in comparison with AFO led to a slight improvement in spatio-temporal gait indicators (from 4.012.5%), but to a deterioration in hip kinematics and a deterioration in the gait index (2.528.1%). Whereas in patient A., it was noted that the use of the THKAFO in comparison with AFO had a negative effect on the spatio-temporal parameters of gait (4.097.6%), on the kinematics of the knee and ankle joints, and on the improvement of the hip kinematics in the sagittal plane, but the effect on the gait index was not unambiguous. According to the totality of the analyzed data, patient D. was recommended to wear AFO instead of the THKAFO. Patient A. was also recommended to wear an AFO instead of a THKAFO, even despite the ambiguous results of the biomechanical research, since the final decision on the choice of the orthosis design took into account not only accurate changes in biomechanical parameters, but also a number of other factors, in particular social and household ones. CONCLUSION: In patients with level GMFCS 3, for improve the biomechanical parameters of gait, it is advisable to give preference to shorter and functional orthoses before prescribing orthoses that capture two or more body segments.