Comparison of three ankle‐foot orthosis configurations for children with spastic hemiplegia

Abstract

The purpose of this study was to examine the effectiveness of the hinged ankle-foot orthosis (HAFO), posterior leaf spring (PLS), and solid ankle-foot orthosis (SAFO), in preventing contracture, improving efficiency of gait, and enhancing performance of functional motor skills in 30 children (21 male, 9 female; mean age 9 years 4 months; age range 4 to 18 years,) with spastic hemiplegia. Following a 3-month baseline period of no ankle-foot orthosis (AFO) use, each AFO was worn for 3 months after which ankle range of motion, gait analysis, energy consumption, and functional motor skills were assessed. The HAFO and PLS increased passive ankle dorsiflexion and normalization of ankle rocker function during gait. Normalization of knee motion in stance was dependent upon the knee abnormality present and AFO configuration. The HAFO was the most effective in controlling knee hyperextension in stance, while PLS was the most effective in promoting knee extension in children with >10˚ knee flexion in stance. Energy efficiency was improved in 21 of the children, with 13 of these children demonstrating the greatest improvement in HAFO and PLS. Improvements in functional mobility were greatest in the HAFO and PLS.

‘Russell and Gorter reply’

“…This is in fact still true. As we reported, Ferdjallah et al (2003) demonstrated a difference in GMFM goal total scores between AFO and barefoot assessments in a very small sample of 5 children with spastic diplegia, while in a much larger sample of 30 children with hemiplegia, Buckon and colleagues 4 found no significant difference in GMFM goal total scores (Standing, and Walking, Running, Jumping) between the different AFOs or between use of AFOs and barefoot function. The fact that Maltais and colleagues found no significant difference between AFOs and shoes compared with shoes alone further highlights the need for additional study.…”

Orthopedic equipment applied in children with cerebral palsy

“…ankle-foot orthosis), a wybór najodpowiedniejszej uzależniony jest od wieku dziecka, nasilenia przykurczy mięśniowych, jak i od stopnia dysfunkcji stawów i towarzyszących zniekształ-ceń stóp. Doniesienia naukowe oparte na nielicznych grupach chorych z mpd, dotyczące używania przez nich AFO, wskazują na korzyści płynące z ich stosowania w aspekcie biomechanicznym (na podstawie analizy trójprzestrzennej chodu), energetycznym (ocenionym za pomocą spirometrii i kalorymetrii), a przede wszystkim funkcjonalnym (wyrażo-nym poprawą wzorca chodu i postawy) [35][36][37][38][39][40][41][42].…”

“…W opinii Buckona i in. [40] zjawisko to świadczyć może o mniejszym zmęczeniu chorego dziecka, które towarzyszy chodzeniu w tym typie zaopatrzenia. Stosowanie AFO, ich zdaniem, poprawia również koordynację ruchową oraz obciążanie kończyn dolnych potwierdzone lepszymi wynikami w skali GMFM.…”

“…They also observed statistically signifi cant decreasing of the average frequency of discharging of the motor units in the electromyographic evaluation of the lower limbs while using orthoses. According to Buckon et al [40] this phenomenon may testify that tiredness of the child which accompanies walking with this kind of equipment is smaller. In their opinion using AFO also improves motor coordination and loading of the lower limbs confi rmed by better results of GMFM.…”

“…Scientifi c reports based on few groups of patients with ICP concerning the usage of AFO indicate the benefi ts taking into account biomechanical aspect (based on three--dimensional analysis of the gait), energetic aspect (evaluated by means of spirometry and calorimetry) and most of all functional aspect (expressed by the gait and posture patterns) [35][36][37][38][39][40][41][42].…”