Effect of postural insoles on static and functional balance in children with cerebral palsy: A randomized controlled study

Abstract

BACKGROUND:Improved gait efficiency is one of the goals of therapy for children with cerebral palsy (CP). Postural insoles can allow more efficient gait by improving biomechanical alignment. OBJECTIVE:The aim of the present study was to determine the effect of the combination of postural insoles and ankle-foot orthoses on static and functional balance in children with CP. METHOD:A randomized, controlled, double-blind, clinical trial. After meeting legal requirements and the eligibility criteria, 20 children between four and 12 years of age were randomly allocated either to the control group (CG) (n=10) or the experimental group (EG) (n=10). The CG used placebo insoles and the EG used postural insoles. The Berg Balance Scale, Timed Up-and-Go Test, Six-Minute Walk Test, and Gross Motor Function Measure-88 were used to assess balance as well as the determination of oscillations from the center of pressure in the anteroposterior and mediolateral directions with eyes open and closed. Three evaluations were carried out: 1) immediately following placement of the insoles; 2) after three months of insole use; and 3) one month after suspending insole use. RESULTS:The EG achieved significantly better results in comparison to the CG on the Timed Up-and-Go Test as well as body sway in the anteroposterior and mediolateral directions. CONCLUSION:Postural insoles led to an improvement in static balance among children with cerebral palsy, as demonstrated by the reduction in body sway in the anteroposterior and mediolateral directions. Postural insole use also led to a better performance on the Timed Up-and-Go Test.

A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions

“…The second compared the same AFO across two different usage conditions (day wear vs. day-night wear) with 105 participants over 8 weeks [ 220 ]. Across the majority of the outcome measures reported by Christovao et al [ 219 ] no difference between the postural insoles and the placebo insoles was evident (6 minute walk test, Berg Balance Scale, centre of pressure measurement and GMFM-88). A significant very large effect sizes was evident for a reduction in the timed up and go test, ES: -1.4 (95% CI -0.05 to -2.75), indicating greater improvement for the postural insoles than the placebo insoles.…”

“…Two studies compared orthotic interventions (Category B), with one study comparing placebo to postural insoles [ 219 ] and reporting on 20 participants over 3 months. The second compared the same AFO across two different usage conditions (day wear vs. day-night wear) with 105 participants over 8 weeks [ 220 ].…”

“…Some of the RCTs examining foot orthoses has stated using placebo orthoses, with these studies using different terminology to describe these control interventions (flat/placebo/sham/control/neutral). This methodological approach was most common in the RCTs examining the effectiveness of foot orthoses in arthritis [ 33 , 38 , 42 , 49 , 51 , 54 ] but was also evident in RCTs examining foot orthotics in plantar fasciitis [ 161 , 164 ], diabetes [ 198 ] and cerebral palsy [ 219 ]. There is currently some debate in the literature about the use of control interventions in trials examining orthoses, with some researchers promoting their use [ 245 ] and others recommending that participants use their own footwear as a control condition [ 246 , 247 ].…”

Análise do equilíbrio postural estático e da intensidade das dores musculoesqueléticas após o uso de palmilhas proprioceptivas por militares do serviço ostensivo

“…Studies in which there are balance dysfunctions are needed 18 . Evidence shows significant reduction in body balance in children with cerebral palsy after insole use 19 .…”

Reliability of the Brazilian Portuguese version of the Gross Motor Function Measure in children with cerebral palsy

“…The original GMFM version has been used in Brazilian research studies mainly aimed at assessing the effects of interventions on the motor functions of children with CP 21 , 29 , 30 . The translation of the manual and evidence of reliability in the Brazilian population of children with CP will enable the use of this test to be expanded to research and clinical practice.…”