Stance balance control with orthoses in a group of children with spastic cerebral palsy

Abstract

Although ankle-foot orthoses (AFOs) are frequently prescribed to correct skeletal malalignment in children with spastic diplegia, their effect on standing balance abilities has not been documented. This study investigated balance differences related to the presence of pathology and orthotic conditions during conditions of unexpected stance perturbation by comparing four children aged between 3 1/2 and 15 years with spastic cerebral palsy and four control children matched for years of independent walking experience. Electromyographic and kinematic data were collected and compared between groups and in three orthotic conditions (no AFOs, solid AFOs, dynamic AFOs). Results revealed that balance responses of children with spasticity were characterized by: increased coactivation of muscles as opposed to distal to proximal recruitment, decreased presence of upright posture in stance, increased use of 'on-toes' strategies, and different sway characteristics compared with the typically developing children. In both groups of children, the use of solid AFOs during perturbed stance resulted in: decreased activation of gastrocnemius muscles, disorganized muscle-response patterns, decreased use of ankle strategies, and increased joint angular velocities at the knee compared with conditions without AFOs or with dynamic AFOs. These preliminary results support the use of dynamic AFOs to correct skeletal malalignment in children with spastic diplegia.

The effect of floor reaction ankle foot orthosis on postural control in children with spastic cerebral palsy

“…9 AFOs neither improve the static foot malalignment (to correct the line of GRF in ML plane) and nor organize muscle use. 12,14 These are the two main disruptions to postural control. 4,6 However, it appears that a FRAFO (one type of solid AFOs) failed to improve the two main areas of deficits in postural control.…”

“…The FRAFOs in this study were custom moulded made of 3-mm thickness polypropylene using a negative cast technique. 3,12 The proximal part of the brace extended to just below the fibular head and its footplate extended to the tips of the toes. 3 Gradual adjustment to alternator ankle hinges was used to reduce the crouch position over a four-week period ( Figure 1).…”

“…However, they were not successful in balancing muscle use in children with CP, who use an excessive degree of antagonist co-activation. 12 Rogozinski et al examined the efficacy of a FRAFO in children with CP and found improved knee extension in the sagittal plane. 9 Lucareli et al showed that a FRAFO can effectively improve the knee and ankle extension in children with spastic CP in the stance phase.…”

Efeitos do uso de órtese na mobilidade funcional de crianças com paralisia cerebral

“…A paralisia cerebral (PC) é uma condição que, freqüentemente, interfere na aquisição de habilidades motoras na infância, as quais são essenciais para o desempenho de atividades e tarefas da rotina diária 1,2,3,4 . A locomoção é uma das atividades motoras que, geralmente, apresenta-se alterada em crianças com PC, quando comparadas com crianças normais.…”

“…Nesse contexto, as órteses de posicionamento são, freqüentemente, utilizadas para auxiliar no tratamento de crianças portadoras de paralisia cerebral. O suporte mecânico oferecido pelas órteses suropodálicas, por exemplo, visa minimizar ou corrigir o padrão eqüino de marcha assumido por algumas destas crianças, proporcionando benefícios como a melhora da qualidade de deambulação e a prevenção de deformidades de tornozelo e pé 2,6 .…”