The role of rigid and hinged polypropylene ankle-foot-orthoses in the management of cerebral palsy

Middleton, Elizabeth; Hurley, Grant; McIlwain, J. S.

doi:10.3109/03093648809079396

Cited by 54 publications

(24 citation statements)

References 10 publications

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“…These findings are consistent with Brodke and coworkers (1989) who reported decreased ankle movement during gait when solid AFOs were worn and other authors (Middleton et al 1988, Lough 1990) who documented more normal plantar/dorsiflexor muscle movements in the stance phase of gait when dynamic AFOs were used by children with CP.…”

Section: Different Orthotic Conditionssupporting

confidence: 91%

“…Investigation of the effectiveness of solid AFOs has been conducted in a variety of studies using single-subject and group-research designs (Mills 1984, Harris and Riffle 1986, Watt et al 1986, Middleton et al 1988, Brodke et al 1989, Embrey et al 1990, Lough 1990, Yamamoto et al 1990. Results of these studies suggest that solid AFOs increase standing balance duration (Harris and Riffle 1986) as well as increasing foot-floor contact and knee extension during the stance phase of gait (Mills 1984, Watt et al 1986, Embrey et al 1990).…”

mentioning

confidence: 99%

“…These include the hinged AFO, which is designed for anterior-posterior movement at the ankle (Cusick 1990), and the spiral AFO which combines controlled plantar-and dorsiflexion with transverse rotation between the tibia and foot (Lehneis 1972, Yamamoto et al 1993. Studies of the effect of dynamic AFO use in children with CP suggest positive changes in stance balance control during gait, including more normal plantar-and dorsiflexion and decreased knee muscle moments during the stance phase of gait (Middleton et al 1988, Lough 1990, and increased walking velocity (Lough 1990).…”

mentioning

confidence: 99%

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

Burtner

Woollacott

Qualls

1999

Dev Med Child Neurol

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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.

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Section: Different Orthotic Conditionssupporting

confidence: 91%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Burtner

Woollacott

Qualls

1999

Dev Med Child Neurol

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“…Uncertainty about which AFO configuration best achieves this outcome has led to a great variation in clinical practice. Prescription of AFO configurations that allow ankle dorsiflexion, such as the hinged AFO (HAFO) or posterior leaf spring (PLS), is based on the premise that ankle motion is essential for the performance of normal movement patterns and postural responses (Middleton et al 1988;Rethlefsen et al 1995Rethlefsen et al , 1999Wilson et al 1997). Conversely, AFO configurations that restrict ankle motion, such as the solid AFO (SAFO), are prescribed to stabilize the ankle joint in stance, control the position of the ground reaction force at the knee (Butler and Nene 1991), and improve proximal joint kinematics (Thomas et al 1989, Radka et al 1997, Abel et al 1998.…”

mentioning

confidence: 99%

Comparison of three ankle—foot orthosis configurations for children with spastic diplegia

Buckon¹,

Thomas²,

Jakobson-Huston³

et al. 2004

Develop Med Child Neuro

112

110

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This study compared the functional efficacy of three commonly prescribed ankle–foot orthosis (AFO) configurations (solid [SAFO], hinged [HAFO], and posterior leaf spring [PLS]). Sixteen independently ambulatory children (10 males, six females; mean age 8 years 4 months, SD 2 years 4 months; range 4 years 4 months to 11 years 6 months) with spastic diplegia participated in this study. Four children were classified at level I of the Gross Motor Function Classification System (GMFCS; Palisano et al. 1997); the remaining 12 were at level II. Children were assessed barefoot (BF) at baseline (baseline assessment of energy consumption was performed with shoes on, no AFO) and in each orthotic configuration after three months of use, using gait analysis, oxygen consumption, and functional outcome measures. AFO use did not markedly alter joint kinematics or kinetics at the pelvis, hip, or knee. All AFO configurations normalized ankle kinematics in stance, increased step/stride length, decreased cadence, and decreased energy cost of walking. Functionally, all AFO configurations improved the execution of walking/running/jumping skills, upper extremity coordination, and fine motor speed/dexterity. However, the quality of gross motor skill performance and independence in mobility were unchanged. These results suggest that most children with spastic diplegia benefit functionally from AFO use. However, some children at GMFCS level II demonstrated a subtle but detrimental effect on function with HAFO use, shown by an increase in peak knee extensor moment in early stance, excessive ankle dorsiflexion, decreased walking velocity, and greater energy cost. Therefore, constraining ankle motion by using a PLS or SAFO should be considered for most, but not all, children with spastic diplegia.

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“…Three AFO configurations frequently prescribed for children with spastic hemiplegia are the hinged AFO (HAFO), the posterior leaf spring AFO (PLS), and the solid AFO (SAFO). The HAFO, which allows free dorsiflexion in stance phase and limits plantarflexion to a pre-set level (usually 90°), has been noted to normalize ankle motion during the stance phase of gait and facilitate the performance of developmental motor skills (Middleton et al 1988, Rethlefsen et al 1995, Wilson et al 1997, Rethlefsen et al 1999. The PLS, which allows slight plantarflexion as well as dorsiflexion in stance because of its posterior trimline, has been reported to promote 'normal' ankle rocker function and create a more dynamic gait (Ounpuu et al 1996, Brunner et al 1998).…”

mentioning

confidence: 99%

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

Buckon¹,

Thomas²,

Jakobson-Huston³

et al. 2001

Dev Med Child Neurol

View full text Add to dashboard Cite

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 degree 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.

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The role of rigid and hinged polypropylene ankle-foot-orthoses in the management of cerebral palsy

Cited by 54 publications

References 10 publications

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

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

Comparison of three ankle—foot orthosis configurations for children with spastic diplegia

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

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