Effect of Hinged Ankle-Foot Orthoses on Standing Balance Control in Children with Bilateral Spastic Cerebral Palsy Comparison of three ankle-foot orthosis configurations for children with spastic diplegia. The Effect of Ankle-Foot Orthoses on Community-Based Walking in Cerebral Palsy: A Clinical Pilot Study The effects of fixed and articulated ankle-foot orthoses on gait patterns in subjects with cerebral palsy. Comparison of three ankle-foot orthosis configurations for children with spastic hemiplegia. A comparison of gait with solid, dynamic, and no ankle-foot orthoses in children with spastic cerebral palsy. Comparison of 2 Orthotic Approaches in Children With Cerebral Palsy The Effect of Dynamic Ankle Foot Orthoses on Function in Children With Cerebral Palsy The effect of hinged ankle-foot orthoses on sit-to-stand transfer in children with spastic cerebral palsy. How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study. Reliability of the PEDro scale for rating quality of randomized controlled trials. Relation of stride activity and participation in mobility-based life habits among children with cerebral palsy. Use of orthoses lowers the O(2) cost of walking in children with spastic cerebral palsy. The efficacy of tone-reducing features in orthotics on the gait of children with spastic diplegic cerebral palsy. Orthotic management of gait in spastic diplegia.
Purpose To identify the characteristics of static st and ing balance and its postural control mechanisms during quiet side-by-side st and ing and the changes in these measures whilst wearing hinged ankle-foot orthoses ( AFOs ) in children with bilateral spastic cerebral palsy ( CP ) . Material s and Methods Twenty-one children with bilateral spastic CP ( 6.10 ± 1.09 year-old ) and 22 typically developing ( TD ) children ( 5.64 ± 0.49 year-old ) were recruited .  Pressure data were recorded while subjects with or without AFOs stood on dual force platforms and net body center of pressure ( CoP ) coordinates were calculated from this data . Net body CoP was traced for measuring mediolateral ( ML ) and anteroposterior ( AP ) displacement and path length per second . Correlation coefficients between parameters representing ankle , hip , and transverse body rotation strategies were also analyzed . Results ML and AP displacement and path length per second of the CoP trajectory were higher in children with CP compared to TD children ( p < 0.05 ) . There were no significant improvements in these parameters whilst wearing hinged AFOs . Compared to TD children , children with CP used less ankle strategy though more hip and transverse rotation strategies for postural control during quiet st and ing . Whilst wearing hinged AFOs , the contribution of ankle strategy was significantly increased for ML balance control in children with CP ( p < 0.05 ) . Conclusion Hinged AFOs for children with CP may be helpful in improving the postural control mechanisms but not the postural stability in quiet side-by-side st and ing 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 Purpose : To examine the effect of ankle-foot orthoses ( AFO ) on walking activity in children with cerebral palsy ( CP ) . Methods : We used a r and omized cross-over design with 11 children with bilateral CP , mean age 4.3 years . Subjects were r and omized to current AFO-ON or AFO-OFF for 2 weeks and then crossed over . Walking activity ( average total steps/day ) , intensity , and stride rate curves were collected via an ankle accelerometer . Group effects were examined with the Wilcoxon signed-rank test and within-subject effects examined for more than 1 st and ard deviation change . Results : No significant group difference was found in average total daily step count between treatment conditions ( P = .48 ) . For the AFO-ON condition , 2 subjects ( 18 % ) increased total steps/day ; 4 ( 36 % ) increased walking time ; 2 ( 18 % ) had more strides at a rate of more than 30 strides/min ; and 2 ( 18 % ) reached higher peak intensity . Conclusions : Clinical ly prescribed AFO/footwear did not consistently enhance walking activity levels or intensity . Larger studies are warranted Twenty-one subjects with spastic diplegic cerebral palsy were studied to quantify the effects of fixed and articulated ankle-foot orthoses ( AFOs ) on gait and delineate criteria for their use . Children underwent gait analysis under three conditions , fixed AFOs ( FAFOs ) , articulated AFOs ( AAFOs ) , and shoes alone . Greater dorsiflexion occurred at initial contact with both FAFOs and AAFOs than shoes alone . Dorsiflexion at terminal stance was greatest in AAFOs . Plantarflexor power generation at preswing was preserved in AAFOs . No differences were found in knee position during stance . Knee-extensor strength was positively related to knee extension during stance . No relationships were found between dorsiflexion range of motion , calf spasticity and strength , and peak dorsiflexion during stance .  AAFOs are appropriate for subjects with varying degrees of calf spasticity , as long as adequate passive range of motion is available . These findings can be applied primarily to children who do not have a preexisting tendency to crouch 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 BACKGROUND AND PURPOSE This study compared the effects of dynamic ankle-foot orthoses ( DAFOs ) with a plantar-flexion stop , polypropylene solid ankle-foot orthoses ( AFOs ) , and no AFOs on the gait of children with cerebral palsy ( CP ) . These orthoses were used to reduce the excessive ankle plantar flexion during the stance phase of gait . SUBJECTS AND METHODS Ten children with spastic CP ( 6 with diplegia and 4 with hemiplegia ) were tested after wearing no AFOs for an initial 2-week period , solid AFOs for 1 month , no AFOs for an additional 2 weeks , and DAFOs for 1 month . The effects of the two orthoses and no AFOs on lower-extremity muscle timing , joint motions , and temporal-distance characteristics were compared . RESULTS Both orthoses  increased stride length , decreased cadence , and reduced excessive ankle plantar flexion when compared with no orthoses . No differences were found for the gait variables when comparing the two orthoses . CONCLUSION AND DISCUSSION Based on the data , the authors believe that although both orthoses would be recommended for children with spastic CP and excessive ankle plantar flexion during stance , additional individual factors should be considered when selecting either orthosis Purpose : To compare dynamic ankle-foot orthoses ( DAFOs ) and adjustable dynamic response ( ADR ) ankle-foot orthoses ( AFOs ) in children with cerebral palsy . Methods : A total of 10 children with cerebral palsy ( 4 - 12 years ; 6 at Gross Motor Function Classification System level I , 4 at Gross Motor Function Classification System level III ) and crouch and /or equinus gait wore DAFOs and ADR-AFOs , each for 4 weeks , in r and omized order . Laboratory-based gait analysis , walking activity monitor , and parent-reported question naire outcomes were compared among braces and barefoot conditions . Results : Children demonstrated better stride length ( 11 - 12 cm ) , hip extension ( 2 ° -4 ° ) , and swing-phase dorsiflexion ( 9 ° -17 ° ) in both braces versus barefoot . Push-off power ( 0.3 W/kg ) and knee extension ( 5 ° ) were better in ADR-AFOs than in DAFOs . Parent satisfaction and walking activity ( 742 steps per day , 43 minutes per day ) were higher for DAFOs . Conclusions : ADR-AFOs  produce better knee extension and push-off power ;  DAFOs produce more normal ankle motion , greater parent satisfaction , and walking activity . Both braces provide improvements over barefoot Dynamic ankle-foot orthoses ( DAFOs ) , with free plantarflexion , are frequently prescribed to facilitate the gross motor skills of children with cerebral palsy . Employing a r and omized crossover design , this project documents the short-term effect of DAFOs in 23 ambulatory children with cerebral palsy aged 1.9 to 7.3 years . Significant improvements in crawling/kneeling , st and ing , and walking/running and jumping skills , as measured by using the Gross Motor Function Measure ( GMFM ) 88 and 66 , were documented ( P < 0.001 ) . Increased motor skills with the use of DAFOs were mildly correlated with the leg length of the participants . Increasing age was negatively correlated with st and ing skill improvement while wearing the DAFOs .  Young children who are independent walkers seem to benefit greater from the DAFOs with free plantarflexion than do children using assistive devices . Future research needs to clarify the long-term influence of the use of DAFOs on gross motor skill acquisition in young children with cerebral palsy OBJECTIVE To investigate the effectiveness of the hinged ankle-foot orthosis ( AFO ) on sit-to-st and ( STS ) transfers in children with spastic cerebral palsy . DESIGN Before-after trial . SETTING University-affiliated hospital . PARTICIPANTS Nineteen spastic diplegic children ( age range , 2 - 6 y ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The transitional movement of STS was tested in r and om order with children while wearing the barefoot and hinged AFOs . The temporal , kinematic , and kinetic data during the task were collected by using a motion analyzer ( with 6 infrared cameras ) . Statistical comparison between barefoot and hinged AFO was done with the Wilcoxon signed-rank test . RESULTS Total duration of STS transfer was significantly shortened with the hinged AFO ( P < .05 ) . The initial knee flexion , the initial angle , and the final angle of ankle dorsiflexion were increased with the AFO , compared with when barefoot ( P < .05 ) . However , the increased pelvic tilt and hip flexion while barefoot was not reduced with the AFO . The maximal moment and power of hip and knee joints were significantly increased with the AFO ( P < .05 ) , whereas the maximal moment and power of the ankle joint were not significantly changed when wearing the AFO . CONCLUSIONS Although proximal compensatory strategy of increased pelvic tilt and hip flexion did not change with the hinged AFO , some improvements of temporal , kinematic , and kinetic parameters were identified during the task . These findings suggest that a hinged AFO is beneficial for STS transfer activity for children with spastic diplegia Several studies indicated that walking with an ankle foot orthosis ( AFO ) impaired third rocker . The purpose of this study was to evaluate the effects of two types of orthoses , with similar goal setting s , on gait , in a homogeneous group of children , using both barefoot and shoe walking as control conditions . Fifteen children with hemiplegia , aged between 4 and 10 years , received two types of individually tuned AFOs : common posterior leaf-spring ( PLS ) and Dual Carbon Fiber Spring AFO ( CFO ) ( with carbon fibre at the dorsal part of the orthosis ) . Both orthoses were expected to prevent plantar flexion , thus improving first rocker , allowing dorsiflexion to improve second rocker , absorbing energy during second rocker , and returning it during the third rocker . The effect of the AFOs was studied using objective gait analysis , including 3D kinematics , and kinetics in four conditions : barefoot , shoes without AFO , and PLS and CFO combined with shoes . Several gait parameters significantly changed in shoe walking compared to barefoot walking ( cadence , ankle ROM and velocity , knee shock absorption , and knee angle in swing ) . The CFO produced a significantly larger ankle ROM and ankle velocity during push-off , and an increased plantar flexion moment and power generation at pre-swing compared to the PLS ( < 0.01 ) . The results of this study further support the findings of previous studies indicating that orthoses improve specific gait parameters compared to barefoot walking ( velocity , step length , first and second ankle rocker , sagittal knee and hip ROM ) . However , compared to shoes , not all improvements were statistically significant BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To examine the relation between walking performance and participation in mobility-related habits of daily life in children with cerebral palsy ( CP ) . To date , walking outcomes in CP have been capacity-based ( what a child does in structured setting ) . Physical activity performance ( what a child really does in daily life ) has been documented to affect the relation of capacity-based gross motor measures and participation . DESIGN Cross-sectional prospect i ve cohort study . SETTING Regional pediatric specialty care centers . PARTICIPANTS A cohort of ambulatory children with CP ( N=128 ; age , 2 to 9y ; 41 % girls ; 49 % having hemiplegia ) participated . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  Walking performance was quantified from a 5-day sample of accelerometry data . Stride activity was summarized through the outcomes of the average number of total strides per day ( independent of intensity ) and the average number of total strides per day at > 30 strides/min ( marker of intensity ) . Mobility-based participation was assessed by using the Assessment of Life Habits for Children question naire categories of personal care , housing , mobility , and recreation . Regression models were developed controlling for sex , age , cognition , communication , pain , and body composition . RESULTS The average number of total strides per day was positively associated with the personal care , housing , mobility , and recreation Assessment of Life Habits for Children question naire categories ( β=.34-.41 , P<.001 ) . The average number of total strides per day at > 30 strides/min was associated with all categories ( β=.54-.60 , P<.001 ) . CONCLUSIONS Accelerometry-based walking activity performance is significantly associated with levels of participation in mobility-based life habits for ambulatory children with CP . Evaluation of other factors and the direction of the relation within the International Classification of Functioning , Disability and Health is warranted to inform rehabilitation strategies PURPOSE The aim of this study was to assess the effects of hinged ankle foot orthoses ( AFO ) on the metabolic and cardiopulmonary cost of walking and gross motor skills of children with cerebral palsy ( CP ) . METHODS Ten habitual users of hinged AFO with spastic diplegic CP ( 9.01 yr + /- 2.10 ) participated in the study . Expired gas and heart rate ( HR ) were measured during sitting and with AFO on and off during steady state treadmill walking at three speeds : 3 km.h(-1 ) , comfortable walking speed ( CWS ) , and 90 % of their fastest walking speed ( FWS ) . Comfortable and fastest ground walking speed and Gross Motor Function Measure scores were also assessed with AFO on and off and analyzed with ANOVA . Because not all children could walk at all speeds on the treadmill , an ANOVA was performed on data for children who walked at 3 km.h(-1 ) and CWS ( N = 8 for HR ; N = 9 for pulmonary ventilation and metabolic variables ) and a t-test on data at 90 % of FWS ( N = 9 for HR ; N = 8 for pulmonary ventilation and metabolic variables ) . RESULTS When children wore their AFO net oxygen uptake ( L.min(-1 ) , absolute -- sitting values ) was significantly ( P < 0.05 ) reduced by 8.9 % at 3 km.h(-1 ) and by 5.9 % at 90 % of FWS . Net pulmonary ventilation ( L.min(-1 ) ) was significantly ( P < 0.05 ) lower with AFO on by 10.3 % but only at 3 km.h(-1 ) . AFO did not affect net HR ( beats.min(-1 ) ) nor the respiratory exchange ratio at any speed , nor any physiologic variable at CWS , nor gross motor skills . CONCLUSIONS Use of hinged AFO reduces the oxygen and ventilatory cost of walking in children with spastic diplegic CP This study analyzed the effects of tone-reducing features in ankle-foot orthotics ( AFOs ) on the gait of eight children ( ages 4 - 11 years ) with spastic diplegic cerebral palsy . A st and ard gait analysis was performed on each subject in each of three trial orthotics and in a baseline shoes-only condition . A 4-week accommodation period was allotted for each of the three devices : a st and ard hinged AFO , an AFO with tone-reducing features , and a supramalleolar orthotic with tone-reducing features . Most significant differences were at the ankle , between free-ankle and plantar flexion-limiting conditions . No significant functional changes in gait were evident with the addition of tone-reducing properties to a st and ard articulating AFO Orthoses are the primary conservative treatment option for control of dynamic equinus in spastic cerebral palsy . Our purpose was to compare the effects of a fixed ankle-foot orthosis ( AFO ) , a supramalleolar orthosis ( SMO ) , and a no-brace condition , but including shoes .  Gait analyses were performed on 11 children with spastic diplegia , using a system with four cameras and two concealed force plates . Ensemble averages of time-distance , kinematic , and kinetic parameters were obtained for each condition , and a repeated measures analysis of variance was performed ( P < 0.05 ) . Among the important findings were as follows : ( 1 ) AFOs significantly reduced ankle excursion , increased dorsiflexion angle at foot strike , increased plantar flexion moment in push-off , decreased ankle power absorbed during loading response , and decreased ankle power generated in push-off ; ( 2 ) SMOs  did not restrict ankle range of motion or significantly alter the power and moment values at the ankle joint . Although neither brace changed stride length and walking speed , AFOs did offer some biomechanical benefits to the child with spastic diplegia , whereas SMOs appeared to have very little measurable effect
Objective : To determine the effects of ankle-foot orthoses ( AFOs ) on gait , balance , gross motor function and activities of daily living in children with cerebral palsy .