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Comparison of 2 Orthotic Approaches in Children With Cerebral Palsy
Tishya A L Wren1, James W Dryden, Nicole M Mueske
1Children's Orthopaedic Center (Drs Wren and Rethlefsen, and Ms Mueske, Dennis, and Healy), Children's Hospital Los Angeles, Los Angeles, California; Department of Radiology (Dr Wren), Children's Hospital Los Angeles, Los Angeles, California; Department of Biomedical Engineering (Dr Wren), University of Southern California, Los Angeles, California; Orthopliance Group (Mr Dryden), North Hollywood, California; Division of Pediatric Rehabilitation Medicine (Ms Dennis and Healy, and Dr Rethlefsen), Children's Hospital Los Angeles, Los Angeles, California.
Insights
Dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy both improve gait. ADR-AFOs enhance knee extension, while DAFOs increase parent satisfaction and walking activity.
Area of Science:
- Biomedical Engineering
- Orthotics and Prosthetics
- Pediatric Rehabilitation
Background:
- Cerebral palsy (CP) often results in gait abnormalities like crouch and equinus.
- Ankle-foot orthoses (AFOs) are commonly used to manage these gait deviations in children with CP.
- Dynamic AFOs offer potential for improved gait mechanics and functional outcomes.
Purpose of the Study:
- To compare the efficacy of dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy.
- To evaluate the impact of DAFOs and ADR-AFOs on gait parameters, walking activity, and parent satisfaction.
Main Methods:
- A randomized crossover study involving 10 children with cerebral palsy (ages 4-12) with crouch and/or equinus gait.
- Participants wore DAFOs and ADR-AFOs for 4 weeks each, with barefoot condition as a control.
- Gait analysis, walking activity monitoring, and parent questionnaires were used for outcome assessment.
Main Results:
- Both DAFOs and ADR-AFOs improved stride length, hip extension, and swing-phase dorsiflexion compared to barefoot walking.
- ADR-AFOs demonstrated superior improvements in push-off power and knee extension.
- DAFOs resulted in higher parent satisfaction and increased daily walking activity (steps and duration).
Conclusions:
- Adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) enhance knee extension and push-off power in children with cerebral palsy.
- Dynamic ankle-foot orthoses (DAFOs) promote more normalized ankle motion, greater parent satisfaction, and increased walking activity.
- Both DAFOs and ADR-AFOs offer significant benefits for children with cerebral palsy compared to no orthotic intervention.
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 randomized order. Laboratory-based gait analysis, walking activity monitor, and parent-reported questionnaire 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.
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