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The Effect of Ankle-Foot Orthoses on Community-Based Walking in Cerebral Palsy: A Clinical Pilot Study
Kristie Bjornson1, Chuan Zhou, Stefania Fatone
1Seattle Children's Research Institute (Drs Bjornson and Zhou and Ms Rashid), University of Washington, Seattle, Washington; Northwestern Prosthetics Research Laboratory and Rehabilitation Engineering Research Program and Physical Medicine and Rehabilitation Department (Dr Fatone), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Orthocare Innovations (Dr Orendurff), Mountlake Terrace, Washington; Division of Developmental and Behavioral Pediatrics (Dr Stevenson), Department of Pediatrics, University of Virginia, Charlottesville, Virginia.
Insights
Ankle-foot orthoses (AFO) did not significantly improve walking activity in children with cerebral palsy (CP). Further research is needed to determine if AFOs enhance daily step count or walking intensity in this population.
Area of Science:
- Pediatric rehabilitation
- Biomechanical engineering
- Neurology
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting motor function.
- Ankle-foot orthoses (AFOs) are frequently prescribed to improve gait and mobility in children with CP.
- The impact of AFOs on objective measures of walking activity requires further investigation.
Purpose of the Study:
- To evaluate the effect of wearing ankle-foot orthoses (AFOs) on daily walking activity in children diagnosed with cerebral palsy (CP).
- To assess changes in walking intensity and stride characteristics with and without AFO use.
Main Methods:
- A randomized cross-over study design was employed with 11 children with bilateral CP (mean age 4.3 years).
- Participants alternated between wearing AFOs (AFO-ON) and not wearing AFOs (AFO-OFF) for two-week periods.
- Walking activity, including daily steps, intensity, and stride rate, was objectively measured using ankle accelerometers.
Main Results:
- No statistically significant difference was observed in the average total daily step count between the AFO-ON and AFO-OFF conditions (P = .48).
- A minority of participants showed improvements: 18% increased daily steps, 36% increased walking time, and 18% demonstrated increased stride rate or peak intensity while wearing AFOs.
Conclusions:
- Current clinical AFO prescriptions did not consistently lead to enhanced walking activity or intensity in children with CP.
- The findings suggest that AFOs may not universally improve objective measures of walking in this population.
- Larger-scale studies are recommended to further elucidate the role and efficacy of AFOs in pediatric CP gait.
Purpose:
To examine the effect of ankle-foot orthoses (AFO) on walking activity in children with cerebral palsy (CP).
Methods:
We used a randomized cross-over design with 11 children with bilateral CP, mean age 4.3 years. Subjects were randomized 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 standard 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:
Clinically prescribed AFO/footwear did not consistently enhance walking activity levels or intensity. Larger studies are warranted.
