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How does applying of one or two orthosis influence gait parameters of children with hemiplegia?
Anna Boryczka-Trefler1, Małgorzata Syczewska1,2, Jolanta Stępowska1,2
1The Children's Memorial Health Institute, Warsaw, Poland.
Insights
This study examined how one versus two orthoses affect gait in children with hemiplegia. Results suggest instrumented gait analysis can guide decisions on prescribing one or two orthoses for hemiplegic cerebral palsy.
Area of Science:
- Pediatrics
- Biomechanical Engineering
- Rehabilitation Medicine
Background:
- Hemiplegic cerebral palsy (CP) significantly impacts gait due to neurological motor impairments.
- Orthotic devices are commonly used to improve gait in children with hemiplegia, but optimal prescription (unilateral vs. bilateral) remains debated.
- Understanding the influence of orthotic quantity on gait parameters is crucial for effective rehabilitation strategies.
Purpose of the Study:
- To evaluate the influence of wearing one versus two orthoses on specific gait parameters in children with hemiplegia.
- To compare gait characteristics between unilateral and bilateral orthotic use in this population.
- To determine the utility of objective gait analysis in guiding orthotic prescription for hemiplegic CP.
Main Methods:
- Four children (3-7 years old) with hemiplegic CP underwent VICON MX motion capture gait analysis.
- Gait was assessed in three conditions: bare feet, unilateral orthoses, and bilateral orthoses.
- Key gait parameters analyzed included velocity, cadence, pelvic motion, step length, stance time, and joint range of motion (hip, knee).
Main Results:
- Wearing one versus two orthoses resulted in quantifiable changes in several gait parameters.
- The study did not definitively establish whether one or two orthoses yielded superior gait outcomes.
- Specific parameters were identified as being affected differently by unilateral versus bilateral orthotic use.
Conclusions:
- Objective, instrumented gait analysis provides valuable data for clinical decision-making regarding orthotic prescription in hemiplegic CP.
- The findings suggest a personalized approach, informed by gait analysis, is necessary to determine the optimal number of orthoses for individual patients.
- Further research with larger cohorts is warranted to establish clearer guidelines on unilateral versus bilateral orthotic use in pediatric hemiplegia.
Abstract:
The aim of this study was to evaluate how wearing one or two orthoses influence the gait parameters in children with hemiplegia. Four children with hemiplegic cerebral palsy participated in the study. Patients were from 3 to 7 years old; one girl and three boys; one patient with right side hemiplegia, three patients with left side hemiplegia. Patients underwent the VICON MX system gait analysis three times (sessions): one with bare feet, the other two with shoes and orthoses: one with orthoses used unilaterally on palsied limb, one with orthoses used bilaterally. The following gait parameters were analyzed: velocity, cadence, pelvis tilt, range of pelvic movement in sagittal plane, separately for affected and non-affected side: step length, stance time (as a percentage of the gait cycle), range of hip movement in sagittal plane, knee flexion at initial contact, maximum knee flexion in swing phase. Results of the study showed which and how many gait parameters changed while wearing one in comparison with two orthoses. The results did not give a clear indication which condition is better: wearing one or two orthoses, however they suggest that when the orthotic devices are considered for patients with hemiplegic cerebral palsy, the objective, instrumented gait analysis can be used to take the best decision whether one or two orthoses should be prescribed.
