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Effects of Orthoses on Standing Postural Control and Muscle Activity in Children With Cerebral Palsy
Rebecca Leonard1, Jane Sweeney, Diane Damiano
1Early Intervention Associates (Dr Leonard), Rockville, Maryland; Doctoral Programs in Pediatric Science (Dr Sweeney), Rocky Mountain University of Health Professions, Provo, Utah; Functional and Applied Biomechanical Lab at National Institutes of Health (Dr Damiano), NIH Bethesda, Maryland; School of Medicine (Dr Bjornson), University of Washington, Seattle, Washington; Marymount University Program in Physical Therapy (Dr Ries), Marymount University, Arlington, Virginia.
Purpose:
This exploratory study assessed postural control and muscle activity in children with cerebral palsy while standing barefoot (BF), in prescribed ankle-foot orthoses (AFOs) and in distal control orthoses (DCOs), which stabilized foot-ankle and deliberately aligned the shank.
Methods:
This within-subject study evaluated 10 participants, Gross Motor Functional Classification System level III, across the 3 ankle-foot conditions in: (1) static standing duration and (2) modified Clinical Test of Sensory Interaction on Balance with electromyography (EMG) on 7 muscles.
Results:
Participants had significantly decreased center of gravity (COG) velocity sway in DCO versus BF and AFO, decreased loss of balance (LOB), and increased standing for DCO versus BF. DCO had minimal effect on EMG activity.
Conclusions:
DCO provided significant stabilizing effects on COG sway velocity, standing duration, and LOB. DCO may be effective in balance training. It is unclear whether benefit was derived from stabilization of the ankle joint, the resultant shank alignment, or both.
