Article

The aim of this study was to compare the effectiveness of treatment
with hinged ankle-foot orthoses (AFOs) during the day vs. during both the day and
the night in young ambulant children with spastic diplegia. DESIGN: In this
prospective randomized controlled trial, 112 ambulatory children (70 boys and 42
girls; mean age, 2 yrs 6.93 mos; range, 1 yr 1 mo to 4 yrs 0 mo) with spastic
diplegia participated. Forty-eight were classified at level I of the Gross Motor
Function Classification System; the remaining 64 were at level II. Using
stratified randomization, all children were assigned to either the day
AFO-wearing group (n = 56, wearing AFOs all day) or the day-night AFO-wearing
group (n = 56, wearing AFOs all day and all night). The two groups underwent
conventional rehabilitative treatments five times a week for 8 wks. The primary
outcomes measured were passive ankle dorsiflexion angle and sections D and E of
the 66-item Gross Motor Function Measure; the root mean square of surface
electromyography in the ventral and dorsal lower limb muscles was compared in a
subgroup (ten from each group). RESULTS: Seven children did not complete the full
intervention: three in the day AFO-wearing group and four in the day-night
AFO-wearing group. Significant baseline-postintervention improvements were found
for passive ankle dorsiflexion angle and the 66-item Gross Motor Function Measure
in both groups (P < 0.05). On the basis of the score changes, there was no
significant difference between these two groups with respect to passive ankle
dorsiflexion angle; however, the improvements in the 66-item Gross Motor Function
Measure were significantly better in the day AFO-wearing group (P < 0.01). A
significant root mean square decrease in gastrocnemius (P < 0.05) was present
after the intervention in the day AFO-wearing group, whereas the muscles affected
in the day-night AFO-wearing group were the gastrocnemius (P < 0.05) and the
tibialis anterior (P < 0.001). CONCLUSIONS: The results demonstrate that the
daytime use of AFOs was more effective in improving Gross Motor Function Measure
scores than the day-night use. In addition, the prolonged wearing of AFOs may
influence muscle activity, which should be monitored in the clinic.

Langue : ANGLAIS