Article

Ankle-Foot Orthoses (AFOs) are commonly prescribed to promote gait in children
with cerebral palsy (CP).
The AFO prescription process is however largely
dependent on clinical experience, resulting in confusing results regarding
treatment efficacy. To maximize efficacy, the AFO's mechanical properties should
be tuned to the patient's underlying impairments. This study aimed to investigate
whether the efficacy of a ventral shell AFO (vAFO) to reduce knee flexion and
walking energy cost could be improved by individually optimizing AFO stiffness in
children with CP walking with excessive knee flexion. Secondarily, the effect of
the optimized vAFO on daily walking activity was investigated. Fifteen children
with spastic CP were prescribed with a hinged vAFO with adjustable stiffness.
Effects of a rigid, stiff, and flexible setting on knee angle and the net energy
cost (EC) [Jkg(-1)m(-1)] were assessed to individually select the optimal
stiffness. After three months, net EC, daily walking activity [stridesmin(-1)]
and knee angle [deg] while walking with the optimized vAFO were compared to
walking with shoes-only. A near significant 9% (p=0.077) decrease in net EC
(-0.5Jkg(-1)m(-1)) was found for walking with the optimized vAFO compared to
shoes-only. Daily activity remained unchanged. Knee flexion in stance was reduced
by 2.4 degrees (p=0.006). These results show that children with CP who walk with
excessive knee flexion show a small, but significant reduction of knee flexion in
stance as a result of wearing individually optimized vAFOs. Data suggest that
this also improves gait efficiency for which an individual approach to AFO
prescription is emphasized.
CI - Copyright (c) 2016 Elsevier B.V. All rights reserved.

Langue : ANGLAIS