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Long-Term Effects of Orthoses Use on the Changes of Foot and Ankle Joint Motions of Children With Spastic Cerebral Palsy

Orthoses commonly are prescribed to children with cerebral palsy (CP)
to provide foot correction and to improve ambulatory function. Immediate effects
of ankle foot orthosis (AFOs) have been investigated,
but long-term kinematic
effects are lacking clinical evidence. OBJECTIVE: To determine changes in
3-dimensional ankle and foot segment motion in pediatric patients with CP between
initial and follow-up visits (18-month average time differences) in both barefoot
gait and gait with their AFO.
We also investigated intravisit changes between
barefoot and AFO gait. DESIGN: A prospective cohort study. SETTING: Children's
Hospital of Wisconsin, Department of Orthopaedic Surgery, Medical College of
Wisconsin. PATIENTS: A total of 23 children with CP, mean age 10.5 years
(6.2-18.1 years) were clinically prescribed either a solid ankle foot orthotic
(SAFO), hinged ankle foot orthotic (HAFO), or supramalleolar orthotic. METHODS:
Holes were cut in the study orthoses so that electromagnetic markers could be
directly placed on the skin. A 6-foot segment model was used. OUTCOME
MEASUREMENTS: Kinematic and kinetic data were recorded for each patient's initial
and follow-up visit (18-month follow-up average, 15-20 months range). RESULTS:
For the SAFO group (gait with AFO), a significant decrease in dorsiflexion was
found between the initial and third visit (P = .008). Furthermore, the SAFO group
(barefoot gait) had an increased eversion at the midfoot for most of the gait
cycle (P < .008). Sagittal forefoot range of motion was reduced for all 3 groups
between the barefoot and AFO groups. CONCLUSION:
The use of AFOs long term either
maintained or improved foot deformities or dysfunction.
LEVEL OF EVIDENCE: Level II.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS

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