Article

Floor reaction ankle-foot orthoses are commonly prescribed to improve
knee extension of children with cerebral palsy having crouch gait. Their effectiveness is debated. Therefore, the objective of this study is to optimize
current prescription criteria for the improvement of crouch gait. STUDY DESIGN:
Cross-sectional interventional study. METHODS: A total of 22 patients with
bilateral spastic cerebral palsy, between 6 and 17 years, Gross Motor Function
Classification System II-IV participated in this study. Instrumented gait
analysis was done under three conditions: barefoot, shoed, and with orthotics.
Patients were divided into two groups: good and non-responders with more and less
than 8.8 degrees improvement of knee extension during walking, respectively. A
multiple predictor analysis was done on parameters that were different between
groups. RESULTS: In total, 12 of 22 patients showed good response in knee
extension with a mean change of 17 degrees (standard deviation = 5 degrees ).
Good responders showed a significantly smaller walking velocity, knee extension
strength, ankle plantarflexion strength, and greater external foot progression
angle compared to non-responders. Foot progression angle together with ankle
plantarflexion strength explained 37% of the variance in improvement of knee
extension. CONCLUSION: With appropriate patient selection, an improvement of
crouch gait by ankle-foot orthoses of 17 degrees (standard deviation = 5 degrees
) can be expected. Patients with slow velocity, weak plantarflexors, and external
foot progression benefit most. Joint contractures were no contraindications.
Clinical relevance This study showed that gait in patients with low functional
level benefit most from ankle-foot orthoses. Unlike in patients with higher
functional status, contractures of hip, knee, and ankle did not reduce the
positive effects on gait. The suggested prescription criteria may help to better
select appropriate patients for orthotics.

Langue : ANGLAIS