The biomechanical optimisation (tuning) of the Ankle Foot Orthosis - Footwear Combination (AFO-FC) of children with Cerebral Palsy - the effects on sagittal gait characteristics, muscle and joint characteristics and quality of life.
Jagadamma, K. (2010) The biomechanical optimisation (tuning) of the Ankle Foot Orthosis - Footwear Combination (AFO-FC) of children with Cerebral Palsy - the effects on sagittal gait characteristics, muscle and joint characteristics and quality of life., no. 411.
The current study aimed to investigate influences of rigid Ankle Foot Orthoses (AFOs) on gait in children with Cerebral Palsy (CP), immediate effects of tuning of AFO-FC (AFO-Footwear Combination) on gait of children with CP, short-term effects of tuning of AFO-FC on gait, muscle and joint characteristics and quality of life in children with CP, and the feasibility of conducting a larger trial. The study included 11 healthy children and 8 children with CP. Outcome measurements included sagittal plane kinematics and kinetics derived using 3D motion analysis, Gait Deviation Index (GDI), physical examination, and quality of life using the PedsQL™ questionnaire. Data from healthy children demonstrated influences of shoes on gait parameters and the role of the ankle joint in adapting to various wedges and rockers during gait. When studying children with CP, beneficial effects of rigid AFO-FC on gait parameters were evident; these were thought to relate to the appropriateness of the AFO-FC and familiarisation with the prescription. Immediate effects of tuning varied according to gait patterns previously demonstrated with non-tuned AFO-FC; benefits to knee kinematics and kinetics were largely seen in legs with extended knee gait, followed by jump knee gait, and with poorest responses in legs with crouch knee gait. Short-term effects of tuning were evident when comparing measurements taken before and after two-to-four months of wearing the tuned AFO-FC. Barefoot walking demonstrated significantly improved walking speed. Stride-length improved when comparing tuned AFO-FC at baseline with the tuned AFO-FC following the intervention period. No short-term changes were seen in PedsQL™ scores, muscle and joint characteristics, and GDI. Feasibility issues were also identified. It was concluded from this exploratory trial that tuning of AFO-FC improved gait for children with CP, although initial gait pattern affected the amount of benefit. This was evident immediately after tuning and some parameters improved further after short-term intervention. A randomised controlled trial is required; power analysis indicates the need for a larger sample of 18 in each group to detect change in GDI with a medium effect size and at a power of 0.8 and p <0.05.