Affiliations: [a] School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany | [b] kbo-Kinderzentrum München, Munich, Germany | [c] Behandlungszentrum Aschau, Aschau im Chiemgau, Germany | [d] Department of Pediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany | [e] Center of Vertigo and Balance Disorders, IFBLMU, Ludwig-Maximilians-University Munich, Munich, Germany
Corresponding author: Nikolai H. Jung, School of Medicine, Social Pediatrics, Technical University of Munich, Heiglhofstr. 65, Munich, 81377, Germany. Tel.: +49 89 71009 236; Fax: +49 89 71009 253; E-mail: [email protected].
Abstract: PURPOSE: This study aims to evaluate the effectiveness of a prefabricated carbon-composite ankle foot orthoses (c-AFOs) on gait parameters in children with unilateral spastic cerebral palsy (USCP) exhibiting a drop foot pattern. METHODS: Sixteen ambulatory children with USCP and a drop foot pattern were included (mean age: 9 years; gross motor function classification system: I = 14, II = 2) and three-dimensional gait analysis was applied under randomly assigned conditions (barefoot; shoe; c-AFO). Kinematics, kinetics, time-distance parameters and gait indices were investigated. RESULTS: Effects on the drop foot pattern were investigated while the children walked in shoes only. The shoes already increased the maximum ankle dorsiflexion in swing (p= 0.004) and initiated more knee flexion during single support (p⩽ 0.013). Compared to shoe walking, the c-AFO led to additional benefits regarding further ankle dorsiflexion during swing (p⩽ 0.001) and initial contact (p< 0.001), ankle movement during loading response (p= 0.002), improved the sole angle during initial contact (p< 0.001) and during mid stance (p= 0.015). Plantarflexion and ankle power generation during push-off decreased when wearing the c-AFO (p⩽ 0.008). CONCLUSION: Investigated c-AFOs are beneficial for improving drop foot patterns in children with USCP. Significant effects on pathological barefoot pattern were already achieved with the child’s regular shoes. This could be considered in clinical decision processes. In comparison to shoe walking, c-AFO additionally improved foot clearance and normalized initial heel contact. The third rocker deteriorates with the c-AFO. Since kinematics improved with the orthoses during swing and early stance phase, c-AFOs might reduce tripping and falling caused by a drop foot during long distance walking.