Mf. Abel et al., GAIT ASSESSMENT OF FIXED ANKLE-FOOT ORTHOSES IN CHILDREN WITH SPASTICDIPLEGIA, Archives of physical medicine and rehabilitation, 79(2), 1998, pp. 126-133
Objective: To evaluate the effectiveness of ankle-foot orthoses (AFOs)
in spastic diplegic cerebral palsy patients for whom orthoses were in
dicated to control equinus or pes planovalgus deformities. Design: A r
etrospective, crass-sectional assessment was performed on diplegic sub
jects who had suitable barefoot and AFO gait trials on the same day. P
atients: Thirty-five subjects with a mean age of 8.7 yrs were included
. Eighteen wore braces to control equinus and 17 to control pes planov
algus and crouch. Outcome Measures: Gait data assessed in all subjects
included temporal-distance factors and sagittal kinematics. Force pla
te data to determine joint moments and powers were obtained in 20. Rep
eated measures analysis of variance was used to compare across conditi
ons and indications. Results: The cohort demonstrated increased veloci
ty (10cm/ sec; p < .001), stride length (10cm; p < .001), and percent
single-limb support (1.8%; p < .002) using AFOs compared with barefoot
gait, In braces, ankle excursion was reduced (p < .0001), while pelvi
c, hip, and knee excursions were increased to account fur the temporal
changes (p < .009). Effects were similar in both indication groups. I
n neither indication group did the AFO significantly alter knee positi
on in stance. Kinetic analysis showed a reduction of abnormal power bu
rst (p < .05) in early stance and an increase in late stance ankle mom
ent (p < .05) with AFOs. Differences in gait characteristics and braci
ng effects are shown ibr both indication groups. Conclusion: Compared
with barefoot gait, AFOs enhanced gait function in diplegic subjects.
Benefits resulted from elimination of premature plantar flexion and im
proved progression of foot contact during stance. Effects on proximal
joint alignment were not significant. (C) 1998 by the American Congres
s of Rehabilitation Medicine and the American Academy of Physical Medi
cine and Rehabilitation.