ORTHOTIC MANAGEMENT OF GAIT IN SPASTIC DIPLEGIA

Orthoses are the primary conservative treatment option for control of dynamic equinus in spastic cerebral palsy. Our purpose was to compare the effects of a fixed ankle-foot orthosis (AFO), a supramalleolar ort hosis (SMO), and a no-brace condition, but including shoes. Gait analy ses were performed on 11 children with spastic diplegia, using a syste m with four cameras and two concealed force plates. Ensemble averages of time-distance, kinematic, and kinetic parameters were obtained for each condition, and a repeated measures analysis of variance was perfo rmed (P < 0.05). Among the important findings were as follows: (1) AFO s significantly reduced ankle excursion, increased dorsiflexion angle at foot strike, increased plantar flexion moment in push-off, decrease d ankle power absorbed during loading response, and decreased ankle po wer generated in push-off; (2) SMOs did not restrict ankle range of mo tion or significantly alter the power and moment values at the ankle j oint. Although neither brace changed stride length and walking speed, AFOs did offer some biomechanical benefits to the child with spastic d iplegia, whereas SMOs appeared to have very little measurable effect.