Comparison of three ankle-foot orthosis configurations for children with spastic hemiplegia

The purpose of this study was to examine the effectiveness of the hinged an kle-foot orthosis (HAFO), posterior leaf spring (PLS), and solid ankle-foot orthosis (SAFO), in preventing contracture, improving efficiency of gait, and enhancing performance of functional motor skills in 30 children (21 mal e, 9 female; mean age 9 years 4 months; age range 4 to 18 years,) with spas tic hemiplegia, Following a S-month baseline period of no ankle-foot orthos is (AFO) use, each AFO was worn for 3 months after which ankle range of mot ion, gait analysis, energy consumption, and functional motor skills were as sessed. The HAFO and PLS increased passive ankle dorsiflexion and normaliza tion of ankle rocker function during gait. Normalization of knee motion in stance was dependent upon the knee abnormality present and AFO configuratio n. The HAFO was the most effective in controlling knee hyperextension in st ance, while PLS was the most effective in promoting knee extension in child ren with >10 degrees knee flexion in stance. Energy efficiency was improved in 21 of the children, with 13 of these children demonstrating the greates t improvement in HAFO and PLS, Improvements in functional mobility were gre atest in the HAFO and PLS.