Biomechanical Outcomes Related with Gait in Children with Cerebral Palsy Using Ankle-Foot Orthotic - A Systematic Review

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Abstract:

Gait in children with cerebral palsy (CP) is often affected by motor impairments which limit the patient's ability to walk. To improve gait and reduce walking limitations, children with CP need to use ankle foot orthoses. An orthosis is an externally applied device that is designed and fitted to the body to achieve one or more of the following goals: a) Control biomechanical alignment. b) Correct or accommodate deformity, and 3) Protect and support an injury. This systematic review aims to describe research evidence supporting the use of ankle-foot orthoses to improve gait biomechanical outcomes among individuals with CP. Literature search was pursued from PubMed database. Studies were included if (1) they evaluated an outcome measure related with gait using ankle-foot orthotic (AFO) in children (2) considered children with a diagnosis of CP and have a (3) GMFCS classification of I, II or III. Papers were excluded if they evaluated (1) other population besides CP, (2) the use of orthoses other than AFOs and (3) gait analysis procedure was not presented. All the included studies have analyzed spatiotemporal parameters, the step length (m), stride length (m) and cadence (steps/minute) were the most frequently reported. Our findings showed that several studies have investigated the effects of AFOs, all of which have reported positive influences on at least one gait parameter, as well as positive changes in joint kinematics and kinetic in children with CP.

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[1] Jagadamma KC, Coutts FJ, Mercer TH, Herman J, Yirrell J, Forbes L, et al. Optimising the effects of rigid ankle foot orthoses on the gait of children with cerebral palsy (CP) - an exploratory trial. Disabil. Rehabil. Assist. Technol. [Internet]. 2014;3107:1–7.

DOI: 10.3109/17483107.2014.908244

Google Scholar

[2] Neto HP, Collange Grecco LA, Christovao TCL, Braun LA, Giannasi LC, Inoue Salgado AS, et al. Effect of posture-control insoles on function in children with cerebral palsy: Randomized controlled clinical trial. Bmc Musculoskelet. Disord. 2012;13:193.

DOI: 10.1186/1471-2474-13-193

Google Scholar

[3] Kerkum YL, Brehm M-A, Van Hutten K, Van Den Noort JC, Harlaar J, Becher JG, et al. Acclimatization of the gait pattern to wearing an ankle–foot orthosis in children with spastic cerebral palsy. Jclb [Internet]. Elsevier Ltd; 2015;30:617–22.

DOI: 10.1016/j.clinbiomech.2015.03.023

Google Scholar

[4] Kerkum YL, Harlaar J, Buizer AI, van den Noort JC, Becher JG, Brehm M-A. Optimising Ankle Foot Orthoses for children with cerebral palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study. BMC Pediatr. [Internet]. BMC Pediatrics; 2013;13:17.

DOI: 10.1186/1471-2431-13-17

Google Scholar

[5] Bjornson, K. F., Zhou C., Stevenson, R. D. & Christakis, D. (2014). Relationship of stride activity and participation in mobility-based life habits among children with cerebral palsy. Arch Phys Med Rehabil, 95(2), 360-368. https.

DOI: 10.1016/j.apmr.2013.10.022

Google Scholar

[6] Abd El-Kafy EM. The clinical impact of orthotic correction of lower limb rotational deformities in children with cerebral palsy: a randomized controlled trial. Clin. Rehabil. 2014;28:1004–14.

DOI: 10.1177/0269215514533710

Google Scholar

[7] Kerkum YL, Harlaar J, Buizer AI, Van Den Noort JC, Becher JG, Brehm MA. An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion. Gait Posture. Elsevier B.V.; 2016;46:104–11.

DOI: 10.1016/j.gaitpost.2016.03.001

Google Scholar

[8] Wren TAL, Dryden JW, Mueske NM, Dennis SW, Healy BS, Rethlefsen SA. Comparison of 2 Orthotic Approaches in Children With Cerebral Palsy. Pediatr. Phys. Ther. 2015;27:218–26.

DOI: 10.1097/pep.0000000000000153

Google Scholar

[9] Schiariti V, Selb M, Cieza A, O'Donnell M. International Classification of Functioning, Disability and Health Core Sets for children and youth with cerebral palsy: A consensus meeting. Dev. Med. Child Neurol. 2015;57:149–58.

DOI: 10.1111/dmcn.12551

Google Scholar

[10] Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev. Med. Child Neurol. 2008;50:744–50.

DOI: 10.1111/j.1469-8749.2008.03089.x

Google Scholar

[11] Brehm M, Bus S, Harlaar J, Nollet F. A candidate core set of outcome measures based on the International Classification of Functioning, Disability and Health for clinical studies on lower limb orthoses. Prosthet. Orthot. Int. 2011;35:269–77.

DOI: 10.1177/0309364611413496

Google Scholar

[12] Khamis S, Martikaro R, Wientroub S, Hemo Y, Hayek S. A functional electrical stimulation system improves knee control in crouch gait. J. Child. Orthop. [Internet]. Springer Berlin Heidelberg; 2015;9:137–43.

DOI: 10.1007/s11832-015-0651-2

Google Scholar

[13] Meilahn JR. Tolerability and Effectiveness of a Neuroprosthesis for the Treatment of Footdrop in Pediatric Patients With Hemiparetic Cerebral Palsy. PM R [Internet]. Elsevier Inc.; 2013;5:503–9.

DOI: 10.1016/j.pmrj.2012.11.005

Google Scholar

[14] Chisholm AE, Perry SD. Ankle-foot orthotic management in neuromuscular disorders: recommendations for future research. Disabil. Rehabil. Assist. Technol. [Internet]. 2012;7:437–49.

DOI: 10.3109/17483107.2012.680940

Google Scholar

[15] Moher D, Liberati A, Tetzlaff J, Altman DG, Grp P. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (Reprinted from Annals of Internal Medicine). Phys. Ther. 2009;89:873–80.

DOI: 10.1093/ptj/89.9.873

Google Scholar

[16] Danino B, Erel S, Kfir M, Khamis S, Batt R, Hemo Y, et al. Influence of orthosis on the foot progression angle in children with spastic cerebral palsy. Gait Posture [Internet]. Elsevier B.V.; 2015;42:518–22.

DOI: 10.1016/j.gaitpost.2015.08.006

Google Scholar

[17] Kerkum YL, Buizer AI, Van Den Noort JC, Becher JG, Harlaar J, Brehm MA. The effects of varying ankle foot orthosis stiffness on gait in children with spastic cerebral palsy who walk with excessive knee flexion. PLoS One [Internet]. 2015;10.

DOI: 10.1371/journal.pone.0142878

Google Scholar

[18] Wahid F, Begg R, Sangeux M, Halgamuge S, Ackland DC. The effects of an ankle foot orthosis on cerebral palsy gait: a multiple regression analysis C3. Eng. Med. Biol. Soc. (EMBC). Proc. Annu. Int. Conf. IEEE Eng. Med. Biol. Soc. [Internet]. 2015;5509–12.

DOI: 10.1109/embc.2015.7319639

Google Scholar

[19] Choi H, Wren TAL, Steele KM. Gastrocnemius operating length with ankle foot orthoses in cerebral palsy. Prosthet. Orthot. Int. [Internet]. 2016;1–12.

DOI: 10.1177/0309364616665731

Google Scholar

[20] Danino B, Erel S, Kfir M, Khamis S, Batt R, Hemo Y, et al. Are Gait Indices Sensitive Enough to Reflect the Effect of Ankle Foot Orthosis on Gait Impairment in Cerebral Palsy Diplegic Patients? J. Pediatr. Orthop. [Internet]. 2016;36:294–8.

DOI: 10.1097/bpo.0000000000000429

Google Scholar

[21] Schmid S, Romkes J, Taylor WR, Lorenzetti S, Brunner R. Orthotic correction of lower limb function during gait does not immediately influence spinal kinematics in spastic hemiplegic cerebral palsy. Gait Posture [Internet]. Elsevier B.V.; 2016;49:457–62.

DOI: 10.1016/j.gaitpost.2016.08.013

Google Scholar

[22] Verschuren O, Ketelaar M, Keefer D, Wright V, Butler J, Ada L, et al. Identification of a core set of exercise tests for children and adolescents with cerebral palsy: A Delphi survey of researchers and clinicians. Dev. Med. Child Neurol. 2011;53:449–56.

DOI: 10.1111/j.1469-8749.2010.03899.x

Google Scholar

[23] Harlaar J, Brehm M, Becher JG, Bregman DJJ, Buurke J, Holtkamp F, et al. Studies examining the efficacy of ankle foot orthoses should report activity level and mechanical evidence. Prosthet. Orthot. Int. 2010;34:327–35.

DOI: 10.3109/03093646.2010.504977

Google Scholar

[24] Brehm MA, Harlaar J, Schwartz M. Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy. J. Rehabil. Med. 2008;40:529–34.

DOI: 10.2340/16501977-0209

Google Scholar