Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy
Journal article, Peer reviewed
Accepted version
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https://hdl.handle.net/10642/6991Utgivelsesdato
2018-08-07Metadata
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Originalversjon
Skaaret I, Steen H, Terjesen T, Holm I. Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy. Prosthetics and orthotics international . 2018:1-9 http://dx.doi.org/10.1177/0309364618791615Sammendrag
Background: Different types of ankle-foot orthoses (AFOs) are commonly used following
lower limb surgery in children with bilateral spastic cerebral palsy (CP). After 3-dimensional
gait analysis one year postoperatively, many children are recommended continued use of
AFOs. Our aims were to quantify the impact of AFOs on gait one year postoperatively and
evaluate predictors for clinically important improvement.
Study design: Prospective cohort study
Methods: Thirty-four ambulating children with bilateral CP, mean age 11 years (range 6-17),
12 girls and 22 boys, were measured with 3-dimensional gait analysis preoperatively
(barefoot) and one year postoperatively (barefoot and with AFOs). Outcome was evaluated
using gait profile score (GPS), key kinematic, kinetic and temporal-spatial variables in paired
sample comparisons. Logistic regression was used to evaluate predictors for clinically
important improvement with orthoses (≥1.6° change in GPS).
Results: Walking barefoot one year postoperatively, major improvements were seen in GPS
and key variables. With AFOs there was significantly improved step length and velocity,
additional moderate reduction/improvement in GPS and knee moments, and decreased stance
ankle dorsiflexion compared to barefoot. Children using ground reaction AFOs (n=14)
decreased stance knee flexion from 13.9° walking barefoot to 8.2° with orthoses. High GPS
and more gait dysfunction preoperatively was a significant predictor of clinically important
improvement walking with orthoses.
Conclusion: The results indicate improved gait function walking with AFOs versus barefoot
one year after lower limb surgery. Stronger impact of AFOs was found in children with more
pronounced gait dysfunction preoperatively.