Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy

Abstract

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.