Gait assessment of fixed ankle-foot orthoses in children with spastic diplegia

Objective: To evaluate the effectiveness of ankle-foot orthoses (AFOs) in spastic diplegic cerebral palsy patients for whom orthoses were indicated to control equinus or pes planovalgus deformities. Design: A retrospective, crass-sectional assessment was performed on diplegic subjects who had suitable barefoot and AFO gait trials on the same day. Patients: Thirty-five subjects with a mean age of 8.7 yrs were included. Eighteen wore braces to control equinus and 17 to control pes planovalgus and crouch. Outcome Measures: Gait data assessed in all subjects included temporal-distance factors and sagittal kinematics. Force plate data to determine joint moments and powers were obtained in 20. Repeated measures analysis of variance was used to compare across conditions and indications. Results: The cohort demonstrated increased velocity (10cm/ sec; p < .001), stride length (10cm; p < .001), and percent single-limb support (1.8%; p < .002) using AFOs compared with barefoot gait, In braces, ankle excursion was reduced (p < .0001), while pelvic, hip, and knee excursions were increased to account fur the temporal changes (p < .009). Effects were similar in both indication groups. In neither indication group did the AFO significantly alter knee position in stance. Kinetic analysis showed a reduction of abnormal power burst (p < .05) in early stance and an increase in late stance ankle moment (p < .05) with AFOs. Differences in gait characteristics and bracing effects are shown ibr both indication groups. Conclusion: Compared with barefoot gait, AFOs enhanced gait function in diplegic subjects. Benefits resulted from elimination of premature plantar flexion and improved progression of foot contact during stance. Effects on proximal joint alignment were not significant. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.