Tishya A L Wren1, James W Dryden, Nicole M Mueske, Sandra W Dennis, Bitte S Healy, Susan A Rethlefsen. 1. Children's Orthopaedic Center (Drs Wren and Rethlefsen, and Ms Mueske, Dennis, and Healy), Children's Hospital Los Angeles, Los Angeles, California; Department of Radiology (Dr Wren), Children's Hospital Los Angeles, Los Angeles, California; Department of Biomedical Engineering (Dr Wren), University of Southern California, Los Angeles, California; Orthopliance Group (Mr Dryden), North Hollywood, California; Division of Pediatric Rehabilitation Medicine (Ms Dennis and Healy, and Dr Rethlefsen), Children's Hospital Los Angeles, Los Angeles, California.
Abstract
PURPOSE: To compare dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy. METHODS: A total of 10 children with cerebral palsy (4-12 years; 6 at Gross Motor Function Classification System level I, 4 at Gross Motor Function Classification System level III) and crouch and/or equinus gait wore DAFOs and ADR-AFOs, each for 4 weeks, in randomized order. Laboratory-based gait analysis, walking activity monitor, and parent-reported questionnaire outcomes were compared among braces and barefoot conditions. RESULTS: Children demonstrated better stride length (11-12 cm), hip extension (2°-4°), and swing-phase dorsiflexion (9°-17°) in both braces versus barefoot. Push-off power (0.3 W/kg) and knee extension (5°) were better in ADR-AFOs than in DAFOs. Parent satisfaction and walking activity (742 steps per day, 43 minutes per day) were higher for DAFOs. CONCLUSIONS: ADR-AFOs produce better knee extension and push-off power; DAFOs produce more normal ankle motion, greater parent satisfaction, and walking activity. Both braces provide improvements over barefoot.
RCT Entities:
PURPOSE: To compare dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy. METHODS: A total of 10 children with cerebral palsy (4-12 years; 6 at Gross Motor Function Classification System level I, 4 at Gross Motor Function Classification System level III) and crouch and/or equinus gait wore DAFOs and ADR-AFOs, each for 4 weeks, in randomized order. Laboratory-based gait analysis, walking activity monitor, and parent-reported questionnaire outcomes were compared among braces and barefoot conditions. RESULTS:Children demonstrated better stride length (11-12 cm), hip extension (2°-4°), and swing-phase dorsiflexion (9°-17°) in both braces versus barefoot. Push-off power (0.3 W/kg) and knee extension (5°) were better in ADR-AFOs than in DAFOs. Parent satisfaction and walking activity (742 steps per day, 43 minutes per day) were higher for DAFOs. CONCLUSIONS: ADR-AFOs produce better knee extension and push-off power; DAFOs produce more normal ankle motion, greater parent satisfaction, and walking activity. Both braces provide improvements over barefoot.
Authors: Benjamin C Conner; Nushka M Remec; Cassidy M Michaels; Chase W Wallace; Emily Andrisevic; Zachary F Lerner Journal: Gait Posture Date: 2021-10-25 Impact factor: 2.840