Developmental Medicine and Child Neurology vol:50 issue:1 pages:63-67
Several positive influences of orthoses on gait in children with cerebral palsy have been documented, as well as some detrimental effects. Most importantly, push-off is decreased in orthoses compromising a physiological third ankle rocker. The aim of this study was to evaluate the effect of three types of orthoses on gait in a homogeneous group of children. All orthoses aimed at improving push-off and normalizing the pathological plantarflexion – knee extension couple. 22 girls and 15 boys with hemiplegia, aged 4-10 years (30 GMFCS 1, 6 GMFCS 2), walked barefoot and with orthoses being either Orteams® (orthoses with dorsal part containing 11 sleeves), Posterior Leafsprings (PLS) or Dual Carbon Fibre Spring AFOs® (CFO; carbon fibre at the dorsal part of the orthosis). All orthoses were expected to prevent plantarflexion and allow dorsiflexion thus improving first, second and third rocker. The latter was expected to improve as energy is absorbed in second rocker, due to the flexibility of the orthosis, and returned in third rocker. The orthoses were compared through objective gait analysis, including 3D kinematics and kinetics. All orthoses successfully improved the gait pattern and only small differences were noted between the different orthoses configurations. The CFO® however, allowed a more physiological third ankle rocker when compared to the Orteam®/PLS. While the PLS ensured the highest correction at the ankle around initial contact, the CFO® created a significantly higher maximal hip flexion moment in stance. In general, the results of this study indicated a substantial functional flexibility of the CFO®.