Title
Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking
Author
Meyns, P. (University of Hasselt)
Kerkum, Y. L. (Vrije Universiteit Amsterdam)
Brehm, M. A. (Universiteit van Amsterdam)
Becher, J. G. (Vrije Universiteit Amsterdam)
Buizer, A. I. (Vrije Universiteit Amsterdam)
Harlaar, J. (TU Delft Biomechatronics & Human-Machine Control; Vrije Universiteit Amsterdam) 
Date
2020
Abstract
In children with cerebral palsy (CP), rigid ventral shell ankle-foot orthoses (vAFOs) are often prescribed to reduce excessive knee flexion in stance and lower the energy cost of walking (ECW). However, how vAFOs affect ECW is a complex issue, as vAFOs may have an impact on lower limb biomechanics, upper body movements, and balance. Besides, the vAFO's biomechanical effect have been shown to be dependent on its stiffness around the ankle joint. We examined whether vAFO stiffness influences trunk movements and gait stability in CP, and whether there is a relationship between these factors and ECW. Fifteen children with spastic CP were prescribed vAFOs. Stiffness was varied into a rigid, stiff and flexible configuration. At baseline (shoes-only) and for each vAFO stiffness configuration, 3D-gait analyses and ECW-tests were performed. From the gait analyses, we derived trunk tilt, lateroflexion, and rotation range of motion (RoM) and the mediolateral and anteroposterior Margins of Stability (MoS) and their variability as measures of gait stability. With the ECW-test we determined the netEC. We found that wearing vAFOs significantly increased trunk lateroflexion (Wald χ2 = 33.7, p < 0.001), rotation RoM (Wald χ2 = 20.5, p < 0.001) and mediolateral gait instability (Wald χ2 = 10.4, p = 0.016). The extent of these effects partly depended on the stiffness of the vAFO. Significant relations between trunk movements, gait stability and ECW were found r = 0.57–0.81, p < 0.05), which indicates that trunk movements and gait stability should be taken into account when prescribing vAFOs to improve gait in children with CP walking with excessive knee flexion.
Subject
Ankle-foot orthosis
Cerebral palsy
Gait
Postural balance
Trunk biomechanics
Walking energy cost
To reference this document use:
http://resolver.tudelft.nl/uuid:8042e419-4780-4ee8-9a7d-d2868ed15174
DOI
https://doi.org/10.1016/j.ejpn.2020.02.009
Embargo date
2020-08-27
ISSN
1090-3798
Source
European Journal of Paediatric Neurology, 26, 68-74
Bibliographical note
Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.
Part of collection
Institutional Repository
Document type
journal article
Rights
© 2020 P. Meyns, Y. L. Kerkum, M. A. Brehm, J. G. Becher, A. I. Buizer, J. Harlaar