Comparison of three ankleÛfoot orthosis configurations for children with spastic diplegia

Comparison of three ankleÛfoot orthosis configurations for children with spastic diplegia
13 Feb 2007
Accepted for publication 18th February 2004.
To cite this article: Cathleen E Buckon MS, Susan Sienko Thomas MA, Sabrina Jakobson-Huston, Michael Moor, Michael Sussman MD, Michael Aiona MD (2004)
Comparison of three ankleÛfoot orthosis configurations for children with spastic diplegia
Developmental Medicine & Child Neurology 46 (9), 590Ò598.
doi:10.1111/j.1469-8749.2004.tb01022.x
Blackwell Synergy

Cathleen E Buckon MS;**Correspondence to last author at Clinical Research Department, Shriners Hospitals for Children, 3101 SW Sam Jackson Park Road, Portland, OR 97239, USA. E-mail: CEB@SHCC.org11Certified OrthotistSusan Sienko Thomas MA;11Certified OrthotistSabrina Jakobson-Huston11Certified Orthotist, Michael Moor22Certified Prosthetist/Orthotist, Michael Sussman MD;33Shriners Hospitals for Children, Portland, OR, USA.Michael Aiona MD33Shriners Hospitals for Children, Portland, OR, USA.,

*Correspondence to last author at Clinical Research Department, Shriners Hospitals for Children, 3101 SW Sam Jackson Park Road, Portland, OR 97239, USA. E-mail: CEB@SHCC.org

AFO Ankle-foot orthosis BF Barefoot BOTMP BruininksÒOseretsky Test of Motor Performance GMFC S Gross Motor Classification System GMFM Gross Motor Function Measure GMPM Gross Motor Performance Measure HAFO Hinged ankleÒfoot orthosis PEDI Pediatric Evaluation Disability Inventory PLS Posterior leaf spring SAFO Solid ankleÒfoot orthosis W/R/J Walking/Running/Jumping dimension of GMFM Abstract
This study compared the functional efficacy of three commonly prescribed ankleÒfoot orthosis (AFO) configurations (solid [SAFO], hinged [HAFO], and posterior leaf spring [PLS]). Sixteen independently ambulatory children (10 males, six females; mean age 8 years 4 months, SD 2 years 4 months; range 4 years 4 months to 11 years 6 months) with spastic diplegia participated in this study. Four children were classified at level I of the Gross Motor Function Classification System (GMFCS; Palisano et al. 1997); the remaining 12 were at level II. Children were assessed barefoot (BF) at baseline (baseline assessment of energy consumption was performed with shoes on, no AFO) and in each orthotic configuration after three months of use, using gait analysis, oxygen consumption, and functional outcome measures. AFO use did not markedly alter joint kinematics or kinetics at the pelvis, hip, or knee. All AFO configurations normalized ankle kinematics in stance, increased step/stride length, decreased cadence, and decreased energy cost of walking. Functionally, all AFO configurations improved the execution of walking/running/jumping skills, upper extremity coordination, and fine motor speed/dexterity. However, the quality of gross motor skill performance and independence in mobility were unchanged. These results suggest that most children with spastic diplegia benefit functionally from AFO use. However, some children at GMFCS level II demonstrated a subtle but detrimental effect on function with HAFO use, shown by an increase in peak knee extensor moment in early stance, excessive ankle dorsiflexion, decreased walking velocity, and greater energy cost. Therefore, constraining ankle motion by using a PLS or SAFO should be considered for most, but not all, children with spastic diplegia.

Blackwell Synergy? is a Blackwell Publishing, Inc.

Complete article may be viewed online.