Effect of Ankle Foot Orthoses on Gait Parameter among Children with Spastic Diplegic Cerebral Palsy
Abstract
Objective: This study evaluated the effects of solid ankle-foot orthosis (SAFO) and ground reaction ankle-foot orthosis (GRAFO) on gait parameters (kinematic and temporospatial) in children with diplegic spastic cerebral palsy (CP).
Material and Methods: This repeated-measure matched pair study included 11 children with diplegic spastic CP (Gross Motor Function Classification System, GMFCS III and IV) who presented with equinus gait from 2 tertiary hospitals in Kota Kinabalu. Participants walked 3 meters under 3 conditions: barefoot, with SAFO, and with GRAFO. Gait was recorded using a high-definition camera in the sagittal plane. Kinematic and temporospatial parameters were analyzed using the Kinovea system and compared with the Wilcoxon signed-rank test.
Results: The participants’ average age was 6.91±3.02 years. Walking with SAFO and GRAFO significantly reduced velocity (p-value=0.021 and 0.008 respectively) and shortened step and stride lengths (p-value=0.006 for both). Both AFOs significantly reduced peak knee extension at stance (p-value=0.003 for both), while increasing peak ankle dorsiflexion at stance (p-value=0.003 for both) and ankle angle at initial contact (p-value=0.003 for both). GRAFO further reduced walking speed (p-value=0.008), step length (p-value=0.004), and stride length (p-value=0.005), but improved knee extension at stance (p-value=0.003) compared to SAFO.
Conclusion: Both SAFO and GRAFO improved knee flexion, ankle plantarflexion at stance, and ankle angle at initial contact in children with CP. GRAFO offered additional benefits by enhancing knee extension at stance.
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