Efficacy of ankle foot orthoses types on walking in children with cerebral palsy : a systematic review

Aboutorabi, A; Arazpour, M; Bani Ismail, MA; Saeedi, H; Head, JS

Abstract

Background: Ankle Foot Orthoses (AFOs) are orthotic devices that can be used to normalize the walking pattern of children with Cerebral Palsy (CP). One of the aims of orthotic management is to produce a more normal gait pattern by positioning joints in proper position to reduce pathological reflex or spasticity.
Objective: To conduct a systematic review of recent, appropriate literature within the field of interest to establish the effect of treatment using various types of AFO’s on the gait patterns of children with CP.
Study design: Qualitative systematic review of relevant papers between 2007 and 2015.
Methods: PubMed, Scopus, ISI Web of knowledge, Cochrane Library, EMBASE and Google Scholar were searched for articles of children with CP that wear AFOs including; Hinged AFO (HAFO), Solid AFO (SAFO), Floor Reaction AFO (FRAFO), Posterior Leaf Spring (PLS) and Dynamic AFO (DAFO). Those studies which used other types of AFOs or combined treatment options were excluded. Relevant literature that established outcomes relating to a corresponding change in gait pattern and subsequent walking ability were evaluated, with the PEDro scale being used to assess the methodological quality of all relevant studies.

Results: Seventeen studies, investigating a total of 1139 children with CP, met the inclusion criteria. Most of the studies only achieved a ‘poor’ PEDro scale score (3/10). Just four studies, totaling 209 children, used an effective randomized, controlled trial that enabled them to achieve a ‘good’ PEDro scale score (5, 7, 9/10) and an appropriate level of evidence. One study used a case-based series, while the remainder employed a cross-sectional design.
There was a general improvement in speed and stride length when AFOs were used on children with CP. The HAFO was effective for the improvement of gait parameters and for decreasing energy expenditure in children with hemiplegic CP when compared to the barefoot condition. Stride length, speed of walking, single limb support and gait symmetry were also improved by use of HAFO in children with hemiplegic CP. Plastic SAFOs and FRAFOs were more effective in reducing energy expenditure in children with diplegic CP. For children with diplegic CP, improvement on gross motor function by the HAFO and SAFO was observed.
Conclusion: Using specific types of AFOs produced a noticeable improvement in the gait parameters of children with CP, including ankle and knee ROM, walking speed and stride length. In addition, relative energy expenditure was decreased by using AFOs on children with spastic CP. However, further studies are required with a ‘good’ PEDro scale score to determine more conclusive evidence regarding the effectiveness of AFO use on children with CP.
Keywords: ankle foot orthoses, orthosis, AFO, gait, children with cerebral palsy, CP

Citation

Aboutorabi, A., Arazpour, M., Bani Ismail, M., Saeedi, H., & Head, J. (2017). Efficacy of ankle foot orthoses types on walking in children with cerebral palsy : a systematic review. Annals of Physical and Rehabilitation Medicine, 60(6), 393-402. https://doi.org/10.1016/j.rehab.2017.05.004

• Journal Article Type: Article
• Acceptance Date: May 27, 2017
• Online Publication Date: Jul 13, 2017
• Publication Date: Nov 1, 2017
• Deposit Date: Oct 2, 2017
• Journal: Annals of Physical and Rehabilitation Medicine
• Print ISSN: 1877-0657
• Publisher: Elsevier
• Volume: 60
• Issue: 6
• Pages: 393-402
• DOI: https://doi.org/10.1016/j.rehab.2017.05.004
• Publisher URL: http://dx.doi.org/10.1016/j.rehab.2017.05.004
• Related Public URLs: https://www.journals.elsevier.com/annals-of-physical-and-rehabilitation-medicine