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Impact of Ankle-Foot Orthosis on Gait efficiency in Ambulatory Children with Cerebral Palsy

A Systematic Review and Meta-Analysis

Betancourt, Jean P., MD1; Eleeh, Prince, BS4; Stark, Stacy, DO1; Jain, Nitin B., MD, MSPH1,2,3

American Journal of Physical Medicine & Rehabilitation: March 26, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001185
Research Article: PDF Only

Objective Children with cerebral palsy (CP) experience functional limitations because of excessive muscle weakness, spasticity, and impaired motor control. They are prescribed ankle foot orthoses (AFOs) to assist with ambulation. Our objective was to analyze stride length and dorsiflexion data comparing the effectiveness of “AFOs” with “barefoot or shoes only” on ambulatory children with CP.

Design An electronic literature search was conducted. Studies were screened by two reviewers based on our inclusion criteria: prospective cohort study or randomized clinical trial (RCT), participants <18 years of age with a primary diagnosis of CP, AFOs with a control group, 20 combined participants in the experimental and control groups for cohort studies, and 10 participants for RCT’s.

Results Seventeen studies were selected. Pooled results of the meta-analyses showed that stride length was significantly better in the AFO group as compared with the control group (Mean difference between groups = 0.05m (95% CI = (0.04, 0.06)). The dorsiflexion angle (5 studies; 124 participants) was improved in patients with AFOs as compared with barefoot or shoes only (Mean difference between groups = 8.62o (95% CI = 8.05, 9.2)).

Conclusion Children with CP using AFOs had improved stride length and dorsiflexion angle during gait in a pooled meta-analyses of cohort studies and clinical trials.

1Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN

2Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN

3Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN

4Meharry Medical College, Meharry Medical School, Nashville, TN

Corresponding Author: Nitin B. Jain, MD, MSPH, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children’s Way, Suite 1318, Nashville, TN 37212, United States of America, Phone: (615) 936-8508; Fax: (615) 322-7454, Email:

FUNDING: No funding sources were used in the creation of this study. We thank the creators of the electronic databases (PubMed, CINAHL+, ScienceDirect, EMBASE, and Cochrane Library)

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