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Brace Evaluation in Children with Diplegic Cerebral Palsy with a Jump Gait Pattern

Smith, Peter A., MD1; Hassani, Sahar, MS1; Graf, Adam, MS1; Flanagan, Ann, PT, PCS1; Reiners, Kathryn1; Kuo, Ken N., MD2; Roh, Jae-Young, MD3; Harris, Gerald F., PhD1

doi: 10.2106/JBJS.G.01369
Scientific Articles
Supplementary Content

Background: Brace prescription for children with diplegic cerebral palsy challenges the clinician with a variety of options and little evidence for rational decisions. Previous studies have indicated that ankle-foot orthoses improve toe-walking, but it is unclear if any brace is better than another. The goal of the present study was to compare the effectiveness of hinged and dynamic ankle-foot orthoses in terms of improving gait and motor function in a homogeneous group of children with diplegic cerebral palsy exhibiting a jump gait pattern.

Methods: Fifteen children (mean age, 7.5 years) with spastic diplegic cerebral palsy who were able to walk independently with a jump gait pattern and twenty children (mean age, 10.6 years) with normal gait participated in the study. Standardized Gross Motor Function Classification System scores, Pediatric Outcomes Data Collection Instrument scores, and gait data were collected, analyzed, and compared. The subjects were tested while barefoot and while wearing hinged and dynamic ankle-foot orthoses. Data were analyzed to detect differences among these conditions.

Results: Significant improvements in gait metrics were seen during brace wear. No significant differences were seen between the two different braces used. The barefoot and braced conditions differed most significantly in terms of ankle kinematics and kinetics. Among the patients with cerebral palsy, no significant differences in the standardized outcome measurements were found between the braced and unbraced conditions or between the two braced conditions.

Conclusions: Our data suggest that gait improves with brace wear in children with cerebral palsy with a level-I Gross Motor Function Classification System score. The Pediatric Outcomes Data Collection Instrument and the Gross Motor Function Measure were not sensitive to brace treatment in the population studied. The hinged and dynamic braces were equally effective for improving ankle kinematics and kinetics in these relatively highly functioning children with cerebral palsy.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

1Shriners Hospitals for Children—Chicago, 2211 North Oak Park Avenue, Chicago, IL 60707. E-mail address for S. Hassani:

2National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan

3Severance Children's Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea

Copyright © 2009 by The Journal of Bone and Joint Surgery, Incorporated
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