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A Comparison of Gait Parameters Using Varying Orthotic Designs in a Child With Spastic Diplegic Cerebral Palsy After Selective Dorsal Rhizotomy Surgery

A Case Report

Barkocy, Marybeth, PT, DPT; Zhang, Zhenxiong, PT, DPT; Dexter, James, PT, MA; Doty, Deane, CPO

JPO: Journal of Prosthetics and Orthotics: April 2019 - Volume 31 - Issue 2 - p 152–158
doi: 10.1097/JPO.0000000000000189

Introduction Cerebral palsy (CP) is the most common developmental disorder in children. Selective dorsal rhizotomy (SDR) is an effective neurosurgical treatment to reduce lower-limb spasticity in children with spastic diplegic CP. An intensive period of rehabilitation, including gait training, is required for most children after this surgery. Orthoses have been widely used in children with CP. However, there is a lack of research showing which orthosis type is the most appropriate for children with spastic diplegic CP after SDR.

Materials and Methods In this retrospective case report, we compared spatial and temporal gait parameters using three commonly used orthoses: foot orthosis (FO), supramalleolar orthosis (SMO), and ankle-foot orthosis/footwear combination (AFO/FC), before and after 3-month accommodation of combination use in a 5-year-old male patient with spastic diplegic CP after SDR.

Results The results showed that although all orthoses improved gait function, the AFO/FCs appeared to initially provide the most stable support; however, after acclimatization, spatial and temporal gait parameters generally demonstrated greater improvement in FO and SMO conditions compared with AFO/FC.

Discussion This report suggests stance phase stability may be enhanced with AFO/FCs, but swing phase may improve with FO and SMO conditions in children with weakness after SDR. Further studies analyzing gait, balance, and motor function using varying orthoses in children with CP after SDR are warranted.

MARYBETH BARKOCY, PT, DPT; ZHENXIONG ZHANG, SPT, DPT; and JAMES DEXTER, PT, MA, are affiliated with the Division of Physical Therapy, Department of Orthopaedics, University of New Mexico, Albuquerque, New Mexico.

DEANE DOTY, CPO, is affiliated with Clinical Specialist, Active Life, Inc, Albuquerque, New Mexico.

Disclosure: The authors declare no conflict of interest.

Correspondence to: Marybeth Barkocy, PT, DPT, Division of Physical Therapy, Department of Orthopaedics, University of New Mexico, 8813 Robin Ave NE, Albuquerque, NM 87112; email:

© 2019 by the American Academy of Orthotists and Prosthetists.