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ADVANTAGES OF SUPRAMALLEOLAR ORTHOTICS OVER ARTICULATING ANKLE-FOOT ORTHOTICS IN THE GAIT AND GROSS MOTOR FUNCTION OF CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY

Kornhaber, Lillian1; Majsak, Michael J.2; Robinson, Alexis2

Pediatric Physical Therapy: April 2006 - Volume 18 - Issue 1 - p 95-96
Abstracts: Abstracts of Platform and Poster Presentations for the 2006 Combined Sections Meeting: Poster Presentations
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1Children's Evaluation and Rehabilitation Center/Rose F. Kennedy University Center for Excellence in Developmental Disabilities, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA (Kornhaber)

2Program in Physical Therapy/School of Public Health, New York Medical College, Valhalla, NY, USA (Majsak, Robinson)

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Background & Purpose:

Ankle-foot orthotics (AFOs) are frequently prescribed for children with spastic diplegic cerebral palsy (CP) to prevent uncontrolled plantarflexion. However, AFOs may disrupt the gait and motor skills of some children. Supramalleolar orthotics (SMOs) are orthotics that control the alignment of the foot while allowing free ankle motion. This case series study analyzed the gait and gross motor function of four children with spastic diplegic CP who were tested in AFOs and SMOs. We hypothesized that children with CP would show: (1) a higher gait velocity, a greater stride length, and a more symmetrical stride in SMOs; (2) a higher level of gross motor function in SMOs in motor skills requiring ankle mobility; and (3) a lower level of gross motor function in SMOs in motor skills requiring ankle stability.

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Case Description:

Four children with spastic diplegic CP who ambulated with articulating AFOs were recruited from the Children's Evaluation and Rehabilitation Center of the Albert Einstein College of Medicine of Yeshiva University. One male, age 4, used a posture walker; one male, age 14, used forearm crutches. Two females, ages 7 and 15, used no assistive devices. In the first of 3 weekly sessions, children were tested in gait and gross motor function wearing their AFOs. The GAITRite Portable Walkway System was used to record the gait velocity, cadence, stride length, and stride symmetry of children for 3 trials of walking at a comfortable speed. Children were allowed to use their assistive devices while ambulating. Gross motor function without the use of assistive devices was then assessed using the Gross Motor Function Measure-66 (GMFM). In the second session, custom-made SMOs were fabricated for each child (see Cusick, 1990). No testing occurred on this day. The children were instructed to use the SMOs 3−4 hours a day over the following week. In the last session, children wore the SMOs while they were retested in gait and gross motor function.

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Outcomes:

The two children who used assistive devices for ambulation walked faster, had a greater stride length, and had greater symmetry of stride in SMOs than in AFOs. Changes were not noted for children who ambulated without assistive devices. All children showed higher scores on the GMFM in SMOs than in AFOs for tasks that required ankle mobility. Younger children improved their performance in mat mobility and stand-to-sit. Older children improved in more difficult tasks such as climbing stairs and jumping. Three children had lower gross motor function scores for the stability task of standing on one foot, but did not score lower on other tasks that required ankle stability.

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Discussion:

SMOs provide an advantage over AFOs in gait and gross motor function for some children with spastic diplegic CP. The use of orthotics needs to be individualized, taking into account each child's specific impairments and functional abilities, age, means of ambulation, and priorities in daily motor tasks.

Keywords:

cerebral palsy; spastic diplegia; orthotics

© 2006 Lippincott Williams & Wilkins, Inc.