“How could I apply this information?”
Physical therapists are often asked “what brace should my child wear?” and “will this brace make my child walk better?” Orthotic prescription is complex. Often more than 1 orthotic might be effective and appropriate. Although orthotics might improve some aspects of gait, they may limit movements that are required to walk efficiently. Therapists determine the goal of the orthotic and consider what movements are being compromised to attain the goal. The results of this study support use of the Ultraflex Adjustable Dynamic Response ankle-foot orthosis when the primary goal of bracing is to improve knee extension in stance or push-off in terminal stance. Alternately, the Dynamic AFO (DAFO) may be more appropriate when the goal of bracing is to improve dorsiflexion in stance, foot clearance in swing, or to increase walking velocity. Families and children preferred DAFO orthotics over the Ultraflex, resulting in improved compliance and increased walking with DAFO use.
“What should I be mindful about when applying this information?”
The limited follow-up precluded assessment of the effect of bracing on passive range of motion over longer periods. Although the authors report no change in the gastrocnemius or soleus muscle over the 4-week study period, the possibility exists for a negative effect on the length tension relationship, resulting in less muscle force, or a decrease in passive muscle length of the gastrocsoleus over periods longer than the 4 weeks. The muscle may become overlengthened, and closed-chain restraint of tibial progression can be diminished facilitating crouch posture or contracture of the gastrocsoleus leading to development of toe walking. As a result, consideration of the natural history of the condition and progression of the individual patient is important when applying these results.
Allan M. Glanzman, PT, DPT, PCS
Julie Cort, PT, DPT
The Children's Hospital of Philadelphia