Comparative analysis of the effect trunk-hip-knee-ankle foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy (case report)

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BACKGROUND: In children with spastic forms of cerebral palsy often prescribed difference type of trunk-hip-knee-ankle foot orthosis (THKAFO). At the same time, we have not found any significant reports in the world literature dedicated to the study of the influence of these orthosis on the gait biomechanical parameters.

AIM: To demonstrate the results of a comparative analysis of the effect of trunk-hip-knee-ankle-foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy.

MATERIALS AND METHODS: The study involved two 13-and 15-year-old children with a diagnosis of “cerebral palsy, spastic diplegia, GMFCS 3, MACS 2–3, Ashworth Scale 2–3”. Six studies were conducted ― three tests for each child (barefoot, in AFO and THKAFO) using the 3D video analysis system “Qualisys” (Sweden). The spatio-temporal and kinematic indicators of gait, as well as the gait index, were evaluated.

RESULTS: Analysis of the results in patient D. demonstrated that using the THKAFO in comparison with AFO led to a slight improvement in spatio-temporal gait indicators (from 4.0–12.5%), but to a deterioration in hip kinematics and a deterioration in the gait index (2.5–28.1%). Whereas in patient A., it was noted that the use of the THKAFO in comparison with AFO had a negative effect on the spatio-temporal parameters of gait (4.0–97.6%), on the kinematics of the knee and ankle joints, and on the improvement of the hip kinematics in the sagittal plane, but the effect on the gait index was not unambiguous. According to the totality of the analyzed data, patient D. was recommended to wear AFO instead of the THKAFO. Patient A. was also recommended to wear an AFO instead of a THKAFO, even despite the ambiguous results of the biomechanical research, since the final decision on the choice of the orthosis design took into account not only “accurate” changes in biomechanical parameters, but also a number of other factors, in particular social and household ones.

CONCLUSION: In patients with level GMFCS 3, for improve the biomechanical parameters of gait, it is advisable to give preference to shorter and functional orthoses before prescribing orthoses that capture two or more body segments.

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About the authors

Andrey A. Koltsov

Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht

Author for correspondence.
ORCID iD: 0000-0002-0862-8826
SPIN-code: 2767-3392

MD, Cand. Sci. (Med.)

Russian Federation, 50, Bestughevskaya street, Sankt-Petersburg, 195067

Andrey Yu. Aksenov

National Medical Research Centre for Traumatology and Orthopedics named after academician G.A. Ilizarov

ORCID iD: 0000-0002-7180-0561
SPIN-code: 9403-8244

MD, Cand. Sci. (Med.)

Russian Federation, Kurgan

Elnur I. Dzhomardly

Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht

ORCID iD: 0000-0002-0281-3262
SPIN-code: 5853-0260

MD, Graduate Student

Russian Federation, 50, Bestughevskaya street, Sankt-Petersburg, 195067


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Supplementary files

Supplementary Files
1. Fig. 1. View (from the front and from the side) of devices for the lower extremities and trunk of the “tee” type and orthoses for the ankle joints used during biomechanical tests: а ― patient A., б ― patient D.

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2. Fig. 2. Recommended ankle orthoses for patients A. and D., taking into account the classification of J. Roddy and H.K. Graham (2001).

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3. Fig. 3. Goniograms of large joints of children with spastic forms of cerebral palsy: gray stripe ― normal; red line ― left lower limb; blue line ― right lower limb; Bf ― barefoot; AFO ― ankle orthosis; THKAFO ― apparatus for lower limbs and trunk.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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