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)
- Authors: Koltsov A.A.1, Aksenov A.Y.2, Dzhomardly E.I.1
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Affiliations:
- Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht
- National Medical Research Centre for Traumatology and Orthopedics named after academician G.A. Ilizarov
- Issue: Vol 24, No 3 (2021)
- Pages: 5-14
- Section: Original study articles
- URL: https://rjmseer.com/1560-9537/article/view/77379
- DOI: https://doi.org/10.17816/MSER77379
- ID: 77379
Cite item
Abstract
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.
Keywords
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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.
Email: katandr2007@yandex.ru
ORCID iD: 0000-0002-0862-8826
SPIN-code: 2767-3392
MD, Cand. Sci. (Med.)
Russian Federation, 50, Bestughevskaya street, Sankt-Petersburg, 195067Andrey Yu. Aksenov
National Medical Research Centre for Traumatology and Orthopedics named after academician G.A. Ilizarov
Email: a.aksenov@hotmail.com
ORCID iD: 0000-0002-7180-0561
SPIN-code: 9403-8244
MD, Cand. Sci. (Med.)
Russian Federation, KurganElnur I. Dzhomardly
Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht
Email: mamedov.ie@yandex.ru
ORCID iD: 0000-0002-0281-3262
SPIN-code: 5853-0260
MD, Graduate Student
Russian Federation, 50, Bestughevskaya street, Sankt-Petersburg, 195067References
- Bar-On L, Aertbelien E, Molenaers G, et al. Muscle activation pattern when passively stretching spastic lower limb muscles of children with cerebral palsy. PLoS ONE. 2014;9(3):e91759. doi: 10.1371/journal.pone.0091759
- Zhou JY, Lowe E, Cahill-Rowley K, et al. Influence of impaired selective motor control on gait in children with cerebral palsy. J Child Orthop. 2019;13(1):73–81. doi: 10.1302/1863-2548.13.180013
- Munger ME, Chen BP, MacWilliams BA, et al. Comparing the effects of two spasticity management strategies on the long-term outcomes of individuals with bilateral spastic cerebral palsy: a multicentre cohort study protocol. BMJ Open. 2019;9(6):e027486. doi: 10.1136/bmjopen-2018-027486
- Min JJ, Kwon SS, Sung KH, et al. Progression of planovalgus deformity in patients with cerebral palsy. BMC Musculoskelet Disord. 2020;21(1):141. doi: 10.1186/s12891-020-3149-0
- Ganjwala D, Shah H. Management of the knee problems in spastic cerebral palsy. Indian J Orthop. 2019;53(1):53–62. doi: 10.4103/ortho.IJOrtho_339_17
- Dursun N, Gokbel T, Akarsu M, Dursun E. Randomized controlled trial on effectiveness of intermittent serial casting on spastic equinus foot in children with cerebral palsy after botulinum toxin ― A treatment. Am J Phys Med Rehabil. 2017;96(4):221–225. doi: 10.1097/PHM.0000000000000627
- Weide G, Sloot L, Oudenhoven L, et al. Comprehensive evaluation of gait, spasticity, and muscle morphology: A case report of a child with spastic paresis treated with botulinum NeuroToxin-A, serial casting, and physiotherapy. Clin Case Rep. 2019;7(9):1637–1646. doi: 10.1002/ccr3.2227
- Aslan A, Diril SK, Demirci D, Yorgancıgil H. Comparison of single event multilevel surgery and multiple surgical events in the lower extremities of children with spastic cerebral palsy. Eklem Hastalik Cerrahisi. 2019;30(3):217–223. doi: 10.5606/ehc.2019.66516
- Langerak NG, Tam N, du Toit J, et al. Gait pattern of adults with cerebral palsy and spastic diplegia more than 15 years after being treated with an Interval Surgery Approach: Implications for Low-Resource Settings. Indian J Orthop. 2019;53(5):655–661. doi: 10.4103/ortho.IJortho_113_19
- Koltsov AA, Dzhomardly EI. Analysis of type and frequency dynamics of rehabilitation assistive devices in children with cerebral palsy. Pediatric Traumatology, Orthopaedics and reconstructive Surgery. 2020;8(2):55–64. (In Russ). doi: 10.17816/PTORS18953
- Leardini A, Sawacha Z, Paolini G, et al. A new anatomically based protocol for gait analysis in children. Gait Posture. 2007;26(4):560–571. doi: 10.1016/j.gaitpost.2006.12.018
- Baker R, McGinley JL, Schwartz MH, et al. The gait profile score and movement analysis profile. Gait Posture. 2009;30(3):265–269. doi: 10.1016/j.gaitpost.2009.05.020
- Rasmussen HM, Nielsen DB, Pedersen NW, et al. Gait deviation index, gait profile score and gait variable score in children with spastic cerebral palsy: Intra-rater reliability and agreement across two repeated sessions. Gait Posture. 2015;42(2):133–137. doi: 10.1016/j.gaitpost.2015.04.019
- Skaaret I, Steen H, Terjesen T, Holm I. Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy. Prosthet Orthot Int. 2019; 43(1):12-20. doi: 10.1177/0309364618791615
- Chibirov GM, Dolganova TI, Dolganov DV, Popkov DA. Analysis of the causes of pathological patterns of kinematic locomotor profile according to computer analysis of gait in children with spastic forms of cerebral palsy. The Genius Orthopedics. 2019;25(4):493–500. (In Russ). doi: 10.18019/1028-4427-2019-25-4-493-500
- Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol. 2001;8(5):98–108. doi: 10.1046/j.1468-1331.2001.00042.x
- Zhao X, Xiao N, Li H, Du S. Day vs day-night use of ankle-foot orthoses in young children with spastic diplegia: a randomized controlled study. Am J Phys Med Rehabil. 2013;92(10):905–911. doi: 10.1097/PHM.0b013e318296e3e8
- Tardieu C, Lespargot A, Tabary C, et al. For how long must the soleus muscle be stretched each day to prevent contractures. Dev Med Child Neurol. 1986;30(1):3–10. doi: 10.1111/j.1469-8749.1988.tb04720.x
- Schwarze M, Horoba L, Block J, et al. Wearing time of ankle-foot orthosis with modular shank supply in cerebral palsy: A descriptive analysis in a clinically prospective approach. Rehabil Res Pract. 2019;2019:2978265. doi: 10.1155/2019/2978265