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The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy

Published on Feb 1, 2019in Gait & Posture2.414
· DOI :10.1016/j.gaitpost.2019.01.006
M. Schwarze1
Estimated H-index: 1
(Heidelberg University),
Joel A. Block45
Estimated H-index: 45
(Heidelberg University)
+ 5 AuthorsSebastian I. Wolf30
Estimated H-index: 30
(Heidelberg University)
Sources
Abstract
Abstract Background Treatment of cerebral palsy includes an interdisciplinary concept and in more severe cases the well-established multi-level surgery (MLS). Different kinds of orthoses are typically part of postoperative treatment but there is a lack of knowledge about their additional benefit. Research question Do ankle foot orthoses lead to an additional, measurable improvement of gait after MLS? Methods 20 children with bilateral spastic cerebral palsy (9 retrospective, 11 in a postoperative clinical routine) were included. All had a preoperative gait analysis before MLS. Postoperatively, they were fitted with different ankle foot orthoses (AFO), depending on their individual needs. Dynamic ankle foot orthoses (DAFO), combined DAFO with additional dynamic, elastic shank adaptation (DESA) and ground reaction force AFOs (GRAFO) were used. Patients underwent a second gait analysis 1.5 (± 0.6) years postoperatively barefoot and with orthoses. Data analysis included testing for normal distribution (Shapiro-Wilk-Test) and further nonparametric statistical testing on basis of a Wilcoxon Single-Rank Test. Results The operation produced changes in the hip, knee and ankle joint, and the pelvis. Spatiotemporal parameters showed significant changes due to additional use of the orthoses. Further, additional kinematic changes occurred at the hip, knee and ankle joint as well as the foot. The Gillette Gait Index (GGI) improved significantly by supplementary orthoses, but not by surgery alone. The Gait Profile Score (GPS) and Gait Deviation Index (GDI) rather showed changes due to the surgery. Significance MLS significantly improves GPS and GDI more than a year after surgery, which can be interpreted as an improvement in gait pattern. In contrast, the GGI is improved by additional postoperative orthotic treatment, which implies that walking ability itself has improved, rather than the gait pattern. Orthoses show a positive additional effect on surgical results at different anatomical levels. Spatiotemporal parameters are positively influenced solely by additional orthotic support.
  • References (34)
  • Citations (1)
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References34
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#1Ingrid Skaaret (University of Oslo)H-Index: 2
#2Harald Steen (University of Oslo)H-Index: 47
Last. Inger Holm (University of Oslo)H-Index: 39
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Background:Different types of ankle-foot orthoses are commonly used following lower limb surgery in children with bilateral spastic cerebral palsy. After three-dimensional gait analysis 1 year post...
2 CitationsSource
#1Aoife Healy (Staffordshire University)H-Index: 11
#2Sybil Farmer (Staffordshire University)H-Index: 4
Last. Nachiappan Chockalingam (Staffordshire University)H-Index: 22
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Background Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world’s population need a prosthesis or orthosis. Objective The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. Methods Literature searche...
7 CitationsSource
#1Thomas Dreher (University Hospital Heidelberg)H-Index: 18
#2Pam Thomason (Royal Children's Hospital)H-Index: 17
Last. H. K. Graham (University of Melbourne)H-Index: 12
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10 CitationsSource
#1Atefeh AboutorabiH-Index: 5
#2Mokhtar ArazpourH-Index: 13
Last. John Head (University of Salford)H-Index: 4
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Background: Ankle Foot Orthoses (AFOs) are orthotic devices that can be used to normalize the walking pattern of children with Cerebral Palsy (CP). One of the aims of orthotic management is to produce a more normal gait pattern by positioning joints in proper position to reduce pathological reflex or spasticity. Objective: To conduct a systematic review of recent, appropriate literature within the field of interest to establish the effect of treatment using various types of AFO’s on the gait pat...
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AbstractObjectivesThe purpose of this article is to determine how many of the current peer-reviewed studies of ankle foot or-thoses (AFOs) on children with cerebral palsy (CP) have included adequate details of the design and material of the AFO, to enable the study to be reproduced and outcomes clearly understood.MethodsA thorough search of studies published in English was conducted in March 2015, with no restriction on dates, within all major databases using relevant phrases. These searches wer...
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#1Cornelia Putz (Heidelberg University)H-Index: 8
#2Leonhard DöderleinH-Index: 16
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Aims Single-event multilevel surgery (SEMLS) has been used as an effective intervention in children with bilateral spastic cerebral palsy (BSCP) for 30 years. To date there is no evidence for SEMLS in adults with BSCP and the intervention remains focus of debate. Methods This study analysed the short-term outcome (mean 1.7 years, standard deviation 0.9) of 97 ambulatory adults with BSCP who performed three-dimensional gait analysis before and after SEMLS at one institution. Results Two objective...
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#2Snir ErelH-Index: 2
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#1Kavi C. Jagadamma (RMIT: RMIT University)H-Index: 4
#2Fiona Coutts (RMIT: RMIT University)H-Index: 14
Last. Marietta L. van der Linden (RMIT: RMIT University)H-Index: 16
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AbstractPurpose: This exploratory trial investigated the effects of rigid ankle foot orthoses (AFO) with an optimally cast Angle of the Ankle in the AFO (AAAFO) on the gait of children with Cerebral Palsy (CP), and whether tuning of the AFO – Footwear Combination (AFO-FC) further affected gait. Methods: Eight children with CP underwent gait analysis and tuning of their AFO-FCs using a 3-D motion analysis system. Comparisons were carried out for selected gait parameters between three conditions –...
9 CitationsSource
#1Mark A. Feger (UVA: University of Virginia)H-Index: 8
#2Christopher D. Lunsford (UVA: University of Virginia)H-Index: 1
Last. Mark F. Abel (UVA: University of Virginia)H-Index: 38
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Abstract Objective To compare the impact of common surgical interventions (selective dorsal rhizotomy, muscle-tendon surgery, and osteotomies) for patients with cerebral palsy (CP) on Gross Motor Function Measure and temporal, kinematic, and kinetic gait variables as assessed via 3-dimensional motion analysis. Design Retrospective cohort study. Setting Motion analyses laboratory. Participants Ninety-four patients with CP, 56 of whom underwent surgery (37, muscle-tendon surgery; 11, osteotomy; an...
4 CitationsSource
#1Mark L. McMulkin (Shriners Hospitals for Children)H-Index: 12
#2Bruce A. MacWilliams (UofU: University of Utah)H-Index: 21
Gait indices are now commonly used to assess overall pathology and outcomes from studies with instrumented gait analyses. There are differences in how these indices are calculated and therefore inherent differences in their sensitivities to detect changes or differences between groups. The purpose of the current study was to examine the three most commonly used gait indices, Gillette Gait Index (GGI), Gait Deviation Index (GDI), and Gait Profile Score (GPS), comparing the statistical sensitivity...
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The aim of this paper is to provide a clinically applicable overview of different tone reducing modalities and how these can interact with or augment concurrent physical therapy (PT). Botulinum toxin (BoNT), oral tone-regulating medication, intrathecal baclofen (ITB), and selective dorsal rhizotomy are discussed within a physiotherapeutic context and in view of current scientific evidence. We propose clinical reasoning strategies to identify treatment goals as well as the appropriate and corresp...
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#1M. Schwarze (Heidelberg University)H-Index: 1
#2L. Horoba (Heidelberg University)
Last. Thomas Dreher (Heidelberg University)H-Index: 18
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Objective. To date there is only limited knowledge about the wearing time of orthoses. Ankle-foot orthoses (AFOs) have not been studied with this research question. Additional influences of the orthotic design as well as weekdays and the weekend are also unknown. Design. Monocentric, clinically prospective intervention study. Patients. Inclusion of 10 patients with bilateral spastic cerebral palsy. Methods. Equipment of all subjects with a dynamic ankle-foot orthosis (DAFO) and modular shank sup...
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