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Dailey AH, Landers J, Anderson S, Dillon MP. Exploring the rationale for prescribing ankle-foot orthoses and supramalleolar orthoses in children with cerebral palsy: A narrative synthesis of rationale statements. Prosthet Orthot Int 2024; 48:290-299. [PMID: 38857165 DOI: 10.1097/pxr.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 07/20/2023] [Indexed: 06/12/2024]
Abstract
BACKGROUND To help improve outcomes for children with cerebral palsy (CP), ankle-foot orthoses (AFOs) and supramalleolar orthoses (SMOs) are prescribed. However, it is not clear why one intervention is prescribed over the other. OBJECTIVES To explore the rationale for prescribing AFOs and SMOs in children with CP and its link to the choice of outcome measure used. STUDY DESIGN Narrative review. METHODS Six databases were searched (eg, Medline) and data extracted from articles that met the inclusion criteria. Data describing the participant demographics, type of orthosis, and outcome measures used were summarized to provide context for the different rationale for orthotic prescription that were thematically analyzed. DISCUSSION Forty-seven articles were included. Participants were aged 9 ± 2 years, 59% were male, 79% had diplegia, and 38% were classified as Gross Motor Function Classification System level I. All studies included a rationale for prescribing AFOs that, in most cases, reflected the outcome measures used. These rationale statements were synthesized into 5 specific themes (e.g., reduced energy expenditure and metabolic costs). By comparison, 5 of these studies described the rationale for providing SMOs, and of those that did, most of the rationale statements were nonspecific. CONCLUSIONS A large and contemporary body of literature describes the rationale for prescribing AFOs for children with CP. There are opportunities for future research that clearly articulates the rationale for prescribing SMOs for children living with CP and to focus the rational for orthotic intervention on the real-world challenges that are most important to children living with CP, such as the ability to participate among peers.
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Affiliation(s)
- Asumi H Dailey
- Department of Orthotics and Prosthetics, The Royal Children's Hospital, Melbourne, Australia
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia
| | - Jessica Landers
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia
| | - Sarah Anderson
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia
| | - Michael P Dillon
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia
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Brasiliano P, Mascia G, Di Feo P, Di Stanislao E, Alvini M, Vannozzi G, Camomilla V. Impact of Gait Events Identification through Wearable Inertial Sensors on Clinical Gait Analysis of Children with Idiopathic Toe Walking. MICROMACHINES 2023; 14:277. [PMID: 36837977 PMCID: PMC9962364 DOI: 10.3390/mi14020277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Idiopathic toe walking (ITW) is a gait deviation characterized by forefoot contact with the ground and excessive ankle plantarflexion over the entire gait cycle observed in otherwise-typical developing children. The clinical evaluation of ITW is usually performed using optoelectronic systems analyzing the sagittal component of ankle kinematics and kinetics. However, in standardized laboratory contexts, these children can adopt a typical walking pattern instead of a toe walk, thus hindering the laboratory-based clinical evaluation. With these premises, measuring gait in a more ecological environment may be crucial in this population. As a first step towards adopting wearable clinical protocols embedding magneto-inertial sensors and pressure insoles, this study analyzed the performance of three algorithms for gait events identification based on shank and/or foot sensors. Foot strike and foot off were estimated from gait measurements taken from children with ITW walking barefoot and while wearing a foot orthosis. Although no single algorithm stands out as best from all perspectives, preferable algorithms were devised for event identification, temporal parameters estimate and heel and forefoot rocker identification, depending on the barefoot/shoed condition. Errors more often led to an erroneous characterization of the heel rocker, especially in shoed condition. The ITW gait specificity may cause errors in the identification of the foot strike which, in turn, influences the characterization of the heel rocker and, therefore, of the pathologic ITW behavior.
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Affiliation(s)
- Paolo Brasiliano
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Guido Mascia
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Paolo Di Feo
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Eugenio Di Stanislao
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
- “ITOP SpA Officine Ortopediche”, Via Prenestina Nuova 307/A, 00036 Palestrina, Italy
| | - Martina Alvini
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
- “ITOP SpA Officine Ortopediche”, Via Prenestina Nuova 307/A, 00036 Palestrina, Italy
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Valentina Camomilla
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, 00135 Rome, Italy
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Valenciano PJ, Conceição NR, Marcori AJ, Teixeira LA. Use of accelerometry to investigate standing and dynamic body balance in people with cerebral palsy: A systematic review. Gait Posture 2022; 96:357-364. [PMID: 35820240 DOI: 10.1016/j.gaitpost.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/28/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with cerebral palsy (CP) often have difficulties related to maintaining body balance in their daily living activities. Accelerometers are low-cost wearable devices with potential use to objectively assess balance. RESEARCH QUESTION What are the main characteristics and findings from protocols used in research aiming to investigate standing or dynamic body balance stability through trunk accelerometry in people with CP? METHOD We searched in December 2021 seven databases, Pubmed, Embase, Cochrane, Science Direct, Scopus, PEDro, and Lilacs, with descriptors related to cerebral palsy, accelerometer, and balance. RESULTS Ten studies were included, with a total of 197 evaluated people with CP. These studies were classified as moderate or high methodological quality. We found convergence on the use of the sensor at the lumbar region (L3), with sampling frequency at 100 Hz. For balance assessment, 60 % of the reviewed studies used the 10-m walk test, while the other studies used different walking distances, or the quiet standing test. For data processing, the low-pass filter at 20 Hz has been used predominantly, and the most commonly used variable to evaluate balance stability has been root mean square of trunk acceleration. Children and adolescents with CP had higher acceleration values and greater gait complexity than typically developing children. Individuals with bilateral impairment had greater anteroposterior and mediolateral trunk accelerations than those with unilateral impairment. Trunk acceleration was shown to be sensitive to improvement in gait stability from interventions, and acceleration-based measures have been found to correlate with qualitative balance assessment tools. SIGNIFICANCE Trunk accelerometry in quiet posture and dynamic tasks was shown to be a valid and sensitive measurement to evaluate balance stability in children and adolescents with CP. It is a small, light, low-cost and easy-to-handle tool that is effective for measuring body balance on different tasks in this population.
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Affiliation(s)
- Paola Janeiro Valenciano
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| | - Núbia Ribeiro Conceição
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| | - Alexandre Jehan Marcori
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
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Ziziene J, Daunoraviciene K, Juskeniene G, Pauk J. An effect of spinal and ankle-foot orthoses on gait of spastic diplegic child: A case report. Technol Health Care 2021; 30:271-281. [PMID: 34806639 DOI: 10.3233/thc-219009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In children with spastic cerebral palsy (CP), the most common motor dysfunction is pathological gait. OBJECTIVE To evaluate the effectiveness of measures for an individual CP case. METHODS The case of one spastic diplegia child has been analyzed. Both lower extremities and spine were examined under three gait conditions: 1) barefoot, 2) with ankle-foot orthoses (AFOs) and thoracolumbosacral spinal orthosis (TLSO), and 3) with TLSO only. Spatiotemporal gait and kinematic parameters of the pelvic, hip, knee, ankle joints, and spine were obtained using Vicon Plug-in-Gait model. The difference (Δ) between the measured values and normative ranges was calculated to determine the efficiency of the orthoses. RESULTS Significant differences were found in kinematic and spatiotemporal parameters comparing results between conditions and body sides. The effectiveness of the measures was confirmed by the smallest Δ values in the double and single support time with the AFOs/TLSO and in the stride and stance time with TLSO. CONCLUSIONS Based on the study results, the best stability of the spine, ankle plantarflexion, and knee hyperextension is achieved with the AFOs/TLSO; therefore, this combination of measures was considered the most effective. However, not only quantitative parameters should be taken into account, but also the child's willingness and comfort.
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Affiliation(s)
- Jurgita Ziziene
- Department of Biomechanical Engineering, Faculty of Mechanics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Kristina Daunoraviciene
- Department of Biomechanical Engineering, Faculty of Mechanics, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Giedre Juskeniene
- Health Science Institute, Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Pauk
- Biomedical Engineering Institute, Bialystok University of Technology, Bialystok, Poland
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Tashiro S, Gotou N, Oku Y, Sugano T, Nakamura T, Suzuki H, Otomo N, Yamada S, Tsuji T, Asato Y, Ishii N. Relationship between Plantar Pressure and Sensory Disturbance in Patients with Hansen's Disease-Preliminary Research and Review of the Literature. SENSORS 2020; 20:s20236976. [PMID: 33291332 PMCID: PMC7730212 DOI: 10.3390/s20236976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022]
Abstract
Orthoses and insoles are among the primary treatments and prevention methods of refractory plantar ulcers in patients with Hansen’s disease. While dynamic plantar pressure and tactile sensory disturbance are the critical pathological factors, few studies have investigated whether a relationship exists between these two factors. In this study, dynamic pressure measured using F-scan system and tactile sensory threshold evaluated with monofilament testing were determined for 12 areas of 20 feet in patients with chronic Hansen’s disease. The correlation between these two factors was calculated for each foot, for each clinical category of the foot (0–IV) and across all feet. A significant correlation was found between dynamic pressure and tactile sensation in Category II feet (n = 8, p = 0.016, r2 = 0.246, Spearman’s rank test). In contrast, no significant correlation was detected for the entire foot or within the subgroups for the remainder of the clinical categories. However, the clinical manifestation of lesion areas showed high variability: (1) pressure concentrated, sensation lost; (2) margin of pressure concentration, sensation lost; (3) pressure concentrated, sensation severely disturbed but not lost; and (4) tip of the toe. These results may indicate that, even though there was a weak relationship between dynamic pressure and tactile sensation, it is important to assess both, in addition to the basics of orthotic treatment in patients with Hansen’s disease presenting with refractory plantar ulceration.
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Affiliation(s)
- Syoichi Tashiro
- Department of Rehabilitation, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (Y.O.); (T.N.); (H.S.)
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan;
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan;
- Correspondence: ; Tel.: +81-3-5363-3833
| | - Naoki Gotou
- Department of Prosthesis and Orthosis, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (N.G.); (T.S.)
| | - Yuki Oku
- Department of Rehabilitation, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (Y.O.); (T.N.); (H.S.)
- Department of Rehabilitation, National Hospital Organization Tokyo Hospital, Kiyose, Tokyo 204-8585, Japan
| | - Takahiro Sugano
- Department of Prosthesis and Orthosis, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (N.G.); (T.S.)
| | - Takuya Nakamura
- Department of Rehabilitation, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (Y.O.); (T.N.); (H.S.)
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan;
| | - Hiromi Suzuki
- Department of Rehabilitation, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan; (Y.O.); (T.N.); (H.S.)
| | - Nao Otomo
- Department of Orthopaedic Surgery, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan;
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Shin Yamada
- Department of Rehabilitation Medicine, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan;
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan;
| | - Yutaka Asato
- Department of Surgery, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan;
| | - Norihisa Ishii
- Department of Dermatology, National Sanatorium Tamazenshoen, Higashi-Murayama, Tokyo 189-0002, Japan;
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