Role of ankle foot orthoses in the outcome of clinical tests of balance

Efficacy of foot-ankle orthosis on balance for children with hemiplegic cerebral palsy: An observational study

Objectives

The aim of this study was to investigate the impact of ankle-foot orthoses (AFOs) on the balance and gait and to compare the effects of hinged AFOs with solid AFOs on balance in patients with cerebral palsy (CP).

Patients and methods

Between January 2015 and January 2016, 19 hemiplegic children with CP (11 males, 8 females; mean age: 9.5±2.2 years; range, 6 to 15 years) and 23 sex- and age-matched controls (8 males, 15 females; mean age: 10±1.6 years; range, 6 to 13 years) were included in this study. All patients were using either solid or hinged AFO. Hemiplegic patients were attended to specific tests with orthoses and barefoot. Pediatric Balance Scale (PBS) and Five Times Sit to Stand Test (FTSST) were used for functional evaluation. The quantitative balance was evaluated using the device-assisted balance tests, Limits of Stability (LOS), Walk Across (WA), and Sit to Stand (STS) tests.

Results

The control group had a better functional balance than the CP group (p<0.001 for PBS and p<0.001 for FTSST) and the CP group with AFO had a better balance than the barefoot (p=0.001 for PBS and p=0.009 for FTSST). Children with CP also showed a higher sway velocity in STS (p<0.001) than the control group. In patients with AFO, a decrease in the sway velocity in STS (p=0.037) and an increase in directional control in LOS (p=0.044) were observed, compared to barefoot.

Conclusion

The AFO use offers a significant contribution to the functional balance in CP. Prescribing AFOs are usually required in ambulatory CP patients in combined with a well-designed standard physiotherapy.

The influence of wearing ski-boots with different rigidity characteristics on postural control

External supports that reduce ankle joint mobility such as ski-boots can impair postural control of healthy participants. Although this disruptive effect has been attributed to the rigidity of the external supports, the results remained controversial and no study has been conducted in order to evaluate the influence of ski-boots rigidity. Hence, the question about the influence of ankle support rigidity on postural control remains open. This study was therefore undertaken in order to investigate the effect of ski-boots rigidity on postural control. Ten healthy active participants were recruited. The wearing of soft and rigid ski-boots was compared to barefoot while standing on a seesaw generating mediolateral and anteroposterior instability. Centre of pressure displacements were sampled with a force platform. The surface electromyographic activity of the main muscles from the leg, thigh and trunk was recorded. A motion analysis system was also used to calculate the ankle, knee and hip angles. The results did not reveal any negative influence of ski-boot rigidity on postural control but rather suggest a less active postural control with the rigid ski-boots which offered a higher mechanical contribution.

The effect of lateral or medial wedges on control of postural sway in standing

The objective of this study was to evaluate the effects of lateral and medial wedges on postural sway. Twenty healthy volunteers (mean age range of 28.45±3.34) participated in the study. They stood barefoot with eyes open or closed on each of the three surfaces: 10° lateral wedges, 10° medial wedges, and no wedges. Force platform data were collected and the mean and root mean square (RMS) distance, range, and velocity and the mean frequency of the center of pressure (COP) were calculated in the anterior-posterior (AP) and medial-lateral (ML) directions. Standing on both lateral and medial wedges was associated with improved postural stability seen through the decreased mean and RMS distance of COP displacement in ML direction. The results of this study suggest that standing on either lateral or medial wedges might enhance postural control in standing.