Yonsei Med J.  2010 Sep;51(5):746-752. 10.3349/ymj.2010.51.5.746.

Effect of Hinged Ankle-Foot Orthoses on Standing Balance Control in Children with Bilateral Spastic Cerebral Palsy

• Rha DW
• Kim DJ
• Park ES

• KMID: 1071428
• DOI: http://doi.org/10.3349/ymj.2010.51.5.746

Abstract

PURPOSE
To identify the characteristics of static standing balance and its postural control mechanisms during quiet side-by-side standing and the changes in these measures whilst wearing hinged ankle-foot orthoses (AFOs) in children with bilateral spastic cerebral palsy (CP).
MATERIALS AND METHODS
Twenty-one children with bilateral spastic CP (6.10 +/- 1.09 year-old) and 22 typically developing (TD) children (5.64 +/- 0.49 year-old) were recruited. Pressure data were recorded while subjects with or without AFOs stood on dual force platforms and net body center of pressure (CoP) coordinates were calculated from this data. Net body CoP was traced for measuring mediolateral (ML) and anteroposterior (AP) displacement and path length per second. Correlation coefficients between parameters representing ankle, hip, and transverse body rotation strategies were also analyzed.
RESULTS
ML and AP displacement and path length per second of the CoP trajectory were higher in children with CP compared to TD children (p < 0.05). There were no significant improvements in these parameters whilst wearing hinged AFOs. Compared to TD children, children with CP used less ankle strategy though more hip and transverse rotation strategies for postural control during quiet standing. Whilst wearing hinged AFOs, the contribution of ankle strategy was significantly increased for ML balance control in children with CP (p < 0.05).
CONCLUSION
Hinged AFOs for children with CP may be helpful in improving the postural control mechanisms but not the postural stability in quiet side-by-side standing.

Keyword

Ankle-foot orthosis; balance; spasticity; cerebral palsy

MeSH Terms

Ankle Joint/*pathology
Cerebral Palsy/rehabilitation/*therapy
Child
Child, Preschool
Humans
Male
*Orthotic Devices
Postural Balance/*physiology

Figure

• 

  Fig. 1 Subjects were instructed to stand in a comfortable position while barefoot with each foot on 1 force platform with their arms hanging at their sides. The center of pressure (CoP) components (x, y) corresponded respectively to mediolatearal (ML) and anteroposterior (AP) signals in the measurement system using dual force platforms. Rright and Rleft are the magnitudes of vertical ground reaction forces under the right and left limbs, respectively.

• 

  Fig. 2 Examples of trajectories in typically developing (TD) child and cerebral palsy (CP) child without an ankle-foot orthosis. (A) A TD child showed packed movement within a narrow range. (B) A child with spastic CP showed movement within a wider range.

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