How does a systematic tuning protocol for ankle foot orthosis–footwear combinations affect gait in children in cerebral palsy?

To investigate the effects of a systematic tuning protocol for ankle foot orthosis footwear combinations (AFO-FC) using incrementing heel height on gait in children with cerebral palsy (CP). Eighteen children with CP (10.8 ± 3 years, Gross Motor Function Classification System (GMFCS) I–II) underwent 3D gait analysis on a treadmill, while the AFO heel surface was systematically incremented with wedges. Children were subdivided based on their gait pattern, i.e., knee hyperextension (EXT) and excessive knee flexion (FLEX). Outcome measures included sagittal hip and knee angles and moments, shank to vertical angle (SVA), foot to horizontal angle, and gait profile score (GPS). For both groups, incrementing heel height resulted in increased knee flexion, more inclined SVA, and increased knee extension moments. This resulted in gait improvements for some children of the EXT-group, but not in FLEX. High variation was found between individuals and within-subject effects were not always consistent for kinematic and kinetics. A systematic AFO-FC tuning protocol using incremented heel height can be effective to improve gait in children with CP walking with EXT. The current results emphasise the importance of including kinematics as well as kinetics of multiple instances throughout the gait cycle for reliable interpretation of the effect of AFO tuning on gait.Implications for rehabilitationA systematic ankle foot orthosis footwear combinations (AFO-FC) tuning protocol using incremented heel height can improve gait in children walking with knee hyperextension.Tuning results in changes throughout the gait cycle.Little evidence is found for an optimal SVA of 10–12° at midstance.For clinical interpretation, both joint kinematic and kinetic parameters should be considered throughout the gait cycle and evaluation should not be based on SVA only. A systematic ankle foot orthosis footwear combinations (AFO-FC) tuning protocol using incremented heel height can improve gait in children walking with knee hyperextension. Tuning results in changes throughout the gait cycle. Little evidence is found for an optimal SVA of 10–12° at midstance. For clinical interpretation, both joint kinematic and kinetic parameters should be considered throughout the gait cycle and evaluation should not be based on SVA only.

本研究旨在探讨采用递增跟高系统调节策略对足踝矫形鞋具组合（AFO-FC）的影响，以研究其对脑瘫儿童步态的效应。十八名脑瘫儿童（年龄10.8±3岁，根据粗大运动功能分类系统（GMFCS）分为I-II级）在跑步机上接受了三维步态分析，同时系统性地使用楔子增加AFO跟部表面高度。儿童根据其步态模式进行细分，即膝过伸（EXT）和过度膝屈（FLEX）。结果指标包括矢状面髋膝角度和力矩、小腿与垂直线角度（SVA）、足与水平线角度以及步态轮廓评分（GPS）。对于两组儿童，跟高增加导致膝屈增加、SVA更加倾斜以及膝伸力矩增加。这导致EXT组中一些儿童的步态得到改善，而FLEX组则没有。个体间的差异较大，且在同一受试者内部，运动学和动力学效果并不总是保持一致。采用递增跟高系统调节策略的AFO-FC调节协议对于EXT组儿童步行时的步态改善具有有效性。当前结果强调了在步态周期中纳入多个实例的运动学和动力学的重要性，以确保对AFO调节对步态影响的有效解读。对于康复意义而言，采用递增跟高系统调节策略的AFO-FC调节协议可以改善膝过伸儿童行走时的步态。调节过程导致步态周期中发生一系列变化。在中支撑期，关于SVA为10-12°的优化证据不多。在临床解读时，应考虑步态周期中关节的运动学和动力学参数，而评价不应仅基于SVA。