Article

Although ankle-foot orthoses (AFOs) are often used to improve gait parameters in individuals with myelomeningocele (MMC), it can be challenging to predict which type of orthosis will best optimize a child's gait mechanics and function. This case report illustrates the clinical application of three-dimensional motion analysis technology to quantify kinematic gait variables, and the effect of external tibial torsion on those variables, during the process of orthotic evaluation in an adolescent with MMC. The participant was a 14-year-old girl with lumbosacral MMC, crouch gait, and bilateral external tibial torsion (thigh foot angle 45[degrees] on the right, 20[degrees] on the left). A three-dimensional optical tracking (Vicon) system was used to compare the sagittal plane joint kinematics, velocity, and step length associated with barefoot walking, articulated AFOs with dorsi-assist and dorsiflexion stop, and ground reaction AFOs (GRAFOs). Ensemble averaged lower limb joint kinematics for an entire gait cycle were compared between conditions and with normal data. The greatest improvements in gait kinematics were observed in the sagittal plane, on the left leg, with the GRAFOs. It is likely that the amount of tibial torsion present on the participant's right side limited the effectiveness of both orthoses on that side. These results suggest that GRAFOs have the potential to improve sagittal plane kinematics in the presence of 20[degrees] of external tibial torsion, thereby improving gait efficiency and reducing musculoskeletal strain. However, more extreme torsional deformities (i.e., 45[degrees]) may impair the biomechanical function of orthotic intervention. Computerized gait analysis can be a useful adjunct to the process of orthotic evaluation.

Langue : ANGLAIS