Article

OBJECTIVE: To determine the effects of ankle-foot orthoses (AFOs) on gait,
balance, gross motor function and activities of daily living in children with
cerebral palsy. DATA SOURCES: Five databases were searched (Pubmed, Psycinfo, Web
of Science, Academic Search Premier and Cochrane Library) before January 2018.
REVIEW METHODS: Studies of the effect of AFOs on gait, balance, gross motor
function and activities of daily living in children with cerebral palsy were
included. Articles with a modified PEDRO score >/= 5/9 were selected. Data
regarding population, AFO, interventions and outcomes were extracted. When
possible, standardized mean differences (SMDs) were calculated from the outcomes.
RESULTS: Thirty-two articles, corresponding to 56 studies (884 children) were
included. Fifty-one studies included children with spastic cerebral palsy. AFOs
increased stride length (SMD = 0.88, P < 0.001) and gait speed (SMD = 0.28, P <
0.001), and decreased cadence (SMD = -0.72, P < 0.001). Gross motor function
scores improved (Gross Motor Function Measure (GMFM) D (SMD = 0.30, P = 0.004), E
(SMD = 0.28, P = 0.02), Pediatric Evaluation of Disability Inventory (PEDI) (SMD
= 0.57, P < 0.001)). Data relating to balance and activities of daily living were
insufficient to conclude. Posterior AFOs (solid, hinged, supra-malleolar,
dynamic) increased ankle dorsiflexion at initial contact (SMD = 1.65, P < 0.001)
and during swing (SMD = 1.34, P < 0.001), and decreased ankle power generation in
stance (SMD = -0.72, P < 0.001) in children with equinus gait. CONCLUSION: In
children with spastic cerebral palsy, there is strong evidence that AFOs induce
small improvements in gait speed and moderate evidence that AFOs have a small to
moderate effect on gross motor function. In children with equinus gait, there is
strong evidence that posterior AFOs induce large changes in distal kinematics.

Langue : ANGLAIS