Article

Ankle foot orthoses (AFOs) are orthotic devices that can be used to normalize the walking pattern of children with cerebral palsy (CP). One of the
aims of orthotic management is to produce a more normal gait pattern by
positioning joints in the proper position to reduce pathological reflex or spasticity. OBJECTIVE: To conduct a systematic review
of the literature and
establish the effect of treatment with various types of AFOs on gait patterns of
children with CP. METHODS: PubMed, Scopus, ISI Web of knowledge, Cochrane
Library, EMBASE and Google Scholar were searched for articles published between
2007 and 2015 of studies of children with CP wearing the following AFOs: hinged
(HAFO), solid (SAFO), floor reaction (FRO), posterior leaf spring (PLS) and
dynamic (DAFO). Studies that combined treatment options were excluded. Outcomes
investigated were a change in gait pattern and subsequent walking ability. The
PEDro scale used to assess the methodological quality of relevant studies.
RESULTS: We included 17 studies investigating a total of 1139 children with CP.
The PEDro score was poor for most studies (3/10). Only 4 studies, of 209 children
in total, were randomized controlled trials, for a good PEDro score (5, 7, 9/10)
and an appropriate level of evidence. One study used a case-based series and the
remainder a cross-sectional design. In general, the use of AFOs improved speed
and stride length. The HAFO was effective for improving gait parameters and
decreasing energy expenditure with hemiplegic CP as compared with the barefoot
condition. It also improved stride length, speed of walking, single limb support
and gait symmetry with hemiplegic CP. The plastic SAFO and FRO were effective in
reducing energy expenditure with diplegic CP. With diplegic CP, the HAFO and SAFO
improved gross motor function. CONCLUSION: For children with CP, use of specific
types of AFOs improved gait parameters, including ankle and knee range of motion,
walking speed and stride length. AFOs reduced energy expenditure in children with
spastic CP. However, further studies with good PEDro scores are required for more
conclusive evidence regarding the effectiveness of AFOs in children with CP.
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Langue : ANGLAIS