Wren Tishya A L, Dryden James W, Mueske Nicole M, Dennis Sandra W, Healy Bitte S, Rethlefsen Susan A
Children's Orthopaedic Center (Drs Wren and Rethlefsen, and Ms Mueske, Dennis, and Healy), Children's Hospital Los Angeles, Los Angeles, California; Department of Radiology (Dr Wren), Children's Hospital Los Angeles, Los Angeles, California; Department of Biomedical Engineering (Dr Wren), University of Southern California, Los Angeles, California; Orthopliance Group (Mr Dryden), North Hollywood, California; Division of Pediatric Rehabilitation Medicine (Ms Dennis and Healy, and Dr Rethlefsen), Children's Hospital Los Angeles, Los Angeles, California.
Pediatr Phys Ther. 2015 Fall;27(3):218-26. doi: 10.1097/PEP.0000000000000153.
To compare dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy.
A total of 10 children with cerebral palsy (4-12 years; 6 at Gross Motor Function Classification System level I, 4 at Gross Motor Function Classification System level III) and crouch and/or equinus gait wore DAFOs and ADR-AFOs, each for 4 weeks, in randomized order. Laboratory-based gait analysis, walking activity monitor, and parent-reported questionnaire outcomes were compared among braces and barefoot conditions.
Children demonstrated better stride length (11-12 cm), hip extension (2°-4°), and swing-phase dorsiflexion (9°-17°) in both braces versus barefoot. Push-off power (0.3 W/kg) and knee extension (5°) were better in ADR-AFOs than in DAFOs. Parent satisfaction and walking activity (742 steps per day, 43 minutes per day) were higher for DAFOs.
ADR-AFOs produce better knee extension and push-off power; DAFOs produce more normal ankle motion, greater parent satisfaction, and walking activity. Both braces provide improvements over barefoot.
比较动态踝足矫形器（DAFO）和可调动态反应（ADR）踝足矫形器（AFO）对脑瘫儿童的效果。
共有10名脑瘫儿童（4至12岁；6名处于粗大运动功能分类系统I级，4名处于粗大运动功能分类系统III级），存在蹲伏和/或马蹄足步态，随机顺序佩戴DAFO和ADR - AFO，每种矫形器佩戴4周。比较基于实验室的步态分析、步行活动监测以及家长报告的问卷结果在佩戴矫形器和赤足状态下的差异。
与赤足相比，儿童在佩戴两种矫形器时步幅（11 - 12厘米）、髋关节伸展（2° - 4°）和摆动期背屈（9° - 17°）均更佳。ADR - AFO的蹬离功率（0.3瓦/千克）和膝关节伸展（5°）优于DAFO。DAFO的家长满意度和步行活动（每天742步，每天43分钟）更高。
ADR - AFO能产生更好的膝关节伸展和蹬离功率；DAFO能产生更接近正常的踝关节运动、更高的家长满意度以及更多的步行活动。两种矫形器均比赤足状态有所改善。
