Böhm Harald, Matthias Hösl, Braatz Frank, Döderlein Leonhard
1 Gait Laboratory, Treatment Centre Aschau GmbH, Orthopaedic Hospital for Children, Bavaria, Germany.
2 Department of Trauma Surgery and Orthopedics, University Medical Center Göttingen, Göttingen, Germany.
Prosthet Orthot Int. 2018 Jun;42(3):245-253. doi: 10.1177/0309364617716240. Epub 2017 Jul 11.
Floor reaction ankle-foot orthoses are commonly prescribed to improve knee extension of children with cerebral palsy having crouch gait. Their effectiveness is debated. Therefore, the objective of this study is to optimize current prescription criteria for the improvement of crouch gait.
Cross-sectional interventional study.
A total of 22 patients with bilateral spastic cerebral palsy, between 6 and 17 years, Gross Motor Function Classification System II-IV participated in this study. Instrumented gait analysis was done under three conditions: barefoot, shoed, and with orthotics. Patients were divided into two groups: good and non-responders with more and less than 8.8° improvement of knee extension during walking, respectively. A multiple predictor analysis was done on parameters that were different between groups.
In total, 12 of 22 patients showed good response in knee extension with a mean change of 17° (standard deviation = 5°). Good responders showed a significantly smaller walking velocity, knee extension strength, ankle plantarflexion strength, and greater external foot progression angle compared to non-responders. Foot progression angle together with ankle plantarflexion strength explained 37% of the variance in improvement of knee extension.
With appropriate patient selection, an improvement of crouch gait by ankle-foot orthoses of 17° (standard deviation = 5°) can be expected. Patients with slow velocity, weak plantarflexors, and external foot progression benefit most. Joint contractures were no contraindications. Clinical relevance This study showed that gait in patients with low functional level benefit most from ankle-foot orthoses. Unlike in patients with higher functional status, contractures of hip, knee, and ankle did not reduce the positive effects on gait. The suggested prescription criteria may help to better select appropriate patients for orthotics.
足底反应式踝足矫形器常用于改善患有蹲伏步态的脑瘫儿童的膝关节伸展。其有效性存在争议。因此，本研究的目的是优化当前改善蹲伏步态的处方标准。
横断面干预研究。
共有22例6至17岁、粗大运动功能分类系统II-IV级的双侧痉挛性脑瘫患者参与本研究。在三种情况下进行仪器化步态分析：赤脚、穿鞋和佩戴矫形器。患者分为两组：反应良好组和无反应组，分别在行走时膝关节伸展改善超过和低于8.8°。对两组之间不同的参数进行多预测因素分析。
22例患者中共有12例膝关节伸展反应良好，平均变化为17°（标准差=5°）。与无反应组相比，反应良好组的步行速度、膝关节伸展力量、踝关节跖屈力量明显更小，足外展角更大。足外展角和踝关节跖屈力量共同解释了膝关节伸展改善差异的37%。
通过适当的患者选择，可预期踝足矫形器能使蹲伏步态改善17°（标准差=5°）。速度慢、跖屈肌无力和足外展的患者受益最大。关节挛缩不是禁忌证。临床相关性 本研究表明，功能水平低的患者步态从踝足矫形器中受益最大。与功能状态较高的患者不同，髋、膝和踝关节挛缩并未降低对步态的积极影响。建议的处方标准可能有助于更好地选择合适的患者使用矫形器。
