Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran.
Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran.
Ann Phys Rehabil Med. 2017 Nov;60(6):393-402. doi: 10.1016/j.rehab.2017.05.004. Epub 2017 Jul 13.
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.
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.
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.
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.
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.
踝足矫形器（AFO）是一种矫形装置，可用于使脑瘫儿童的行走模式正常化。矫形管理的目的之一是通过将关节置于适当位置来减少病理性反射或痉挛，从而产生更正常的步态模式。
对文献进行系统综述，确定各种类型的 AFO 对脑瘫儿童步态模式的治疗效果。
在 2007 年至 2015 年间，使用 PubMed、Scopus、ISI Web of Knowledge、Cochrane 图书馆、EMBASE 和 Google Scholar 搜索了以下 AFO 治疗脑瘫儿童的研究文章：铰链式（HAFO）、实心（SAFO）、地板反应（FRO）、后叶弹簧（PLS）和动态（DAFO）。排除了结合治疗方案的研究。研究的结果是步态模式的变化和随后的行走能力。使用 PEDro 量表评估相关研究的方法学质量。
我们纳入了 17 项共 1139 名脑瘫儿童的研究。大多数研究的 PEDro 评分较差（3/10）。只有 4 项研究（共 209 名儿童）为随机对照试验，PEDro 评分为 5、7、9/10，具有适当的证据水平。一项研究采用病例系列，其余研究采用横断面设计。一般来说，AFO 的使用提高了速度和步长。与赤脚条件相比，HAFO 对改善偏瘫脑瘫的步态参数和降低能量消耗有效。它还改善了偏瘫脑瘫的步长、行走速度、单肢支撑和步态对称性。塑料 SAFO 和 FRO 可有效降低双瘫脑瘫的能量消耗。对于双瘫脑瘫，HAFO 和 SAFO 可改善粗大运动功能。
对于脑瘫儿童，使用特定类型的 AFO 可改善步态参数，包括踝关节和膝关节活动范围、行走速度和步长。AFO 可减少痉挛性脑瘫儿童的能量消耗。然而，需要具有较高 PEDro 评分的进一步研究，以获得关于 AFO 对脑瘫儿童有效性的更具结论性证据。
