Ricardo Diogo, Raposo Maria Raquel, Cruz Eduardo Brazete, Oliveira Raul, Carnide Filomena, Veloso António Prieto, João Filipa
CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada-Dafundo, 1499-002 Oeiras, Portugal.
Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Av. D. João II, 1990-096 Lisboa, Portugal.
Children (Basel). 2021 Oct 10;8(10):903. doi: 10.3390/children8100903.
Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane.
A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670.
We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO.
Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.
脑性瘫痪（CP）是儿童运动残疾的最常见原因，可导致严重的步态偏差。双侧CP患儿矢状面步态模式分类是康复过程规划的重要指南。踝足矫形器应改善矢状面病理性步态的生物力学参数。
进行系统的文献检索，以确定测量踝足矫形器（AFO）对痉挛型双侧CP患儿步态影响的随机对照试验（RCT）和对照临床试验（CCT），包括动力学、运动学和功能结果。在2020年2月之前检索了五个数据库（PubMed、Scopus、ISI Web of SCIENCE、SciELO和Cochrane图书馆）。使用PEDro评分评估所选研究的方法学质量，并审查与Cochrane方法的一致性。Prospero注册号：CRD42018102670。
我们纳入了10项研究，共涉及285例痉挛型双侧CP患儿。没有一项研究的PEDro评分低于4/10，其中包括5项RCT。我们确定了所有研究中使用的五种不同类型的AFO（实心；动态；铰链式；地面反应式；后叶弹簧式）。只有两项研究提到了步态模式分类。在不同的结果中，发现佩戴AFO时，步行速度、步长和步频、运动范围、地面力反应和关节力矩以及功能评分存在显著差异。
总体而言，在痉挛型双侧CP患儿中使用AFO可将病理性步态的影响降至最低，持续改善一些运动学、动力学和时空参数，并使他们的步态更接近正常发育儿童。为未来涉及AFO的研究制定标准化方案将有助于新科学数据的报告，并帮助临床医生运用临床推理技能为患者推荐最佳的AFO。
