How the use of ankle foot orthoses affects spinal posture and balance in children with cerebral palsy?

Year 2025, Volume: 11 Issue: 5, 299 - 306

Tamer Çankaya , Seda Ayaz Taş , Muhammed Abdullatif Alsairavan

https://doi.org/10.31459/turkjkin.1737820

Abstract

Evidence on the effect of Ankle Foot Orthoses (AFO) on spinal posture which is very important for postural control, is insufficient. The purpose of the study was to investigate the effect of ankle foot orthoses in spinal posture, balance and lower extremity functional skills in children with Cerebral Palsy (CP). This study was conducted using a repeated-measures design. 25 children with CP aged 6-17 years were included. Children were classified according to the Gross Motor Function Classification System (GMFCS), Manual Skills Classification System (MACS) and Communication Function Classification System (CFCS). Spinal postures with Spinal Mouse (SM), balance and lower extremity functional skills were evaluated using the Pediatric Berg Balance Scale and Pediatric Functional Reach and Timed Up & Go Test twice with ankle foot orthoses and barefoot. There was significance difference between lumbar (p=0.04) and total spine (p=0.05) angulations at upright position in sagittal plane barefoot and with ankle foot orthoses measurements. In frontal plane, there was a significance difference between two measurements sacrum-hip (p=0.00), thorax (p=0.004), lumbar (p=0.005) and total spine (p=0.002) angulation degrees at left lateral flexion position. Similarly, thorax (p=0.02), lumbar (p=0.012) and total spine (p=0.017) angulation degrees at right lateral flexion position. Also, the statistically difference was found on Pediatric Berg Balance Scale (p=0.008). Ankle foot orthoses provides smooth spinal posture in sagittal and frontal planes and increase in spinal mobility. While it improves balance skills, it does not affect lower extremity functional skills.

Keywords

Cerebral palsy , posture , spinal mouse , spine

Ethical Statement

The study was approved by the Abant Izzet Baysal University Clinical Research Ethics Committee (2022/339) and ıt was registered on ClinicalTrials.gov with the registration number NCT06473363. It was carried out in accordance with the Code of Ethics of the World Medical Association also known as a declaration of Helsinki.

Supporting Institution

The authors declare that the study received no funding.

Thanks

We would like to thanks to the children and their families who participated the study.

References

• Assaiante C., Mallau S., Viel S., Jover M., & Schmitz C. (2005). Development of postural control in healthy children: A functional approach. Neural Plast, 12(2–3), 109–118. doi: 10.1155/NP.2005.109
• Badawi N., Watson L., Petterson B., Blair E., Slee J., Haan E., & Stanley, F. (1998). What constitutes cerebral palsy? Dev Med Child Neurol, 40(8), 520–527. doi: 10.1111/J.1469-8749.1998.TB15410.X
• Bartlett D., & Birmingham, T. (2003). Validity and reliability of a pediatric reach test. Pediatr Phys Ther, 15(2), 84–92. doi: 10.1097/01.PEP.0000067885.63909.5C
• Bregman D. J. J., Rozumalski A., Koops D., De Groot V., Schwartz M., & Harlaar J. (2009). A new method for evaluating ankle foot orthosis characteristics: BRUCE. Gait Posture, 30(2), 144-149. doi: 10.1016/j.gaitpost.05.012
• Brogren Carlberg E., & Hadders-Algra M. (2005). Postural dysfunction in children with cerebral palsy: Some implications for therapeutic guidance. Neural Plast, 12(2–3), 221–228. doi: 10.1155/NP.2005.221
• Carey H., Martin K., Combs Miller S., & Heathcock J. C. (2016). Reliability and responsiveness of the timed up and go test in children with cerebral palsy. Pediatr Phys Ther, 28(4), 401–408. doi: 10.1097/PEP.0000000000000301
• Cherng R. J., Su F. C., Chen J. J. J., & Kuan T. (1999). Performance of static standing balance in children with spastic diplegic cerebral palsy under altered sensory environments. Am J Phys Med Rehabil, 78(4), 336-343.
• Cohen H., Blatchly A.C., Gombash L.L., 1993. A study of the clinical test of sensory interaction and balance. Phys Ther, 73, 346-351.
• Hidecker, M. J., Paneth, N., Rosenbaum, P. L., Kent, R. D., Lillie, J., Eulenberg, J. B., Chester, K., Jr, Johnson, B., Michalsen, L., Evatt, M., & Taylor, K. (2011). Developing and validating the communication function classification system for individuals with cerebral palsy. Dev Med Child Neurol, 53(8), 704–710. doi: 10.1111/j.1469-8749.2011.03996.x
• El Ö., Baydar M., Berk H., Peker Ö., Koşşay C., & Demiral, Y., (2012). Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disabil Rehabil, 34(12), 1030–1033. https://doi.org/10.3109/09638288.2011.632466
• Eliasson A.C., Rösblad B.P., Arner M., Rosenbaum P., 2007. The Manual Ability Classification System (MACS) for children with cerebral palsy: Scale development and evidence of validity and reliability. Dev Med Child Neurol, 48(7), 549–554. doi: 10.1111/j.1469-8749.2006.tb01313.x
• Erden A., Acar Arslan E., Dündar B., Topbaş M., Cavlak, U., 2021. Reliability and validity of Turkish version of pediatric balance scale. Acta Neurol Belg, 121(3), 669–675. https://doi.org/10.1007/S13760-020-01302-9
• Faul F., Erdfelder E., Lang A.G., & Buchner A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods, 39(2), 175–191. doi: 10.3758/BF03193146
• Franjoine M. R., Gunther J. S., Taylor M. J. (2003). Pediatric balance scale: A modified version of the Berg Balance Scale for the school-age child with mild to moderate motor ımpairment. Pediatr Phys Ther, 15(2),114-128. doi: 10.1097/01.PEP.0000068117.48023.18
• Laerkner E., Egerod I., & Hansen H. P. (2015). Nurses’ experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the intensive care unit: A qualitative study. Intensive Crit Care Nurs, 31(4), 196–204. doi: 10.1016/j.iccn.2015.01.005
• Latash, M. L. (2010). Stages in learning motor synergies: A view based on the equilibrium-point hypothesis. Hum Mov Sci, 29(5), 642–654. doi: 10.1016/J.HUMOV.2009.11.002
• Leonard, R., Sweeney, J., Damiano, D., Bjornson, K., & Ries, J. (2021). Effects of orthoses on standing postural control and muscle activity in children with cerebral palsy. Pediatr Phys Ther, 33(3), 129-135. doi: 10.1097/PEP.0000000000000802.
• Mutlu, A., Kara, Ö. K., Livanelioğlu, A., Karahan, S., Alkan, H., Yardımcı, B. N., & Hidecker, M. J. C. (2018). Agreement between parents and clinicians on the communication function levels and relationship of classification systems of children with cerebral palsy. Disabil Health J, 11(2), 281–286. doi: 10.1016/j.dhjo.2017.11.001
• Nashner, L. M., Shumway-Cook, A., & Marin, O. (1983). Stance posture control in select groups of children with cerebral palsy: deficits in sensory organization and muscular coordination. Exp Brain Res, 49(3), 393–409. doi: 10.1007/BF00238781
• Morris C. (2002). A review of the efficacy of lower-limb orthoses used for cerebral palsy. Dev Med Child Neurol, 44(3), 205–211. doi: 10.1017/s0012162201001943
• O'Reilly, T., Hunt, A., Thomas, B., Harris, L., & Burns, J. (2009). Effects of ankle-foot orthoses for children with hemiplegia on weight-bearing and functional ability. Pediatr Phys Ther, 21(3), 225–234. doi: 10.1097/PEP.0b013e3181b126fb
• Ozer Kaya D., Kocak U.Z., Emuk Y., Olgac Dundar N., Bozkaya Yilmaz S., & Gencpinar, P. (2021). The comparison of regional spinal curvatures and movements in sitting posture in ambulatory children with cerebral palsy having minimal-to-moderate functional limitations. Gait Posture, 90, 408–414. doi: 10.1016/J.GAITPOST.2021.09.192
• Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., Dan, B., & Jacobsson, B. (2007). A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol, 109(Supplement), 8-14.
• Perry, J., & Burnfield J. M. (2024). Gait analysis: Normal and pathological function. CRC Press.
• Ramstrand N., Ramstrand S., 2010. AAOP state-of-the-science evidence report: the effect of ankle-foot orthoses on balance-A systematic review. J Prosthet Orthot, 22(10), 4-23. doi: 10.1097/JPO.0b013e3181f379b7
• Richardson, S. (1991). The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 39(2), 142–148. doi: 10.1111/J.1532-5415.1991.TB01616.X
• Ridgewell, E., Dobson, F., Bach, T., & Baker R. (2010). A systematic review to determine best practice reporting guidelines for AFO interventions in studies involving children with cerebral palsy. Prosthet Orthot Int, 34(2), 129–145. doi: 10.3109/03093641003674288
• Rosenbaum P. L., Palisano R. J., Bartlett D. J., Galuppi, B. E., Russell, D. J. (2008). Development of the gross motor function classification system for cerebral palsy. Dev Med Child Neurol, 50(4), 249–253. doi: 10.1111/j.1469-8749.2008.02045.x
• Rosenbaum P., & Stewart D. (2004). The world health organization international classification of functioning, disability, and health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. Semin Pediatr Neurol, 11(1), 5–10. doi: 10.1016/J.SPEN.2004.01.002
• Ruthard, K., Raabe-Oetker, A., Ruthard, J., Oppermann, T., Duran, I., Schönau, E. (2020). Reliability of a radiation-free, noninvasive and computer-assisted assessment of the spine in children with cerebral palsy. Eur Spine J, 29(5), 937–942. doi: 10.1007/S00586-020-06328-4
• Schmid, S., Romkes, J., Taylor, W. R., Lorenzetti, S., & Brunner, R. (2016). Orthotic correction of lower limb function during gait does not immediately influence spinal kinematics in spastic hemiplegic cerebral palsy. Gait Posture, 49, 457-462. doi: 10.1016/j.gaitpost.2016.08.013
• Sim, Y. J., Yang, Y. J., & Yi, C. H. (2015). Immediate effect of fabric ankle foot orthosis on balance in children with unilateral cerebral palsy. Phys Ther Korea, 22(2), 52-58. doi: 10.12674/ptk.2015.22.2.052
• Gage, J. R. (1991). Gait analysis in cerebral palsy. Mac Keith.
• Bernstein, N. (1967). The coordination and regulation of movements. London: Pergamon.
• Watson, M. J. (2002). Refining the ten-metre walking test for use with neurologically impaired people. Phys Ther, 88: 386–97. doi: 10.1016/S0031-9406(05)61264-3
• Wesdock, K. A., & Edge, A. M. (2003). Effects of wedged shoes and ankle-foot orthoses on standing balance and knee extension in children with cerebral palsy who crouch. Pediatr Phys Ther, 15(4), 221-231. doi: 10.1097/01.PEP.0000096383.80789.A4
• Williams, E. N., Carroll, S. G., Reddihough, D. S., Phillips, B. A., & Galea, M. P. (2005). Investigation of the timed ‘up & go’test in children. Dev Med Child Neurol, 47(8), 518-524. doi: 10.1017/S0012162205001027
• Wright, E., & DiBello, S. A. (2020). Principles of ankle-foot orthosis prescription in ambulatory bilateral cerebral palsy. Phys Med Rehabil Clin N Am, 31(1), 69-89. doi: 10.1016/j.pmr.2019.09.007