Comparison of the Effects of Foot and Ankle Orthoses in Children with Cerebral Palsy and Neuromuscular Disease on Gait Performance and Energy Expenditure

Abstract

Objective: The aim of this study is to compare the effects of foot and ankle orthoses used for walking in children with cerebral palsy and neuromuscular disease on walking performance and energy expenditure. Materials and Methods: In a retrospective descriptive study design, the 6 Minute Walk Test (6MWT) was performed with and without orthoses. The evaluation results of walking distance, heart rate, respiratory rate, dyspnea, and general fatigue severity (with Borg scale) were compared between children with a diagnosis of cerebral palsy (CP) and neuromuscular disease (NMD). In addition, the Physiological Cost Index was used to calculate the energy expenditure of the children during walking. Results: As a result of file scans, 13 (52 %) of the children who were eligible for inclusion criteria were grouped as the SP group and 12 (48 %) as the NMH group. Heart rate, respiratory rate, dyspnea, and fatigue severity values, changes in recorded walking distance, and energy consumption within the scope of 6MWT showed similar changes for both groups when performing with and without orthosis (p>0.05). In between-group comparisons, it was concluded that there was no difference between gait performance and energy consumption with and without orthosis (p>0.05). Conclusion: This retrospective study should be considered as a valuable study in terms of presenting the effect of the choice of orthoses suitable for their conditions and the effect of gait performance in both the NMH and CP groups and the comparison between the groups. Although there is an attempt to provide an overview of the effects of ankle-ankle orthoses on gait performance and energy consumption in two different pediatric situations, more comprehensive research is needed in the field to present multifactorial effects, including biomechanical effects.

Keywords

• Ankle-foot orthosis
• Cerebral palsy
• Neuromuscular diseases
• Gait
• Physiologic cost index

Serebral Palsi ve Nöromusküler Hastalığı olan Çocuklarda Yürüyüş için Kullanılan Ayak ve Ayak Bileği Ortezlerinin Yürüme Performansı ve Enerji Harcamasına Etkilerinin İncelenmesi

Abstract

Amaç: Bu çalışmanın amacı; serebral palsi (SP) ve nöromusküler hastalığı (NMH) olan çocuklarda yürüyüş için kullanılan ayak ve ayak bileği ortezlerinin (AFO) yürüme performansı ve enerji harcamasına etkilerinin incelenmesidir. Gereç ve Yöntem: Retrospektif tanımlayıcı bir araştırma dizaynı içerisinde hastalara, ortez kullanmaksızın ve ortez kullanılarak uygulanmış olan 6 Dakika Yürüme Testi (6DYT) ile elde edilen yürüme mesafesi, kalp atım hızı, solunum frekansı, dispne ve genel yorgunluk şiddetinin (Borg skalası ile) değerlendirme sonuçları SP ve NMH tanısı olan çocuklar arasında karşılaştırıldı. Ayrıca çocukların yürüme sırasındaki enerji tüketimlerinin hesaplanması amacıyla Fizyolojik Harcama İndeksi kullanıldı. Bulgular: Ocak 2018 –Aralık 2019 tarih aralığını kapsayan dosya taramaları sonucunda dahil edilme kriterlerine uygun olan çocukların 13’ü (%52) SP grubu olarak, 12’si (% 48) ise NMH grubu olarak gruplandırıldı. 6DYT kapsamında elde edilen kalp atım hızı, solunum frekansı, dispne ve yorgunluk şiddeti değerleri, kaydedilen yürüme mesafesindeki değişimler ve enerji tüketimleri her iki grup için de ortez kullanılmadığı ve kullanıldığı durumlarda benzer değişim gösterdi (p>0,05). Gruplar arası karşılaştırmalarda ortez kullanımı ile yürüyüş performansı ve enerji tüketimi açısından fark olmadığı sonucuna ulaşıldı (p>0,05). Sonuç: Bu retrospektif çalışmada AFO kullanımının SP ve NMH’li çocuklarda tanıdan bağımsız olarak yürüyüş performansını ve enerji tüketimini etkilediği sonucuna ulaşıldı. Her ne kadar konuya ilişkin genel bir bakış sağlamaya çalışılsa da, alanda biyomekanik etkilerin de dahil edildiği çok faktörlü etkileri inceleyen daha kapsamlı araştırmalara ihtiyaç duyulduğu görülmektedir.

Keywords

• Ayak-ayak bileği ortezleri
• Serebral palsi
• Nöromusküler hastalıklar
• Yürüyüş
• Fizyolojik harcama indeksi

References

1. Andersson, C., Asztalos, L., & Mattsson, E. (2006). Six-minute walk test in adults with cerebral palsy. A study of reliability. Clinical Rehabilitation, 20(6), 488-495.
2. Balaban, B. r., Yasar, E., Dal, U., Yazi˙ ci˙ oglu, K. l., Mohur, H., & Kalyon, T. A. (2007). The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy. Disability and rehabilitation, 29(2), 139-144.
3. Beckung, E., Hagberg, G., Uldall, P., Cans, C., & Surveillance of Cerebral Palsy in, E. (2008). Probability of walking in children with cerebral palsy in Europe. Pediatrics, 121(1), e187-192. doi:10.1542/peds.2007-0068
4. Biggar, W. D. (2006). Duchenne muscular dystrophy. Pediatrics in Review, 27(3), 83.
5. Borg, G. A. (1982). Psychophysical bases of perceived exertion. Medicine & science in sports & exercise.
6. Brehm, M. A., Becher, J., & Harlaar, J. (2007). Reproducibility evaluation of gross and net walking efficiency in children with cerebral palsy. Developmental Medicine & Child Neurology, 49(1), 45-48.
7. Bushby, K., Finkel, R., Birnkrant, D. J., Case, L. E., Clemens, P. R., Cripe, L., . . . Pandya, S. (2010). Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. The Lancet Neurology, 9(2), 177-189.
8. de Groot, I. J., & de Witte, L. P. (2005). Physical complaints in ageing persons with spinal muscular atrophy.

9. DeJaeger, D., Willems, P. A., & Heglund, N. C. (2001). The energy cost of walking in children. Pflügers Archiv, 441(4), 538-543.
10. Emery, A. E. (1991). Population frequencies of inherited neuromuscular diseases—a world survey. Neuromuscular disorders, 1(1), 19-29.
11. Enright, P. L. (2003). The six-minute walk test. Respiratory care, 48(8), 783-785.
12. Forghany, S., Nester, C. J., & Richards, B. (2013). The effect of rollover footwear on the rollover function of walking. J Foot Ankle Res, 6(1), 24. doi:10.1186/1757-1146-6-24
13. Fritz, C. O., Morris, P. E., & Richler, J. J. (2012). Effect size estimates: current use, calculations, and interpretation. Journal of experimental psychology: General, 141(1), 2.
14. Geiger, R., Strasak, A., Treml, B., Gasser, K., Kleinsasser, A., Fischer, V., . . . Stein, J. I. (2007). Six-minute walk test in children and adolescents. The Journal of pediatrics, 150(4), 395-399. e392.
15. Harmatz, P., Giugliani, R., Schwartz, I. V. D., Guffon, N., Teles, E. L., Miranda, M. C. S., . . . Scarpa, M. (2008). Long-term follow-up of endurance and safety outcomes during enzyme replacement therapy for mucopolysaccharidosis VI: final results of three clinical studies of recombinant human N-acetylgalactosamine 4-sulfatase. Molecular genetics and metabolism, 94(4), 469-475.
16. Hayek, S., Hemo, Y., Chamis, S., Bat, R., Segev, E., Wientroub, S., & Yzhar, Z. (2007). The effect of community-prescribed ankle–foot orthoses on gait parameters in children with spastic cerebral palsy. Journal of children's orthopaedics, 1(6), 325-332.
17. Kotrlik, J., & Williams, H. (2003). The incorporation of effect size in information technology, learning, information technology, learning, and performance research and performance research. Information Technology, Learning, and Performance Journal, 21(1), 1.
18. Laboratories, A. T. S. C. o. P. S. f. C. P. F. (2002). ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 166(1), 111-117. doi:10.1164/ajrccm.166.1.at1102
19. Li, A. M., Yin, J., Au, J. T., So, H. K., Tsang, T., Wong, E., . . . Ng, P. C. (2007). Standard reference for the six-minute-walk test in healthy children aged 7 to 16 years. Am J Respir Crit Care Med, 176(2), 174-180.
20. Maher, C. A., Williams, M. T., & Olds, T. S. (2008). The six-minute walk test for children with cerebral palsy. International Journal of Rehabilitation Research, 31(2), 185-188.
21. McDonald, C., Henricson, E., Han, J., Nicorici, A., Abresch, R., Atkinson, L., . . . Miller, L. (2008). TP 1.02 The 6 min walk test (6MWT) as a clinical trial outcome measure in Duchenne/Becker Muscular Dystrophy (DMD/BMD). Neuromuscular disorders, 18(9), 739.
22. Montes, J., McDermott, M., Martens, W., Dunaway, S., Glanzman, A., Riley, S., . . . Tawil, R. (2010). Six-Minute Walk Test demonstrates motor fatigue in spinal muscular atrophy. Neurology, 74(10), 833-838.
23. Morrell, D. S., Pearson, J. M., & Sauser, D. D. (2002). Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy. Radiographics, 22(2), 257-268. doi:10.1148/radiographics.22.2.g02mr19257
24. Morris, C., Bowers, R., Ross, K., Stevens, P., & Phillips, D. (2011). Orthotic management of cerebral palsy: recommendations from a consensus conference. NeuroRehabilitation, 28(1), 37-46. doi:10.3233/NRE-2011-0630
25. Mossberg, K., Linton, K., & Friske, K. (1990). Ankle-foot orthoses: effect on energy expenditure of gait in spastic diplegic children. Archives of physical medicine and rehabilitation, 71(7), 490-494.
26. Muenzer, J., Wraith, J. E., Beck, M., Giugliani, R., Harmatz, P., Eng, C. M., . . . Gucsavas-Calikoglu, M. (2006). A phase II/III clinical study of enzyme replacement therapy with idursulfase in mucopolysaccharidosis II (Hunter syndrome). Genetics in Medicine, 8(8), 465-473.
27. Newman, C. J., Walsh, M., O'Sullivan, R., Jenkinson, A., Bennett, D., Lynch, B., & O’Brien, T. (2007). The characteristics of gait in Charcot-Marie-Tooth disease types I and II. Gait & posture, 26(1), 120-127.
28. Nixon, P. A., Joswiak, M. L., & Fricker, F. J. (1996). A six-minute walk test for assessing exercise tolerance in severely ill children. The Journal of pediatrics, 129(3), 362-366.
29. Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., . . . Goldsmith, S. (2013). A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol, 55(10), 885-910. doi:10.1111/dmcn.12246
30. Piepers, S., Van Den Berg, L., Brugman, F., Scheffer, H., Ruiterkamp-Versteeg, M., van Engelen, B., . . . Wokke, J. (2008). A natural history study of late onset spinal muscular atrophy types 3b and 4. Journal of neurology, 255(9), 1400-1404.
31. Raja, K., Joseph, B., Benjamin, S., Minocha, V., & Rana, B. (2007). Physiological cost index in cerebral palsy: its role in evaluating the efficiency of ambulation. Journal of pediatric orthopaedics, 27(2), 130-136.
32. Ramdharry, G. M., Pollard, A. J., Marsden, J. F., & Reilly, M. M. (2012). Comparing gait performance of people with Charcot‐Marie‐Tooth disease who do and do not wear ankle foot orthoses. Physiotherapy research international, 17(4), 191-199.
33. Rodby-Bousquet, E., & Hagglund, G. (2012). Better walking performance in older children with cerebral palsy. Clin Orthop Relat Res, 470(5), 1286-1293. doi:10.1007/s11999-011-1860-8
34. Sawilowsky, S. S. (2009). New effect size rules of thumb. Journal of Modern Applied Statistical Methods, 8(2), 26.
35. Stevens, P. M. (2006). Lower limb orthotic management of Duchenne muscular dystrophy: a literature review. JPO: Journal of Prosthetics and Orthotics, 18(4), 111-119.
36. Stuberg, W. (2001). Home Accessibility and adaptive equipment in Duchenne muscular dystrophy: A case report. Pediatric Physical Therapy, 13(4), 169-174.
37. Takeuchi, Y., Katsuno, M., Banno, H., Suzuki, K., Kawashima, M., Atsuta, N., . . . Sobue, G. (2008). Walking capacity evaluated by the 6‐minute walk test in spinal and bulbar muscular atrophy. Muscle & nerve, 38(2), 964-971.
38. Vinci, P., & Perelli, S. L. (2002). Footdrop, foot rotation, and plantar flexor failure in Charcot-Marie-Tooth disease. Archives of physical medicine and rehabilitation, 83(4), 513-516.
39. Waters, R. L., & Mulroy, S. (1999). The energy expenditure of normal and pathologic gait. Gait & posture, 9(3), 207-231.
40. White, H., Jenkins, J., Neace, W. P., Tylkowski, C., & Walker, J. (2002). Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: a retrospective study. Developmental Medicine & Child Neurology, 44(4), 227-232.