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The Effect of Modified Floor Reaction Ankle Foot Orthoses on Walking Abilities in Children with Cerebral Palsy

The Effect of Modified Floor Reaction Ankle Foot Orthoses on Walking Abilities in Children with Cerebral Palsy

Cerebral palsy (CP) is one of the most common causes of abnormal gait in children (1). CP has a prevalence of 1.5 to 2.5 per 1000 children in the USA (2). Diplegia is the most common type of CP with an incidence rate of 32% (3). Diplegic gait is characterized as being a low-speed gait due to weakness and spasticity in the lower limbs (4). Walking is an important function (5), and pathologies such as CP can have a detrimental effect on the functional performance of the individual (6). Improved walking ability is a key purpose for the treatment of gait abnormalities in children with CP (7). A wide range of orthoses such as rigid ankle foot orthoses (AFOs) (8) , dynamic AFOs (9), floor reaction AFOs (10) and lycra garments (11) have all been shown to improve walking in these children. Limitation of normal tibial rotation over the weight-
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Feasibility of designing, manufacturing and delivering 3D printed ankle-foot orthoses: a systematic review

Feasibility of designing, manufacturing and delivering 3D printed ankle-foot orthoses: a systematic review

Ankle-foot orthoses (AFO) are externally worn medical devices that support the foot, ankle and lower leg to manage lower limb impairments such as foot drop, bony foot deformities and poor balance. They are routinely prescribed to improve the walking ability of children and adults with neurological disorders such as cerebral palsy, Charcot-Marie-Tooth disease, cerebrovascular accident (stroke) and multiple sclerosis [1]. Customised AFOs are often prescribed to prevent trips and falls resulting from foot drop, alleviate chronic pain associated with joint de- formity, and control the ground reaction force during the stance phase of gait to reduce fatigue. Many users of AFOs experience poor fit, pain and discomfort, dislike the aesthetics of the devices and are limited by the choice of design and associated footwear [1–3]. In par- ticular children and adolescents, females and people liv- ing alone are reported to be the most dissatisfied users of AFOs [1]. Hence, many children and adults with mus- culoskeletal and neuromuscular disorders don ’ t wear their prescribed AFOs and instead utilise compensatory strategies during gait despite these being physiologically inefficient and potentially injurious [4]. Therefore, many users only choose to wear their devices when their con- dition becomes severe even though earlier AFO use might have significant clinical benefits [4].
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Visualisation to enhance biomechanical tuning of ankle foot orthoses (AFOs) in stroke: study protocol for a randomised controlled trial

Visualisation to enhance biomechanical tuning of ankle foot orthoses (AFOs) in stroke: study protocol for a randomised controlled trial

Background: There are a number of gaps in the evidence base for the use of ankle-foot orthoses for stroke patients. Three dimensional motion analysis offers an ideal method for objectively obtaining biomechanical gait data from stroke patients, however there are a number of major barriers to its use in routine clinical practice. One significant problem is the way in which the biomechanical data generated by these systems is presented. Through the careful design of bespoke biomechanical visualisation software it may be possible to present such data in novel ways to improve clinical decision making, track progress and increase patient understanding in the context of ankle-foot orthosis tuning.
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Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop : a meta analysis providing direction for future research

Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop : a meta analysis providing direction for future research

Conclusion: Functional electrical stimulation and ankle foot orthoses have an equally positive thera- peutic effect on walking speed in non-progressive central nervous system diagnoses. The current ran- domized controlled trial evidence base does not show whether this improvement translates into the user’s own environment or reveal the mechanisms that achieve that change. Future studies should fo- cus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and in- volve a variety of central nervous system diagnoses.
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Measuring wearing time of knee ankle foot orthoses in children with cerebral palsy: comparison of parent report and objective measurement

Measuring wearing time of knee ankle foot orthoses in children with cerebral palsy: comparison of parent report and objective measurement

MAAS, Jose, DALLMEIJER, Annet J., OUDSHOORN, Bodil, BOLSTER, Eline A. M., HUIJING, Peter A., JASPERS, Richard T. and BECHER, Jules G. (2018). Measuring wearing time of knee-ankle-foot orthoses in children with cerebral palsy: comparison of parent-report and objective measurement. Disability and Rehabilitation, 40 (4), 398-403.

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Best practice statement : use of ankle-foot orthoses following stroke

Best practice statement : use of ankle-foot orthoses following stroke

When adequately stiff, either prefabricated or custom-made AFOs can prevent plantarflexion of the foot in swing phase, reducing the risk of tripping. By preventing plantarflexion, they may also help inhibit extensor thrust in the lower limb. Many prefabricated AFOs are insufficiently stiff to resist plantarflexion in stance phase, leading to significant gait problems for the patient. Additionally, following a stroke, many patients develop complex triplanar deformities in the subtalar and midtarsal joints of the foot. To control these deformities, it is important Ankle-foot orthoses
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Comparison of the Immediate Effect between Functional Electrical Stimulation and Ankle Foot Orthoses on Gait Parameters in Cerebral Palsy

Comparison of the Immediate Effect between Functional Electrical Stimulation and Ankle Foot Orthoses on Gait Parameters in Cerebral Palsy

Efficient and effective walking is an important treatment goal for children with CP since mobility is associated with functional independence and participation of the child in society [4]. Positional bracing is the current standard of care for individuals with CP who have limited ankle dorsiflexion and a treatment modality to reduce gait abnormalities and related limitations in physical mobility. The most typical use of an ankle foot orthoses (AFO) is to optimize the normal dynamics of walking by applying a mechanical constraint (control moment) to the ankle to control motion and, at the same time, produce a more efficient gait. The solid AFO (SAFO) achieves the maximum orthotic control by restricting the movements of both plantar flexion and dorsiflexion in the stance and swing phases. Its rigid construction prevents ankle rocker function in stance. Improvements in walking pattern have been demonstrated with ankle foot orthosis in patients with planterflexion deformity [5,6].
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The effects of powered ankle-foot orthoses on joint kinematics and muscle activation during walking in individuals with incomplete spinal cord injury

The effects of powered ankle-foot orthoses on joint kinematics and muscle activation during walking in individuals with incomplete spinal cord injury

Under therapist control, the therapist quickly learned to use pushbuttons to activate the orthoses, providing ankle torque with timing and amplitude similar to normal walking. In healthy subjects, triceps surae muscles nor- mally develop active force from 10% to 60% of the stride cycle [41]. In our study, the therapist activated the orthoses so that they developed active force from 25% to 60% of the stride cycle (Figure 2). Peak plantar flexion torque in healthy subjects ranges from ~1.0–1.75 N-m/kg [42,43]. In this study the orthoses generated less peak torque (~0.4 N-m/kg), but bodyweight support (~38% unloading on average) decreased the mechanical loading of the limbs. Both forward and vertical work per stride are reduced in direct proportion to bodyweight unloading during walking [44]. Assuming that the same propor- tional reduction occurs in the peak ankle torque for healthy walking, we would expect peak plantar flexion torque to range from ~0.62–1.1 N-m/kg with ~38% bod- yweight unloading. Therefore, the orthoses provided ~36–65% of the normal peak plantar flexion torque expected during walking with this level of bodyweight support. When the powered ankle-foot orthoses were worn by healthy subjects during walking without body- weight support, they provided ~56% peak ankle plantar flexor torque [40]. It is important to highlight the possi- bility that adjustments by both the patient and therapist could result in the observed timing of ankle assistance. Future work could examine the transient behaviour of both the patient and therapist during the period leading up to when a steady cycle is established.
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Best Practice Statement : Use of Ankle-Foot Orthoses Following Stroke

Best Practice Statement : Use of Ankle-Foot Orthoses Following Stroke

When adequately stiff, either prefabricated or custom-made AFOs can prevent plantarflexion of the foot in swing phase, reducing the risk of tripping. By preventing plantarflexion, they may also help inhibit extensor thrust in the lower limb. Many prefabricated AFOs are insufficiently stiff to resist plantarflexion in stance phase, leading to significant gait problems for the patient. Additionally, following a stroke, many patients develop complex triplanar deformities in the subtalar and midtarsal joints of the foot. To control these deformities, it is important Ankle-foot orthoses
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A comparison of the initial orthotic effects of functional electrical stimulation and ankle-foot orthoses on the speed and oxygen cost of gait in multiple sclerosis

A comparison of the initial orthotic effects of functional electrical stimulation and ankle-foot orthoses on the speed and oxygen cost of gait in multiple sclerosis

Conventionally, foot drop has been treated using ankle-foot orthoses (AFO). AFO, worn on the lower leg and foot, are designed primarily to prevent excessive ankle plantarflexion where there is a loss of, or weak, dorsiflexion and eversion, by supporting the foot in a neutral position. An alternative treatment for foot drop, functional electrical stimulation (FES) was first developed by Liberson et al. 10 and is usually delivered via skin surface electrodes which stimulate the common peroneal nerve. 10 The resulting contraction of anterior tibialis during the swing phase of gait, which is trig- gered by either a foot switch or tilt mechanism, aug- ments ankle dorsiflexion and assists foot drop impairment.
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A randomised controlled trial of laser scanning and casting for the construction of ankle foot orthoses

A randomised controlled trial of laser scanning and casting for the construction of ankle foot orthoses

construction technique used. Background: Three-dimensional laser scanning has been used for patient measurement for cranial helmets and spinal braces. Ankle foot orthoses are commonly prescribed for children with orthopaedic conditions. This trial sought to compare ankle foot orthoses produced by laser scanning or traditional plaster casting. Objectives: Assessment of the effectiveness and efficiency of using laser scanning to produce AFOs. Methods: A randomised double blind trial comparing fabrication of AFOs from casts or laser scans. Results: The time spent in the rectification and moulding of scanned AFOs was around 50% less than for cast AFOs. A non-significant increase of 9 days was seen in the time to delivery to the patient for LSCAD/CAM. There was a higher incidence of problems with the scan-based AFOs at delivery of the device, but no difference in how long the AFOs lasted. Costs associated with laser scanning were not significantly different from traditional methods of AFO manufacture. Conclusions: Compared with conventional casting techniques laser scan based AFO manufacture neither significantly improved the quality of the final product nor delivered a useful saving in time.
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Development of a best practice statement on the use of ankle-foot orthoses following stroke in Scotland

Development of a best practice statement on the use of ankle-foot orthoses following stroke in Scotland

educators in prosthetics and orthotics working in collaboration with service providers from a variety of professional backgrounds to produce guidance on practice in response to a need identified by those working in the field of stroke rehabilitation clinical service. Successful implementation will raise standards and promote a consistent, cohesive and achievable approach to the use of the use of ankle-foot orthoses following stroke. To assess the extent to which the BPS has influenced clinical practice an audit should be undertaken in due course. This model may serve as a useful framework for the development of further guidelines on stroke or other areas of clinical practice in other counties.
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Use of the ICF to investigate impairment, activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities

Use of the ICF to investigate impairment, activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities

Ankle-foot orthoses (AFOs) are externally applied devices that encompass the joints of the ankle and foot. They are used to modify the structure and function of the neuromuscular and skeletal systems [1] and are used to manage mobility disabilities caused by a wide range of conditions such as stroke, cerebral palsy, spina bifida, poliomyelitis and peripheral nerve injury[2-6]. AFOs have been shown to improve timed walking speed, step length and clearance of the toe in the swing phase of gait. [2,3,5,7-14]. Whilst these outcome measures are valuable in providing evidence for orthotic intervention, they focus on specific aspects of physical activity that can be measured in a gait laboratory. Consequently, they do not provide any information about patients’ use of AFOs in their day to day lives or the extent to which use of AFOs is associated with physical, psychological and social well-being. These outcomes are important because they are of value to the patient. Specifically, consideration of psychological well–being is vital because of its relationship with functional outcomes [15,16]. This paper adds to the literature by focusing on AFO use in a real life setting and by incorporating psychological measures to investigate differences in impairment, activity limitation and participation restriction across 3 groups of AFO users; people using AFOs as recommended, people using AFOs differently to recommended; and those not aware of recommendations for use.
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The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study

The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study

Anklefoot orthoses (AFOs) are frequently prescribed to improve walking ability in hemiparetic patients, as they provide passive or dynamic support of ankle move- ment. AFOs provide support not only during the stance phase of gait by encouraging lateral stability or improv- ing early stance knee moments, but also in the swing phase to maintain ankle dorsiflexion and facilitate toe clearance [11–17]. The effect of AFOs on the swing phase is additionally reflected in the compensatory movements. Cruz et al. [18] demonstrated that the com- pensatory pelvic obliquity observed in response to im- paired ankle dorsiflexion in hemiplegic patients was minimized when the patients wore an AFO. Improved joint motions and decreased compensatory movement when using AFOs could potentially contribute to an effi- cient gait and promote walking activity in hemiparetic patients.
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Effect of Hinged Ankle Foot Orthoses on Standing Balance Control in Children with Bilateral Spastic Cerebral Palsy

Effect of Hinged Ankle Foot Orthoses on Standing Balance Control in Children with Bilateral Spastic Cerebral Palsy

Purpose: To identify the characteristics of static standing balance and its postural control mechanisms during quiet side-by-side standing and the changes in these measures whilst wearing hinged ankle-foot orthoses (AFOs) in children with bila- teral spastic cerebral palsy (CP). Materials and Methods: Twenty-one children with bilateral spastic CP (6.10 ± 1.09 year-old) and 22 typically developing (TD) children (5.64 ± 0.49 year-old) were recruited. Pressure data were recorded while subjects with or without AFOs stood on dual force platforms and net body center of pressure (CoP) coordinates were calculated from this data. Net body CoP was traced for measuring mediolateral (ML) and anteroposterior (AP) displacement and path length per second. Correlation coefficients between parameters representing ankle, hip, and transverse body rotation strategies were also analyzed. Results: ML and AP displacement and path length per second of the CoP trajectory were higher in children with CP compared to TD children (p < 0.05). There were no significant improvements in these parameters whilst wearing hinged AFOs. Compared to TD children, children with CP used less ankle strategy though more hip and transverse rotation strategies for postural control during quiet standing. Whilst wearing hinged AFOs, the contribution of ankle strategy was significantly increased for ML balance control in children with CP (p < 0.05). Conclusion: Hinged AFOs for children with CP may be helpful in improving the postural control mechanisms but not the postural stability in quiet side-by-side standing.
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A novel experimental setup for evaluating the stiffness of ankle foot orthoses

A novel experimental setup for evaluating the stiffness of ankle foot orthoses

Ankle foot orthoses (AFOs) are external medical devices, applied around the ankle joint, to provide support and stability for weakened muscles, proper control of the limbs and protection [1–3]. Their impact depends on the properties of the material used and the design: for obtain- ing the optimal functional gains it is essential to custom- ize the AFOs to the patient needs [4]. Currently, the most used AFOs are custom-molded thermoplastic AFOs [5], which provide the patient with an intimate fit. A critical role is played by the craftsmen, who directly manufac- ture the devices, in a process which is manual and time consuming [6, 7]. However, this manufacturing process does not allow modifications of the design parameters before the realization of the devices. Researchers are cur- rently focusing on the use of new additive manufactur- ing (AM) techniques, which should permit the tuning
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Optimising Ankle Foot Orthoses for children with Cerebral Palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study

Optimising Ankle Foot Orthoses for children with Cerebral Palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study

Although more than half of all children with bilateral spastic CP (SCP) walk independently with or without an assistive device [5], most experience mobility-related problems, such as reduced gait speed and/or an increased walking energy cost [6-12]. These problems are often caused by gait deviations [13-16], which can be corrected by prescribing ankle-foot orthoses (AFOs). An AFO imposes a mechanical constraint on the ankle, ei- ther to compensate for loss of function [17-19] or to counteract an excess of function [20,21]. An AFO there- fore acts by applying control to the ankle and foot and, dependent on its design, it can indirectly stabilise the knee and hip joints [22]. As such, AFOs aim to improve, i.e. normalise joint kinetics, joint kinematics and spatio- temporal parameters [17,23-26]. Improvements in joint kinetics and kinematics have been shown to be closely coupled to an improved walking energy cost, which leads to benefits in walking ability; an effect also noted in the context of orthotic interventions [23,25-27]. This applies especially to children who walk with excessive knee flexion in midstance, since this walking pattern is par- ticularly energy consuming [9,10] and these children are liable to show deterioration in walking ability in (pre-) puberty [28,29].
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Ankle foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children

Ankle foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children

The outcome also seem to be age-related where a higher proportion of 7–19 year old children maintained or improved their range of motion when treated with AFO compared to 0–6 year old children. This may be explained by their initial lower ROM. The use of AFOs peaked at 5 years of age. In two earlier studies based on children from southern Sweden, the development of spasticity of the gastrosoleus muscle and range of mo- tion of the ankle joint with age were analysed [19,20]. The muscle tone, measured with the Modified Ashworth scale, [21] increased until 4–6 years of age and then de- creased at 12–15 years of age [20]. The mean range of dorsiflexion of the foot decreased from 30° to 20° up to 5 years of age and then persisted at the same level for the remaining growth period [19]. These findings may explain why 4–6 year old children presented the highest use of AFOs.
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The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis : a multicentre randomized trial

The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis : a multicentre randomized trial

16 368 Results from this randomised trial which to the best of our knowledge is the first and 369 largest study undertaken comparing the clinical and cost effectiveness of two 370 interv[r]

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Finite element analysis of ankle foot orthoses

Finite element analysis of ankle foot orthoses

The magnitude of the maximum stress, ankle moment and heel rotation were all found to depend on the distribution of imposed displacement at the foot region simulating rotation about the [r]

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