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Exploratory Investigation into Energy Expenditure Using Tuned versus Nontuned Ankle-Foot Orthoses–Footwear Combinations in Children with Cerebral Palsy JPO032-1B
Journal of Prosthetics and Orthotics: Volume 32, Issue 1
Keyword(s)
JPO 32-1B, JPO032-1B
Introduction: Children with cerebral palsy (CP) commonly expend two to three times as much energy to walk as typically developing children. Research shows that the effects of nontuned ankle-foot orthoses (AFOs) on energy expenditure are inconclusive. Tuning of an ankle-foot orthosis–footwear combination (AFO-FC) has demonstrated an improvement in the kinetics and kinematics of pathological gait, particularly knee flexion during stance phase, which are key determinants of an energy-efficient gait. The objective of this study was to compare the submaximal energy expenditure via indirect calorimetry and speed and distance walked of tuned and nontuned AFO-FCs and barefoot gait in children with CP.
Methods: This study is a performance assessment of four children aged between 7 and 10 years with a diagnosis of CP (one hemiplegic and three diplegic participants, two female and two male, with a Gross Motor Function Classification System [GMFCS] of 2) at a gait analysis laboratory.
Results: There was a reduction in gross submaximal energy expenditure and energy efficiency index (EEI) based on O2 in three of the four participants tested when wearing tuned compared with a nontuned AFO-FC. The reduction ranged from 9.2% to 33.7%. Speed and distance covered also showed improvement in the tuned condition.
Conclusions: Tuning the AFO-FC of children with CP has the potential to decrease energy expenditure and increase speed and distance compared with providing a nontuned AFO-FC. (J Prosthet Orthot. 2020;32:14–23)
Credit Information
2.0 Credits (Scientific)
Author(s)
Eddison, Nicola PhD; Chockalingam, Nachiappan PhD; Healy, Aoife PhD; Needham, Robert PhD; Unnithan, Vish PhD
Description
Cerebral palsy (CP) has often been considered the prototype childhood “neurodisability.” It is a group of disorders with widely varying type, timing, location, and extent of injury to the brain, and it has been defined as, “A group of permanent disorders of the development of movement and posture, causing activity limitation that is attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems.”