Individualized orthotic alignment and footwear for balance and mobility in children with bilateral spastic cerebral palsy: A randomized trial.

Autor: Bjornson KF; Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, USA., Fatone S; Northwestern University, Chicago, IL, USA.; University of Washington, Seattle, WA, USA., Orendurff M; Oregon Biomechanics Institute, Ashland, OR, USA., Zhou C; Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, USA., Hurvitz PM; Center for Studies in Demography and Ecology; Urban Form Lab, University of Washington, Seattle, WA, USA., Shippen G; Hanger Clinics, Bellevue, WA, USA.
Jazyk: angličtina
Zdroj: Developmental medicine and child neurology [Dev Med Child Neurol] 2024 Jan; Vol. 66 (1), pp. 52-60. Date of Electronic Publication: 2023 Jun 20.
DOI: 10.1111/dmcn.15675
Abstrakt: Aim: To examine whether designed-to-be-rigid ankle-foot orthoses and footwear combinations with individualized alignment and footwear designs (AFO-FC/IAFD) would be more effective than designed-to-be-rigid AFO with non-individualized alignment and footwear designs (AFO-FC/NAFD) in children with cerebral palsy (CP).
Method: Nineteen children with bilateral spastic CP were randomized to AFO-FC/NAFD (n = 10) or AFO-FC/IAFD (n = 9) groups. Fifteen were male, average age 6 years 11 months (range 4 years 2 months-9 years 11 months), classified in Gross Motor Function Classification System levels II (n = 15) and III (n = 4). The Pediatric Balance Scale (PBS), Gait Outcomes Assessment List (GOAL), Patient-Reported Outcomes Measurement Information System (PROMIS), and Orthotic and Prosthetic Users' Survey (OPUS) measures of satisfaction were collected at baseline and after 3 months' wear.
Results: Compared with the AFO-FC/NAFD group, those with AFO-FC/IAFD demonstrated greater change in PBS total scores (mean 12.8 [standard deviation 10.5] vs 3.5 [5.8]; p = 0.03) and GOAL total scores (3.5 [5.8] vs -0.44 [5.5]; p = 0.03). There were no significant changes in OPUS or PROMIS scores.
Interpretation: After 3 months, individualized orthosis alignment and footwear designs had a greater positive effect on balance and parent-reported mobility than a non-individualized approach. No effect was documented for the PROMIS and OPUS. Results may inform orthotic management for ambulatory children with bilateral spastic CP.
What This Paper Adds: Balance and parent-reported mobility increased more over time for the ankle-foot orthoses and footwear combinations with individualized alignment and footwear designs (AFO-FC/IAFD) group. Changes in balance over time suggest a therapeutic effect of the AFO-FC/IAFD approach.
(© 2023 Mac Keith Press.)
Databáze: MEDLINE
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