The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy

Benjamin M. Rogozinski, Jon Davids, Roy B. Davis, Gene G. Jameson, Dawn W. Blackhurst

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: The floor-reaction ankle-foot orthosis is commonly prescribed for children with cerebral palsy who walk with excessive ankle dorsiflexion and excessive knee flexion during the stance phase of gait. The purposes of this study were to evaluate the efficacy of this orthosis objectively and to identify clinical parameters that may compromise its function. Methods: All children with cerebral palsy who had comprehensive gait analyses in both barefoot and braced walking conditions during a single visit to our Motion Analysis Laboratory between January 2001 and August 2007 were identified. Kinematic study parameters included mean sagittal dynamic range of motion of the ankle in stance, peak ankle dorsiflexion in stance, peak knee extension in midstance, and mean foot progression angle in stance. The minimum sagittal knee moment in midstance was also examined in this study for subjects who walked without assistive devices. Range-of-motion and skeletal alignment data obtained fromthe physical examination record of each subject included knee flexion contracture, popliteal angle, hip flexion contracture, and thigh-foot angle. Results: Twenty-seven children had quantitative gait analyses (barefoot and with the orthoses in the same visit). The mean sagittal plane dynamic range of motion of the ankle in stance was reduced from 23° ± 9° when walking barefoot to 10° ± 3° when the orthosis was worn (p < 0.001), and the mean peak knee extension in midstance improved from 29° ± 14° of flexion to 18° ± 14° of flexion (p = 0.013). Strong negative linear correlations were found between the magnitude of knee and hip flexion contractures on physical examination and the amount of peak knee extension in midstance (r = 20.784 and r =20.705, respectively). A strong positive correlation was found between the meanminimum sagittal knee moment in midstance and the amount of peak knee extension in midstance (r = 0.820). Our investigation did not provide evidence of a correlation between peak knee extension in midstance and any of the following parameters in the orthosis: clinical examination measurements of the thigh-foot angle (r = 0.120), the popliteal angle (r = 20.300), or the mean foot progression angle in the stance phase of gait (r = 20.188). Conclusions: The floor-reaction ankle-foot orthosis is effective in restricting sagittal plane ankle motion during the stance phase of gait in patients with cerebral palsy. As a result, improvements in knee extension and the sagittal plane knee extensor moment in stance phase are achieved. The best outcomes with this orthosis, as determined by peak knee extension in midstance, were seen in the subjects with knee and hip flexion contracture of ≤10°. Knee and hip flexion contractures of ≥15° were found to limit the efficacy of the orthosis in controlling knee extension in midstance. Such contractures should be considered as contraindications to the prescription of this orthosis or should be addressed (surgically or otherwise) prior to the application of a floor-reaction ankle-foot orthosis in these patients. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)2440-2447
Number of pages8
JournalJournal of Bone and Joint Surgery - Series A
Volume91
Issue number10
DOIs
StatePublished - Oct 1 2009
Externally publishedYes

Fingerprint

Foot Orthoses
Cerebral Palsy
Ankle
Knee
Orthotic Devices
Hip Contracture
Gait
Foot
Articular Range of Motion
Contracture
Thigh
Physical Examination
Walking
Self-Help Devices

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy. / Rogozinski, Benjamin M.; Davids, Jon; Davis, Roy B.; Jameson, Gene G.; Blackhurst, Dawn W.

In: Journal of Bone and Joint Surgery - Series A, Vol. 91, No. 10, 01.10.2009, p. 2440-2447.

Research output: Contribution to journalArticle

Rogozinski, Benjamin M. ; Davids, Jon ; Davis, Roy B. ; Jameson, Gene G. ; Blackhurst, Dawn W. / The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy. In: Journal of Bone and Joint Surgery - Series A. 2009 ; Vol. 91, No. 10. pp. 2440-2447.
@article{8a977267cd9946de9e0f428b9d9139f2,
title = "The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy",
abstract = "Background: The floor-reaction ankle-foot orthosis is commonly prescribed for children with cerebral palsy who walk with excessive ankle dorsiflexion and excessive knee flexion during the stance phase of gait. The purposes of this study were to evaluate the efficacy of this orthosis objectively and to identify clinical parameters that may compromise its function. Methods: All children with cerebral palsy who had comprehensive gait analyses in both barefoot and braced walking conditions during a single visit to our Motion Analysis Laboratory between January 2001 and August 2007 were identified. Kinematic study parameters included mean sagittal dynamic range of motion of the ankle in stance, peak ankle dorsiflexion in stance, peak knee extension in midstance, and mean foot progression angle in stance. The minimum sagittal knee moment in midstance was also examined in this study for subjects who walked without assistive devices. Range-of-motion and skeletal alignment data obtained fromthe physical examination record of each subject included knee flexion contracture, popliteal angle, hip flexion contracture, and thigh-foot angle. Results: Twenty-seven children had quantitative gait analyses (barefoot and with the orthoses in the same visit). The mean sagittal plane dynamic range of motion of the ankle in stance was reduced from 23° ± 9° when walking barefoot to 10° ± 3° when the orthosis was worn (p < 0.001), and the mean peak knee extension in midstance improved from 29° ± 14° of flexion to 18° ± 14° of flexion (p = 0.013). Strong negative linear correlations were found between the magnitude of knee and hip flexion contractures on physical examination and the amount of peak knee extension in midstance (r = 20.784 and r =20.705, respectively). A strong positive correlation was found between the meanminimum sagittal knee moment in midstance and the amount of peak knee extension in midstance (r = 0.820). Our investigation did not provide evidence of a correlation between peak knee extension in midstance and any of the following parameters in the orthosis: clinical examination measurements of the thigh-foot angle (r = 0.120), the popliteal angle (r = 20.300), or the mean foot progression angle in the stance phase of gait (r = 20.188). Conclusions: The floor-reaction ankle-foot orthosis is effective in restricting sagittal plane ankle motion during the stance phase of gait in patients with cerebral palsy. As a result, improvements in knee extension and the sagittal plane knee extensor moment in stance phase are achieved. The best outcomes with this orthosis, as determined by peak knee extension in midstance, were seen in the subjects with knee and hip flexion contracture of ≤10°. Knee and hip flexion contractures of ≥15° were found to limit the efficacy of the orthosis in controlling knee extension in midstance. Such contractures should be considered as contraindications to the prescription of this orthosis or should be addressed (surgically or otherwise) prior to the application of a floor-reaction ankle-foot orthosis in these patients. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.",
author = "Rogozinski, {Benjamin M.} and Jon Davids and Davis, {Roy B.} and Jameson, {Gene G.} and Blackhurst, {Dawn W.}",
year = "2009",
month = "10",
day = "1",
doi = "10.2106/JBJS.H.00965",
language = "English (US)",
volume = "91",
pages = "2440--2447",
journal = "Journal of Bone and Joint Surgery - American Volume",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "10",

}

TY - JOUR

T1 - The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy

AU - Rogozinski, Benjamin M.

AU - Davids, Jon

AU - Davis, Roy B.

AU - Jameson, Gene G.

AU - Blackhurst, Dawn W.

PY - 2009/10/1

Y1 - 2009/10/1

N2 - Background: The floor-reaction ankle-foot orthosis is commonly prescribed for children with cerebral palsy who walk with excessive ankle dorsiflexion and excessive knee flexion during the stance phase of gait. The purposes of this study were to evaluate the efficacy of this orthosis objectively and to identify clinical parameters that may compromise its function. Methods: All children with cerebral palsy who had comprehensive gait analyses in both barefoot and braced walking conditions during a single visit to our Motion Analysis Laboratory between January 2001 and August 2007 were identified. Kinematic study parameters included mean sagittal dynamic range of motion of the ankle in stance, peak ankle dorsiflexion in stance, peak knee extension in midstance, and mean foot progression angle in stance. The minimum sagittal knee moment in midstance was also examined in this study for subjects who walked without assistive devices. Range-of-motion and skeletal alignment data obtained fromthe physical examination record of each subject included knee flexion contracture, popliteal angle, hip flexion contracture, and thigh-foot angle. Results: Twenty-seven children had quantitative gait analyses (barefoot and with the orthoses in the same visit). The mean sagittal plane dynamic range of motion of the ankle in stance was reduced from 23° ± 9° when walking barefoot to 10° ± 3° when the orthosis was worn (p < 0.001), and the mean peak knee extension in midstance improved from 29° ± 14° of flexion to 18° ± 14° of flexion (p = 0.013). Strong negative linear correlations were found between the magnitude of knee and hip flexion contractures on physical examination and the amount of peak knee extension in midstance (r = 20.784 and r =20.705, respectively). A strong positive correlation was found between the meanminimum sagittal knee moment in midstance and the amount of peak knee extension in midstance (r = 0.820). Our investigation did not provide evidence of a correlation between peak knee extension in midstance and any of the following parameters in the orthosis: clinical examination measurements of the thigh-foot angle (r = 0.120), the popliteal angle (r = 20.300), or the mean foot progression angle in the stance phase of gait (r = 20.188). Conclusions: The floor-reaction ankle-foot orthosis is effective in restricting sagittal plane ankle motion during the stance phase of gait in patients with cerebral palsy. As a result, improvements in knee extension and the sagittal plane knee extensor moment in stance phase are achieved. The best outcomes with this orthosis, as determined by peak knee extension in midstance, were seen in the subjects with knee and hip flexion contracture of ≤10°. Knee and hip flexion contractures of ≥15° were found to limit the efficacy of the orthosis in controlling knee extension in midstance. Such contractures should be considered as contraindications to the prescription of this orthosis or should be addressed (surgically or otherwise) prior to the application of a floor-reaction ankle-foot orthosis in these patients. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

AB - Background: The floor-reaction ankle-foot orthosis is commonly prescribed for children with cerebral palsy who walk with excessive ankle dorsiflexion and excessive knee flexion during the stance phase of gait. The purposes of this study were to evaluate the efficacy of this orthosis objectively and to identify clinical parameters that may compromise its function. Methods: All children with cerebral palsy who had comprehensive gait analyses in both barefoot and braced walking conditions during a single visit to our Motion Analysis Laboratory between January 2001 and August 2007 were identified. Kinematic study parameters included mean sagittal dynamic range of motion of the ankle in stance, peak ankle dorsiflexion in stance, peak knee extension in midstance, and mean foot progression angle in stance. The minimum sagittal knee moment in midstance was also examined in this study for subjects who walked without assistive devices. Range-of-motion and skeletal alignment data obtained fromthe physical examination record of each subject included knee flexion contracture, popliteal angle, hip flexion contracture, and thigh-foot angle. Results: Twenty-seven children had quantitative gait analyses (barefoot and with the orthoses in the same visit). The mean sagittal plane dynamic range of motion of the ankle in stance was reduced from 23° ± 9° when walking barefoot to 10° ± 3° when the orthosis was worn (p < 0.001), and the mean peak knee extension in midstance improved from 29° ± 14° of flexion to 18° ± 14° of flexion (p = 0.013). Strong negative linear correlations were found between the magnitude of knee and hip flexion contractures on physical examination and the amount of peak knee extension in midstance (r = 20.784 and r =20.705, respectively). A strong positive correlation was found between the meanminimum sagittal knee moment in midstance and the amount of peak knee extension in midstance (r = 0.820). Our investigation did not provide evidence of a correlation between peak knee extension in midstance and any of the following parameters in the orthosis: clinical examination measurements of the thigh-foot angle (r = 0.120), the popliteal angle (r = 20.300), or the mean foot progression angle in the stance phase of gait (r = 20.188). Conclusions: The floor-reaction ankle-foot orthosis is effective in restricting sagittal plane ankle motion during the stance phase of gait in patients with cerebral palsy. As a result, improvements in knee extension and the sagittal plane knee extensor moment in stance phase are achieved. The best outcomes with this orthosis, as determined by peak knee extension in midstance, were seen in the subjects with knee and hip flexion contracture of ≤10°. Knee and hip flexion contractures of ≥15° were found to limit the efficacy of the orthosis in controlling knee extension in midstance. Such contractures should be considered as contraindications to the prescription of this orthosis or should be addressed (surgically or otherwise) prior to the application of a floor-reaction ankle-foot orthosis in these patients. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=70349904510&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70349904510&partnerID=8YFLogxK

U2 - 10.2106/JBJS.H.00965

DO - 10.2106/JBJS.H.00965

M3 - Article

C2 - 19797580

AN - SCOPUS:70349904510

VL - 91

SP - 2440

EP - 2447

JO - Journal of Bone and Joint Surgery - American Volume

JF - Journal of Bone and Joint Surgery - American Volume

SN - 0021-9355

IS - 10

ER -