The Journal of Bone and Joint Surgery (American). 2009;91:356-365.
doi:10.2106/JBJS.G.01369
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Brace Evaluation in Children with Diplegic Cerebral Palsy with a Jump Gait Pattern

Peter A. Smith, MD1, Sahar Hassani, MS1, Adam Graf, MS1, Ann Flanagan, PT, PCS1, Kathryn Reiners1, Ken N. Kuo, MD2, Jae-Young Roh, MD3 and Gerald F. Harris, PhD1

1 Shriners Hospitals for Children—Chicago, 2211 North Oak Park Avenue, Chicago, IL 60707. E-mail address for S. Hassani: Sahar-1{at}msn.com
2 National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
3 Severance Children's Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea

Investigation performed at Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Shriners Hospitals for Children, Grant #8540. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Brace prescription for children with diplegic cerebral palsy challenges the clinician with a variety of options and little evidence for rational decisions. Previous studies have indicated that ankle-foot orthoses improve toe-walking, but it is unclear if any brace is better than another. The goal of the present study was to compare the effectiveness of hinged and dynamic ankle-foot orthoses in terms of improving gait and motor function in a homogeneous group of children with diplegic cerebral palsy exhibiting a jump gait pattern.

Methods: Fifteen children (mean age, 7.5 years) with spastic diplegic cerebral palsy who were able to walk independently with a jump gait pattern and twenty children (mean age, 10.6 years) with normal gait participated in the study. Standardized Gross Motor Function Classification System scores, Pediatric Outcomes Data Collection Instrument scores, and gait data were collected, analyzed, and compared. The subjects were tested while barefoot and while wearing hinged and dynamic ankle-foot orthoses. Data were analyzed to detect differences among these conditions.

Results: Significant improvements in gait metrics were seen during brace wear. No significant differences were seen between the two different braces used. The barefoot and braced conditions differed most significantly in terms of ankle kinematics and kinetics. Among the patients with cerebral palsy, no significant differences in the standardized outcome measurements were found between the braced and unbraced conditions or between the two braced conditions.

Conclusions: Our data suggest that gait improves with brace wear in children with cerebral palsy with a level-I Gross Motor Function Classification System score. The Pediatric Outcomes Data Collection Instrument and the Gross Motor Function Measure were not sensitive to brace treatment in the population studied. The hinged and dynamic braces were equally effective for improving ankle kinematics and kinetics in these relatively highly functioning children with cerebral palsy.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.


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