Comparing Gait Biomechanics and Function in Children with Bilateral Spastic Cerebral Palsy When Wearing OSKAR AFO-Footwear Combination Versus Standard AFO-Footwear Combination: An Exploratory Study

Suwanee, GA

INTRODUCTION: Ankle foot orthoses (AFOs) are often prescribed for children with spastic cerebral palsy (CP) to enhance ankle/foot alignment and improve gait. Typical AFOs are made to hold the ankle at a right angle, or plantigrade position, without consideration of structural limitations or musculoskeletal function, causing compensatory gait patterns and compromised foot postures in children with CP with limited gastrocnemius muscle length. Literature suggests that walking ability can be maximized when AFOs are optimized to accommodate for structural limitations and tuned to facilitate a walking pattern that more closely aligns with typical gait parameters. There is limited research examining gait biomechanics and function when walking in ankle foot orthoses footwear combinations (AFOFCs) that have been designed and tuned to achieve optimum segmental alignment using published algorithms from OSKAR, or optimal segment kinematics and alignment approach to rehabilitation.

OBJECTIVE: The primary objective of this study was to examine peak knee extension gait function when wearing OSKAR AFOFCs versus standard AFOFCs in children with spastic CP. Client satisfaction with each AFO condition was also assessed.

METHODS: Ambulatory children with a diagnosis of spastic diplegic cerebral palsy ages 7 to 13 participated in this exploratory study. A cross-sectional, repeated-measures design was used to collect kinetic and kinematic gait data via three-dimensional gait analysis in the two AFO conditions. Functional walking ability was also evaluated using the Pediatric Balance Scale, Standardized Walking Obstacle Course, and 6-Minute Walk Test. Client satisfaction was assessed using the Orthotic and Prosthetic User Survey (OPUS) when wearing OSKAR AFOFCs and standard AFOFCs.

DATA ANALYSIS: Non-parametric Wilcoxon signed-rank test were performed to compare gait parameters, functional gait scores, and satisfaction with orthoses when walking in the different AFOFCs.

RESULTS: Peak knee extension was not significantly different when wearing the two orthoses. However, PBS scores were significantly higher when wearing the OSKAR AFOFCs but all other gait functions (SWOC, 6MWT) were comparable between conditions. Although not statistically significant, participant satisfaction was higher in the OSKAR condition.

CONCLUSION: Results from this study could help inform clinicians about individualized orthotic assessment and design, as well as provide helpful clinical gait data for maximizing functional mobility with orthotic intervention. Future studies with more participants are needed to evaluate the effectiveness of OSKAR AFOFCs.