Effect of ankle-foot orthoses on gait in children with cerebral palsy: A meta-analysis.

OBJECTIVE: Different ankle-foot orthoses (AFO) are often prescribed in children with cerebral palsy (PC) although their efficiency on gait remains unclear.

PURPOSE: (1) To determine the effect of AFOs on gait in children with CP and (2) to evaluate the effect of each types of AFO.

MATERIAL AND METHODS: Studies in English with control condition (barefoot or shoes) assessing effect of AFO about children with CP gait were search on the Pubmed, CINAHL+, Web of Science, Cochrane Library databases. Quality of each study was assessed by modified PEDRO scale. Only studies with a score more than 4 were selected. 10 gait parameters were extracted in each study. Effect size and 95% confidence interval were calculated for each parameter.

RESULTS: Seventeen studies (490 subjects) were included. Comparing AFOs to control condition, stride length increased (15 studies) d=1.04 [95% CI: 0.69; 1.38], velocity increased (16 studies) d=0.27 [95% CI: 0.14; 0.41], cadence decreased (15 studies) d=-0.69, [95% CI: -0.95; -0.43]. Ankle dorsiflexion increased at initial contact (11 studies) d=1.64, [95% CI: 1.16; 2.11] and in swing phase (7 studies) d=5.21, [95% CI: 1.91; 8.52]. Ankle power generation in stance phase decreased (6 studies) d=-0.26, [95% CI: -0.38; -0.14]. The duration of tibialis anterior activation and energy data did not changed significantly. Four types of orthosis were found: dynamic AFO, hinged AFO, solid AFO, supra-malleolar orthosis. Hinged AFO was the orthosis that improved the greater number of gait parameters and was the only one to improve velocity with an effect size>0.8 (large effect).

DISCUSSION/CONCLUSION: This study shows clinically significant effect of AFO on stride length, ankle dorsiflexion at initial contact and swing phase. Hinged AFO seems to have the greatest effect on gait. New data are needed to refine the choice of the orthosis according to the child gait pattern.