Carbon fiber AFO-SMO orthoses improved gait in patient with cerebral palsy

HOUSTON — The use of a carbon fiber ankle-foot orthosis with supramalleolar orthosis inner boots improved the gait of a 13-year-old patient with spastic diplegic cerebral palsy, according to data presented at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting.

The patient presented with bilateral forefoot adduction, midfoot supination, hindfoot varus, decreased knee motion and weakened gastroc-soleus muscles. Christina Bickley, PT, PhD, BOCO, of Shriners Hospital for Children, and colleagues recommended an ankle-foot orthosis (AFO) with supramalleolar orthosis (SMO) inner boots to address gait deficiencies.

“The goal for the AFO was to improve knee motion and increase plantar flexor strength,” Bickley said. “The goal for the SMO was to maintain and improve bilateral ankle-foot alignment.”

Researchers conducted a longitudinal, instrumented gait study on day 1, at 6 months and at 12 months to assess the effects of open bilateral adductor tenotomies. The day-1 study was performed immediately after the patient was fitted with bilateral AFOs and SMOs. Four walking conditions were compared: barefoot walking; sneakers only; SMOs only; and AFO-SMOs. The 6-month study assessed the short-term effects of AFO-SMOs on gait and function. Barefoot and AFO-SMOs were compared. The 12-month study assessed long-term effects of AFO-SMOs on gait, function and clinical exam. Barefoot walking, AFO-SMOs and AFO-SMOs with a 0.25-inch heel wedge were compared.

Investigators found significant improvement in knee motion with increasing peak knee flexion and increased total knee motion with use of the AFO-SMOs. The patient also showed improved pelvic alignment in the transverse plane and improved temporal-spatial parameters with AFO-SMOs.

“His gait improved in left-right symmetry with and without the orthoses,” Bickley said. “His parents reported a noticeable reduction in falls and believe his walking and running have improved over the last 6 months.

She added, “Comparison of day-1 vs. 6-month barefoot conditions showed improvement of knee motion, which support carry-over effects when the patient’s AFOs are not donned.”

The findings also showed continued knee motion improvements and improvement in plantar flexion strength of approximately two muscle grades.

While the study supports the use of bilateral AFO-SMOs, further research is needed, Bickley said. “Advancing the understanding of effects of carbon-fiber AFOs with varying orthotic setups on gait, function and clinical exam will help improve orthotic prescription and patient care.” – by Shawn M. Carter


Bickley C, et al. Longitudinal instrumented gait analysis on the use of a carbon-fiber AFO for a child with cerebral palsy. Presented at: Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting; March 22-25, 2017; Houston.

Disclosure: Bickley reports no relevant financial disclosures.


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