Evaluation of orthoses used in the management of children with cerebral palsy and who walk with frames

Objective: The aim of this study was to evaluate the effect that orthoses have on the gait and energy expenditure of a group of children with cerebral palsy (CP) and who walk with the assistance of frames. The study complemented a qualitative investigation to examine the views and opinions of the children about their orthoses. Method: Fifteen children were recruited to the investigation from physiotherapy departments located in a residential school and two child development centres. All children recruited were aged between 5 and 16 years, had CP, wore orthoses, and walked with the assistance of a frame. The children took part in one assessment which comprised of an interview followed by biomechanical data collection. They walked around a 20m course using their walking frame for a period of 5 minutes during which time data were recorded using a video camera filming in the sagittal plane and a heart rate monitor. Children were assessed with and without their orthoses, in random order. Video was analyzed to provide sagittal plane joint angles, walking velocity, stride length, and stance/swing phase timing. Energy expenditure was evaluated using the Physiological Cost Index (PCI). Results: There were mixed results with the orthotics having positive effects in some children, negative in others, and in many children no changes occurred. Consequently the orthoses did not improve joint angles, PCI, and temporal/spatial parameters across the board. In some children PCI, temporal, or spatial parameters improved but joint kinematics did not (and vice versa). Eight of the children showed consistent results. Four participants consistently improved with orthoses, and four showed no change. Although ankle kinematics improved in many of the children only three showed improvement at either the knee or hip. Conclusion: In light of the findings it would seem important that careful consideration is given to identifying the specific aim of prescribing orthoses, and selection of the correct type. Following prescription it would also be useful, although not always possible, to use gait analysis to evaluate whether those goals have been achieved.