Comparison of 2 Orthotic Approaches in Children With Cerebral Palsy

Purpose: To compare dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy. Methods: A total of 10 children with cerebral palsy (4-12 years; 6 at Gross Motor Function Classification System level I, 4 at Gross Motor Function Classification System level III) and crouch and/or equinus gait wore DAFOs and ADR-AFOs, each for 4 weeks, in randomized order. Laboratory-based gait analysis, walking activity monitor, and parent-reported questionnaire outcomes were compared among braces and barefoot conditions. Results: Children demonstrated better stride length (11-12 cm), hip extension (2 degrees-4 degrees), and swing-phase dorsiflexion (9 degrees-17 degrees) in both braces versus barefoot. Push-off power (0.3 W/kg) and knee extension (5 degrees) were better in ADR-AFOs than in DAFOs. Parent satisfaction and walking activity (742 steps per day, 43 minutes per day) were higher for DAFOs. Conclusions: ADR-AFOs produce better knee extension and push-off power; DAFOs produce more normal ankle motion, greater parent satisfaction, and walking activity. Both braces provide improvements over barefoot.