Background: Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. Methods: A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. Results: We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO. Conclusions: Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.

Background: Cerebral palsy (CP) is a complex pathology that describes a group of motor disorders with different presentations and functional levels. Three-dimensional gait analysis is widely used in the assessment of CP children to assist in clinical decision making. Thus, it is crucial to assess the repeatability of gait measurements to evaluate the progress of the rehabilitation process. The purpose of the study is to evaluate test-retest reliability of a six-degree-of-freedom (6DoF) marker set in key points of gait kinematics, kinetics, and time-distance parameters in children with CP. Methods: trials were performed on two different days within a period of 7.5 ± 1.4 day. Motion capture data was collected with 14 infrared, high-speed cameras at a frequency rate of 100 Hz, synchronized in time and space with two force plates. Intraclass correlation coefficients considering the two-way mixed model, and absolute agreement (ICC[A,k]) were calculated for anthropometric, time–distance, kinematic and kinetic parameters of both lower limbs. Results: the majority of gait parameters demonstrated a good ICC, and the lowest values were in the kinematic variables. Conclusions: this study indicates wide-ranging reliability values for lower limb joint angles and joint moments of force during gait, especially for frontal and transverse planes. Although the use of a 6DoF-CAST in CP children was shown to be a feasible method, the gait variation that can be observed between sessions in CP children seems to be related not only to the extrinsic factors but also to their different gait patterns and affected sides.

Background Cerebral Palsy (CP) is the most common cause of motor disability in children, often leading to different musculoskeletal abnormalities, including foot deformities. Ankle-foot orthoses are commonly prescribed to minimize abnormal foot posture and to minimize the impact of spasticity on daily function. Dynamic pedobarography may provide new data to better assess the changes in plantar pressure distribution throughout the stance phase of gait in children with Cerebral Palsy.Methods Nine children with CP walked wearing plantar pressure insoles inside their orthoses and regular footwear. Mean values and standard deviation were calculated for each variable in a total and a segmented foot analysis. Clusters based on clinical distribution of spasticity, gait pattern and type of orthoses were created to allow for further analysis.Results Overall data was consistent across all participants and clusters. The use of AFO did not significantly impact any of the mean values for the variables in study, when referencing to the means of the same variables in children with CP walking in regular footwear. The cluster analysis revealed increased pedobarography values in Unilateral CP, Apparent Equinus gait pattern and Dynamic AFO sub-groups. In the segmented foot analysis, all variables increased from heel to the fore foot.Conclusions The use of AFO in children with CP produce positive changes in plantar pressure measurements, approximating them to the reference percentiles of typically developing children.