Background: Impaired postural control is a key feature of cerebral palsy that affects daily living. Measures of trunk movement and acceleration have been used to assess dynamic postural control previously. In many children with cerebral palsy, ankle-foot orthoses are used to provide a stable base of support, but their effect on postural control is not yet understood. Objectives: The objectives of the current study were to investigate the effects of ankle-foot orthoses on postural control and energy cost of walking in children with cerebral palsy. Study design: Clinical study with controls. Methods: Trunk accelerometry (amplitude and structure) and energy cost of walking (J/kg/m) were recorded from five-minute walking trials with and without ankle-foot orthoses for children with cerebral palsy and without orthoses for the reference group. Results: Nineteen children with unilateral spastic cerebral palsy and fourteen typically developed children participated. The use of ankle-foot orthoses increased structure complexity of trunk acceleration in mediolateral and anterior–posterior directions. The use of ankle-foot orthoses changed mediolateral-structure toward values found in typically developed children. This change was not associated with a change in energy cost during walking. Conclusions: The use of ankle-foot orthoses does affect trunk acceleration that may indicate a beneficial effect on postural control. Using measures of trunk acceleration may contribute to clinical understanding on how the use of orthoses affect postural control.

Introduction: Practice of ankle-foot orthoses (AFO) provision for ambulatory children with cerebral palsy is underreported and the literature is not consistent on choice of AFO-design. This study describes clinical practice of AFO provision for children with cerebral palsy and evaluates how clinical practice aligns with existing recommendations. Methods: An online, cross-sectional survey was conducted, inviting all Norwegian orthotists working with children with cerebral palsy. Orthotic practice was investigated using a self-reported survey design. Results: From all eligible orthotists, 54% responded, revealing that AFO provision involves patients, physicians, and physiotherapists at different stages. Patient preference directly influenced the ultimate AFO-design. Shank vertical angle was evaluated by 79%. For children with crouch gait and those with short gastrocnemius, a majority preferred a combination of rigid and articulated/flexible AFO-designs. Instrumented gait analysis was conducted by 51% at AFO delivery stage. Conclusions: The findings show that AFO provision in Norway is collaborative, involving clinical team members and consideration of patient preferences. A discrepancy between clinical practice and existing recommendations for children with crouch gait and those with short gastrocnemius is observed.

Background/Objectives: Ankle–foot orthoses (AFOs) are commonly used to improve gait in children with cerebral palsy (CP), but their effect on specific gait patterns is underreported. This study evaluates the utilization of the Gait Pattern Classification System for Children with Spastic CP (GaP-CP) to investigate the effects of ankle–foot orthoses on gait kinematics, spatio-temporal parameters and the energy cost of walking. Methods: In this retrospective study, 66 ambulatory children with spastic CP underwent 3D gait analysis with and without AFOs or functional electrical stimulation. Gait patterns were classified according to GaP-CP. AFOs were articulated, flexible, or rigid. Thirty-six children also performed a 5 min walk test with gas exchange measurements. Step length, walking speed, and the energy cost of walking were calculated. Gait kinematics were analyzed with statistical nonparametric mapping. Non-parametric statistics were used to investigate orthotic effects for the total group and for each gait pattern. Results: Ankle kinematics improved in swing phase and initial contact (10 degrees less plantarflexion, p < 0.05) for the total group, dropfoot and genu recurvatum. During the stance phase, reduced knee extension in genu recurvatum (by 3 degrees, p < 0.05) and increased knee extension in crouch (by 3 degrees, p < 0.05) were observed. Median changes in non-dimensional step length were clinically significant (>0.039, p ≤ 0.02, effect size ≥ 0.55) for the total group and the dropfoot, genu recurvatum, and crouch subgroups, while changes in most gait indices, walking speed and the energy cost of walking were not clinically significant. Conclusions: The combined use of GaP-CP and kinematic analysis provided new insights into the effects of ankle–foot orthoses on gait. Articulated and flexible orthoses may not have provided adequate support for genu recurvatum and crouch gait, showing a potential value in gait pattern specific orthotic design to optimize gait kinematics.