Article

Splint: the efficacy of orthotic management in rest to prevent equinus in children with cerebral palsy, a randomised controlled trial

Department of Rehabilitation Medicine and the EGMO+ Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
BMC Pediatrics (Impact Factor: 1.92). 03/2012; 12:38. DOI: 10.1186/1471-2431-12-38
Source: PubMed

ABSTRACT Range of motion deficits of the lower extremity occur in about the half of the children with spastic cerebral palsy (CP). Over time, these impairments can cause joint deformities and deviations in the children's gait pattern, leading to limitations in moblity. Preventing a loss of range of motion is important in order to reduce secondary activity limitations and joint deformities. Sustained muscle stretch, imposed by orthotic management in rest, might be an effective method of preventing a decrease in range of motion. However, no controlled study has been performed.
A single blind randomised controlled trial will be performed in 66 children with spastic CP, divided over three groups with each 22 participants. Two groups will be treated for 1 year with orthoses to prevent a decrease in range of motion in the ankle (either with static or dynamic knee-ankle-foot-orthoses) and a third group will be included as a control group and will receive usual care (physical therapy, manual stretching). Measurements will be performed at baseline and at 3, 6, 9 and 12 months after treatment allocation. The primary outcome measure will be ankle dorsiflexion at full knee extension, measured with a custom designed hand held dynamometer. Secondary outcome measures will be i) ankle and knee flexion during gait and ii) gross motor function. Furthermore, to gain more insight in the working mechanism of the orthotic management in rest, morphological parameters like achilles tendon length, muscle belly length, muscle fascicle length, muscle physiological cross sectional area length and fascicle pennation angle will be measured in a subgroup of 18 participants using a 3D imaging technique.
This randomised controlled trial will provide more insight into the efficacy of orthotic management in rest and the working mechanisms behind this treatment. The results of this study could lead to improved treatments.
Nederlands Trial Register NTR2091.

Download full-text

Full-text

Available from: Richard T Jaspers, Sep 02, 2015
1 Follower
 · 
130 Views
 · 
35 Downloads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To examine whether using a knee-ankle-foot orthosis helps maintain ankle-foot dorsiflexion range of motion over time. Design: A multicentre randomized controlled trial. Setting: Two hospitals and one rehabilitation centre in the Netherlands and the USA. Subjects: Children (4-16 years old) with spastic cerebral palsy who were able to walk. Intervention: Use of a knee-ankle-foot orthosis, equipped with an Ultraflex (R) ankle power unit, for at least 6 hours every other night for one year. Main measures: Primary outcome measure: ankle-foot dorsiflexion range of motion. Secondary outcome measures: ankle-foot and knee angle in gait and gross motor function. Wearing time was also measured. Measurements were taken at baseline and at 3, 6, 9 and 12 months. Results: 28 children (experimental group: n=15, control group: n=13) participated in the study. 11 participants (experimental: n=4, control: n=7) did not complete all five measurements, as they needed additional treatment. No significant difference was found in the decrease of ankle-foot dorsiflexion range of motion between the experimental and control groups (difference: -1.05 degrees, 95% confidence interval: -4.71 degrees-2.61 degrees). In addition, secondary outcome measures did not show differences between groups. Despite good motivation, knee-ankle-foot orthosis wearing time was limited to a mean +/- SD of 3.2 +/- 1.9 hours per prescribed night due to discomfort. Conclusions: Knee-ankle-foot orthosis with dynamic ankle and fixed knee are poorly tolerated and are not beneficial in preventing a reduction in ankle-foot dorsiflexion range of motion in children with spastic cerebral palsy, at least with limited use.
    Clinical Rehabilitation 07/2014; 28(10). DOI:10.1177/0269215514542355 · 2.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this paper we present and validate a methodology to avoid the training procedure of a classifier based on an Hidden Markov Model (HMM) for a real-time gait recognition of two or four phases, implemented to control pediatric active orthoses of lower limb. The new methodology consists in the identification of a set of standardized parameters, obtained by a data set of angular velocities of healthy subjects age-matched. Sagittal angular velocities of lower limbs of ten typically developed children (TD) and ten children with hemiplegia (HC) were acquired by means of the tri-axial gyroscope embedded into Magnetic Inertial Measurement Units (MIMU). The actual sequence of gait phases was captured through a set of four foot switches. The experimental protocol consists in two walking tasks on a treadmill set at 1.0 and 1.5 km/h. We used the Goodness (G) as parameter, computed from Receiver Operating Characteristic (ROC) space, to compare the results obtained by the new methodology with the ones obtained by the subject-specific training of HMM via the Baum-Welch Algorithm. Paired-sample t-tests have shown no significant statistically differences between the two procedures when the gait phase detection was performed with the gyroscopes placed on the foot. Conversely, significant differences were found in data gathered by means of gyroscopes placed on shank. Actually, data relative to both groups presented G values in the range of good/optimum classifier (i.e. G ≤ 0.3), with better performance for the two-phase classifier model. In conclusion, the novel methodology here proposed guarantees the possibility to omit the off-line subject-specific training procedure for gait phase detection and it can be easily implemented in the control algorithm of active orthoses.
    Conference: 2015 IEEE International Symposium on Medical Measurements and Applications; 05/2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this paper we present and validate a methodology to avoid the training procedure of a classifier based on an Hidden Markov Model (HMM) for a real-time gait recognition of two or four phases, implemented to control pediatric active orthoses of lower limb. The new methodology consists in the identification of a set of standardized parameters, obtained by a data set of angular velocities of healthy subjects age-matched. Sagittal angular velocities of lower limbs of ten typically developed children (TD) and ten children with hemiplegia (HC) were acquired by means of the tri-axial gyroscope embedded into Magnetic Inertial Measurement Units (MIMU). The actual sequence of gait phases was captured through a set of four foot switches. The experimental protocol consists in two walking tasks on a treadmill set at 1.0 and 1.5 km/h. We used the Goodness (G) as parameter, computed from Receiver Operating Characteristic (ROC) space, to compare the results obtained by the new methodology with the ones obtained by the subject-specific training of HMM via the Baum-Welch Algorithm. Paired-sample t-tests have shown no significant statistically differences between the two procedures when the gait phase detection was performed with the gyroscopes placed on the foot. Conversely, significant differences were found in data gathered by means of gyroscopes placed on shank. Actually, data relative to both groups presented G values in the range of good/optimum classifier (i.e. G ≤ 0.3), with better performance for the two-phase classifier model. In conclusion, the novel methodology here proposed guarantees the possibility to omit the off-line subject-specific training procedure for gait phase detection and it can be easily implemented in the control algorithm of active orthoses.
    2015 IEEE International Symposium on Medical Measurements and Applications; 05/2015