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The effect of orthotic devices on gait symmetry of children with spasticity in the lower extremities


1. Physical Therapy, Missouri State University, Springfield, MO, USA;
2. Midland Children’s Rehabilitation Center, Midland, TX, USA

Background/Objectives: As children with cerebral palsy mature, orthotic devices may help to eliminate secondary complications associated with asymmetrical gait. The purpose of this pilot study was to investigate the effect of orthotic devices on the symmetry of gait in children with cerebral palsy.

Design: The study was a controlled, crossover design with randomization of conditions order.

Participants and Setting: Twenty-eight children with cerebral palsy, who demonstrate some degree of hypertonicity of one or both lower extremities, participated in the study.

Materials/Methods: Participants were asked to walk barefooted, with shoes, and with orthoses and shoes at their preferred speed along the GAITRite carpet. Gait symmetry was defined as the difference in percentage of time in single leg stance between the right and left leg. The difference in percentage of single stance times between legs is used as the criterion measure, because it has been shown to be consistent across trials and ages among typically developing children. Of the 28 participants, four could not complete the task independently and were not included in data analyzed. Eleven of the remaining 24 participants demonstrated asymmetry of single leg stance and thirteen demonstrated symmetry. Separate repeat measure analyses of variance were completed for both the symmetrical and asymmetrical groups. Step-wise multiple regression was used to analyze factors (gender, asymmetry of muscle tone, history of BOTOX injections, type of orthotic device used, and frequency of physical therapy), which might contribute to the differences between the groups.

Results: There were no significant changes in percentages of single stance time between right and left lower limbs when comparing barefoot, shoes, or orthotic devices and shoes trials in either group, (symmetry group, Mean ± SD = .96 ±0.13, .96±0.13, 97 ±0.12, F (2, 24)=.121, p<NS; asymmetry group, Mean ±SD = .85 ±08, .95 ±23, .92±26, F (2, 20) = .900, p<NS). Step-wise multiple regressions revealed a relationship between the participant’s sex and a history of BOTOX injections and percentage of single stance times differences between the right and left limbs in all conditions. Males and individuals who had received BOTOX injections were more likely to demonstrate differences.

Conclusions/Significance: For more participants, use of orthotic devices did not have a greater effect on single stance symmetry during walking than walking barefooted or with shoes alone. One of the major limitations in this pilot study is lack of statistical power. The power for each group was low (.08 and .13). Therefore, the findings in this study should not be used to justify the continuation or discontinuation of orthotic devices use among children with cerebral palsy. Although BOTOX injection is valuable in controlling spasticity, its effect on gait symmetry and possible contribution to secondary complications as these children age need to be investigated.

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