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Impact of ankle-foot orthosis on gait efficiency in ambulatory children with cerebral palsy: a systematic review and meta-analysis
Betancourt JP, Eleeh P, Stark S, Jain NB
American Journal of Physical Medicine & Rehabilitation 2019 Sep;98(9):759-770
systematic review

OBJECTIVE: Children with cerebral palsy experience functional limitations because of excessive muscle weakness, spasticity, and impaired motor control. They are prescribed ankle-foot orthoses to assist with ambulation. Our objective was to analyze stride length and dorsiflexion data comparing the effectiveness of "ankle-foot orthoses" with "barefoot or shoes only" on ambulatory children with cerebral palsy. DESIGN: An electronic literature search was conducted. Studies were screened by two reviewers based on our inclusion criteria: prospective cohort study or randomized clinical trial, participants younger than 18 yrs with a primary diagnosis of cerebral palsy, ankle-foot orthoses with a control group, 20 combined participants in the experimental and control groups for cohort studies, and 10 participants for randomized clinical trials. RESULTS: Seventeen studies were selected. Pooled results of the meta-analyses showed that stride length was significantly better in the ankle-foot orthoses group as compared with the control group (mean difference between groups 0.05 m (95% confidence interval 0.04 to 0.06). The dorsiflexion angle (5 studies, 124 participants) was improved in patients with ankle-foot orthoses as compared with barefoot or shoes only (mean difference between groups 8.62 degrees (95% confidence interval 8.05 to 9.2). CONCLUSIONS: Children with cerebral palsy using ankle-foot orthoses had improved stride length and dorsiflexion angle during gait in a pooled meta-analyses of cohort studies and clinical trials.

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