Kinematic Comparison of Orthopedic Shoes and Ankle-Foot Orthoses in Children With Cerebral Palsy
Background. In patients with cerebral palsy (CP), secondary orthopedic deformities and violations of the walking pattern are often observed, so various methods of treatment are used for its correction, including orthosis. Abroad, orthoses (AFO) for ankle joints are most often used in clinical practice, whereas in Russia complex orthopedic shoes are used. At the same time, there are no comparative studies investigating the influence of these orthopedic products on the biomechanical parameters of gait. The aim of the study was to compare the kinematic parameters of walking in children with cerebral palsy, depending on the type of fixation of the foot and ankle joint. Methods. 25 biomechanical studies (9 barefoot tests; 7 tests in orthopedic shoes; 9 tests in AFO) were conducted in 9 patients with GMFCS 2 and GMFCS 3 levels of global motor function impairment. Results. The analysis showed that using AFO compared to walking barefoot, regardless of the GMFCS level, positively affects the space-time characteristics of walking, the kinematics of the ankle and knee joints, without significantly affecting the function of the hip joint. In this regard, an improvement in the integral indicator - the gait index - was noted. The use of orthopedic shoes in patients with GMFCS 2 and GMFCS 3 levels of global motor functions led to an improvement in the kinematics of the ankle and knee joints. At the same time, in patients in the GMFCS 2 group, the use of orthopedic shoes provided an improvement in more components of the gait index, whereas in the GMFCS 3 group, the number of such variables was significantly less. A comparative analysis of the results showed that the kinematic parameters of walking in orthopedic shoes are better in patients of the GMFCS 2 group, but in the GMFCS 3 group it is significantly better when using AFO. Conclusion. The choice of the type of foot fixation in patients with cerebral palsy, taking into account the level of global motor functions impairment, can significantly affect the correction of biomechanical parameters of walking.