Ankle-foot orthoses improve motor function of children with cerebral palsy: a Meta-analysis based on 12 randomized controlled trials

doi:10.12307/2022.239

Abstract

Abstract: OBJECTIVE: Cerebral palsy seriously affects children's physical and mental health due to its high morbidity and disability rate. Ankle-foot orthoses are an important treatment for this disease. However, it is not very clear about the clinical effect of ankle-foot orthoses on the motor function of children with cerebral palsy. Therefore, this paper systematically assesses the clinical effect of ankle-foot orthoses on the improvement of motor function in children with cerebral palsy.
METHODS: Literature retrieval was carried out in the electronic databases of PubMed, EMbase, Web of Science, Cochrane Library, CBM, CNKI, WanFang, and VIP. The time limit for retrieval was from the establishment of these databases to September 9, 2020. According to the inclusion and exclusion criteria, randomized controlled trials of ankle-foot orthoses in the treatment of children with cerebral palsy were included. At least two evaluators extracted the data independently and used Cochrane 5.1.0 bias risk assessment tool to evaluate the quality of included studies. The data were analyzed by Revman 5.3 software.
RESULTS: In the end, a total of 12 randomized controlled trials with high quality, involving 480 children with cerebral palsy, were included in this study. Among them, 239 patients in the ankle-foot orthosis group wore ankle-foot orthosis; 241 patients in the control group did not wear ankle-foot orthosis. The treatment course was 0-48 weeks. Meta-analysis results showed that the improvement of Gross Motor Function Measure-88-D/E score (mean difference (MD)=6.26, 95% confidence interval (CI):3.54-8.98, P < 0.000 01), modified Ashworth scale score (MD=-0.60, 95%CI: -0.80 to -0.40, P < 0.000 01), dorsiflexion mean in swing (MD=14.96, 95%CI: 12.03-17.90, P < 0.000 01), effectiveness in improving motor function (MD=2.99, 95%CI: 1.19-7.50, P=0.02), and stride length (MD=0.06, 95%CI: 0.04-0.09, P < 0.000 01) in the ankle-foot orthosis group was better than that in the control group.
CONCLUSION: Evidence from these 12 randomized controlled trials indicates that no matter walking with ankle-foot orthosis, or walking without ankle-foot orthosis after wearing for a certain period of time, in the short time, it has remarkable clinical value in improving motor function. However, further studies on the long-term recovery of motor function are required.

Key words: cerebral palsy, ankle-foot orthoses, gross motor function, dorsiflexion of ankle, gait analysis, randomized controlled trial, Meta-analysis

CLC Number:

Liu Gang, Ma Chao, Wang Le, Zeng Jie, Jiao Yong, Zhao Yi, Ren Jingpei, Hu Chuanyu, Xu Lin, Mu Xiaohong. Ankle-foot orthoses improve motor function of children with cerebral palsy: a Meta-analysis based on 12 randomized controlled trials[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(8): 1299-1304.

Figures/Tables 12

References

[1] 李晓捷,唐久来,马丙祥,等.脑性瘫痪的定义,诊断标准及临床分型[J].中华实用儿科临床杂志,2014,29(19):1520.
[2] GULATI S, SONDHI V. Cerebral palsy: an overview. Indian J Pediatr. 2018;85(11): 1006-1016.
[3] MU XH, DENG BW, ZENG J, et al. Orthopedic treatment of the lower limbs in spastic paralysis. Brain Sci Adv. 2020;6(1):2-19.
[4] SUN Q, HUANG WL, MU XH, et al. The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR). Brain Sci Adv. 2020;6(1):42-55.
[5] 穆晓红,李筱叶.痉挛型脑性瘫痪外科治疗专家共识[J].中国矫形外科杂志,2020, 28(1):77-81.
[6] RIES AJ, SCHWARTZ MH. Ground reaction and solid ankle-foot orthoses are equivalent for the correction of crouch gait in children with cerebral palsy. Dev Med Child Neurol. 2019;61(2):219-225.
[7] LIU XC, EMBREY D, TASSONE C, et al. Long-term effects of orthoses use on the changes of foot and ankle joint motions of children with spastic cerebral palsy. PM R. 2018;10(3):269-275.
[8] SACAZE E, GARLANTEZEC R, REMY-NERIS O, et al. A survey of medical and paramedical involvement in children with cerebral palsy in Britanny: preliminary results. Ann Phys Rehabil Med. 2013;56(4):253-267.
[9] 唐久来,秦炯,邹丽萍,等.中国脑性瘫痪康复指南(2015):第一部分[J].中国康复医学杂志,2015,30(7):747-754.
[10] ABOUTORABI A, ARAZPOUR M, AHMADI BANI M, et al. Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: a systematic review. Ann Phys Rehabil Med. 2017;60(6):393-402.
[11] LINTANF M, BOURSEUL JS, HOUX L, et al. Effect of ankle-foot orthoses on gait, balance and gross motor function in children with cerebral palsy: a systematic review and meta-analysis. Clin Rehabil. 2018;32(9):1175-1188.
[12] BETANCOURT JP, ELEEH P, STARK S, et al. Impact of ankle-foot orthosis on gait efficiency in ambulatory children with cerebral palsy: a systematic review and meta-analysis. Am J Phys Med Rehabil. 2019;98(9):759-770.
[13] ALTSCHUCK N, BAUER C, NEHRING I, et al. Efficacy of prefabricated carbon-composite ankle foot orthoses for children with unilateral spastic cerebral palsy exhibiting a drop foot pattern. J Pediatr Rehabil Med. 2019;12(2):171-180.
[14] PAUK J, IHNATOUSKI M, DAUNORAVICIENE K, et al. Research of the spatial-temporal gait parameters and pressure characteristic in spastic diplegia children. Acta Bioeng Biomech. 2016;18(2):121-129.
[15] WREN TA, DRYDEN JW, MUESKE NM, et al. Comparison of 2 orthotic approaches in children with cerebral palsy. Pediatr Phys Ther. 2015;27(3):218-226.
[16] BJORNSON KF, SCHMALE GA, Adamczyk-Foster A, et al. The effect of dynamic ankle foot orthoses on function in children with cerebral palsy. J Pediatr Orthop. 2006; 26(6):773-776.
[17] 朱振兴.悬吊训练配合踝足矫形器对小儿脑瘫膝过伸的疗效研究[J].基层医学论坛,2018,22(31):4410-4411.
[18] 黄艳芳,何东梅.踝足矫形器在小儿脑瘫康复中的应用价值分析[J].中国医药科学,2018,8(16):73-75.
[19] 陶静.踝足矫形器治疗痉挛型脑瘫患儿动静态尖足的疗效[J].中国伤残医学, 2017,25(3):94-96.
[20] 周陶成,童光磊,张敏,等.踝足矫形器联合肉毒毒素治疗痉挛型脑性瘫痪儿童尖足畸形的疗效观察[J].中华物理医学与康复杂志,2015,37(10):761-764.
[21] 王景刚,王爱虹,王伟烈,等.定量评定踝足矫形器对痉挛型脑性瘫痪的疗效[J].中国现代医生,2012,50(25):45-46.
[22] 罗颖,刘夕东,梅洪.踝足矫形器(AFO)对痉挛型脑瘫运动功能及ADL的作用[J].中国康复,2011,18(6):469-470.
[23] 喻锦成.踝足矫形器对痉挛型脑性瘫痪儿童足底压力、足底形态及步态的影响[D].广州:中山大学,2008.
[24] 陈秀恩,左群.踝足矫形器在痉挛型脑瘫患儿术后康复治疗中的作用[J].中国康复医学杂志,2007,22(2):174-175.
[25] SCHIARITI V, SELB M, CIEZA A, et al. International classification of functioning, disability and health core sets for children and youth with cerebral palsy: a consensus meeting. Dev Med Child Neurol. 2015;57(2): 149-158.
[26] 邓博文,徐林,穆晓红,等.腰骶段SPR术对痉挛型脑瘫患儿腰椎稳定性影响的长期观察[J].中国矫形外科杂志,2019, 27(21):1959-1964.
[27] MEYNS P, KERKUM YL, BREHM MA, et al. Ankle foot orthoses in cerebral palsy: effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking. Eur J Paediatr Neurol. 2020;26:68-74.
[28] SON I, LEE D, HONG S, et al. Comparison of gait ability of a child with cerebral palsy according to the difference of dorsiflexion angle of hinged ankle-foot orthosis:a case report. Am J Case Rep. 2019;3(20): 1454-1459.
[29] SWINNEN E, BAEYENS JP, VAN MULDERS B, et al. The influence of the use of ankle-foot orthoses on thorax, spine, and pelvis kinematics during walking in children with cerebral palsy. Prosthet Orthot Int. 2018; 42(2):208-213.
[30] CONTINI BG, BERGAMINI E, ALVINI M, et al. A wearable gait analysis protocol to support the choice of the appropriate ankle-foot orthosis: a comparative assessment in children with Cerebral Palsy. Clin Biomech. 2019;70:177-185.