dynamic response afo in the correction of crouch gait for ... · 1m evans, md 1k zvara, md 2xc liu,...

1 M Evans, MD 1 K Zvara, MD 2 XC Liu, MD, PhD 3 D Heyd, CO 1 Department of Physical Medicine and Rehabilitation, 2 Center for Motion Analysis, Department of Orthopaedic Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin; 3 Brace Master Intl; Milwaukee, WI Background Crouch gait in children with spastic cerebral palsy is usually defined as increased knee flexion during walking. One option to improve excessive knee flexion is the use of a floor reaction orthosis (FRO). The mechanism of the FRO prevents excessive ankle dorsiflexion and reduces high knee flexion. However, in the FRO knee extension sometimes occurs before mid-stance, which may disrupts forward progression. Objectives The goal of this demonstration is to describe the biomechanics of the dynamic response AFO (DRAFO) in the correction of crouch gait and briefly highlight the impact of the DRAFO in the treatment of dynamic alignments. Description The DRAFO is a stance phase control orthosis which is designed based upon the kinematic functions of the lower extremity. An insufficient shank incline or excessive shank incline movement determines the characteristics of the DRAFO. The DRAFO aims to: 1) to stabilize the tibia, ankle, and foot without over tensioning the plantar flexors and to assure that the knee and midfoot aren’t compromised during stance phase. 2) to align orthosis to the floor utilizing a series of simple heel and sole modification to a shoe (Figure 1). Significance The DRAFO allows body to facilitate better balance and provides balistic movement of the lower limb and trunk. All of these improvements results in an efficient gait and energy conservation. The DRAFO designs are appropriate whenever stance phase control and correction are required for improved ambulation in children with neuromuscular impairments. The patient must have the ability to pre-stand and ambulation. Dynamic Response AFO in the Correction of Crouch Gait for a Child with CP This dynamic alignment process is designed to “tune” into stance and then subsequently the exit into swing. The case study reported that the use of the DRAFO leads to increased walking speed, cadence, stride length, and an improved gait deviation index. Use of shoes with simple heel and sole modifications significantly improves excessive dorsiflexion of the ankle joint bilaterally (Figure 2), while to some extent still providing tibial inclination, which achieves an important ankle plantarflexion-knee extension mechanism during the 3 rd rocker and pre- swing. However, the FRO is lack of this coupling biomechanics at the terminal stance. Figure 1. Left: The shank is reclined; Center: After adding a simple heel, the shank is inclined but the ankle joint is still in the plantarflexion; Right: a sole modification to a shoe. Figure 2. An increased dorsiflexion of the ankle joint during barefoot walking; Right: Reduced dorsiflexion of the ankle joint after wearing the DRAFO and shoe with high heel Acknowledgements We would like to thank Carlos Marquez- Barrientos, MS, research biomechanical engineer, for his assistance.

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Page 1: Dynamic Response AFO in the Correction of Crouch Gait for ... · 1M Evans, MD 1K Zvara, MD 2XC Liu, MD, PhD 3D Heyd, CO 1Department of Physical Medicine and Rehabilitation, 2Center

1M Evans, MD 1K Zvara, MD 2XC Liu, MD, PhD 3D Heyd, CO 1Department of Physical Medicine and Rehabilitation, 2Center for Motion Analysis, Department of Orthopaedic Surgery,

Children’s Hospital of Wisconsin, Medical College of Wisconsin; 3Brace Master Intl; Milwaukee, WI

Background!!

Crouch gait in children with spastic cerebral palsy is usually defined as increased knee flexion during walking. One option to improve excessive knee flexion is the use of a floor reaction orthosis (FRO). The mechanism of the FRO prevents excessive ankle dorsiflexion and reduces high knee flexion. However, in the FRO knee extension sometimes occurs before mid-stance, which may disrupts forward progression. !

Objectives!!

The goal of this demonstration is to describe the biomechanics of the dynamic response AFO (DRAFO) in the correction of crouch gait and briefly highlight the impact of the DRAFO in the treatment of dynamic alignments. !

Description!!

The DRAFO is a stance phase control orthosis which is designed based upon the kinematic functions of the lower extremity. An insufficient shank incline or excessive shank incline movement determines the characteristics of the DRAFO. The DRAFO aims to:! 1) to stabilize the tibia, ankle, and foot without over tensioning the plantar flexors and to assure that the knee and midfoot aren’t compromised during stance phase.! 2) to align orthosis to the floor utilizing a series of simple heel and sole modification to a shoe (Figure 1).

Significance!!

The DRAFO allows body to facilitate better balance and provides balistic movement of the lower limb and trunk. All of these improvements results in an efficient gait and energy conservation. The DRAFO designs are appropriate whenever stance phase control and correction are required for improved ambulation in children with neuromuscular impairments. The patient must have the ability to pre-stand and ambulation. !

Dynamic Response AFO in the Correction of Crouch Gait for a Child with CP

This dynamic alignment process is designed to “tune” into stance and then subsequently the exit into swing. The case study reported that the use of the DRAFO leads to increased walking speed, cadence, stride length, and an improved gait deviation index. Use of shoes with simple heel and sole modifications significantly improves excessive dorsiflexion of the ankle joint bilaterally (Figure 2), while to some extent still providing tibial inclination, which achieves an important ankle plantarflexion-knee extension mechanism during the 3rd rocker and pre-swing. However, the FRO is lack of this coupling biomechanics at the terminal stance.!

Figure 1. Left: The shank is reclined; Center: After adding a simple heel, the shank is inclined but the ankle joint is still in the plantarflexion; Right: a sole modification to a shoe. !

Figure 2. An increased dorsiflexion of the ankle joint during barefoot walking; Right: Reduced dorsiflexion of the ankle joint after wearing the DRAFO and shoe with high heel!

Acknowledgements!We would like to thank Carlos Marquez-Barrientos, MS, research biomechanical engineer, for his assistance.

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