Individualized orthotic alignment and footwear for balance and mobility in children with bilateral spastic cerebral palsy: A randomized trial

Abstract

Children with cerebral palsy (CP) face challenges in controlling the position of their feet and legs, which can limit balance in standing and walking. These challenges with foot and leg positioning also limit speed of walking and participation in everyday activities, like playing with friends or engaging in sports. A common treatment to improve balance in standing and walking is to use plastic ankle foot braces.

This research study compared a typical solid plastic brace with standard alignment worn with regular shoes, to a rigid plastic brace with alignment individualized to the specific needs of the child with shoes adapted to further improve balance. These two treatments were tested in 19 children with CP, ages 6 to 11 years. Four of the children who participated in the study walked with a reverse or posterior walker (pulled from behind), while the others did not use a walker. Children were assigned to wear one of the treatments for 3 months based on a coin flip, with half of the children wearing the typical solid braces with standard alignment and regular shoes and the other half wearing the rigid plastic braces with individualized alignment and adapted shoes. The children's balance was evaluated at the start and end of 3 months. The rigid plastic braces with individualized alignment and adapted shoes effected a greater change in balance and daily walking mobility at 3 months. There was no difference in the number of comfort or skin issues reported between the two treatment groups.

These results suggest that the rigid plastic braces with individualized alignment and adapted shoes may be a worthwhile treatment for helping children with CP have better balance during standing and walking, enabling them to have greater participation in everyday activities.