As part of our series celebrating the cerebral palsy World Cup at St Georges Park Nicola Eddison, PhD student at Staffordshire University and principle orthotist at the Royal Wolverhampton NHS Trust and Nachiappan Chockalingam, Professor of Clinical Biomechanics At Staffordshire University write on the biomechanics of cerebral palsy and use of ankle foot orthoses for addressing gait issues.
Cerebral palsy (CP) is defined as a group of permanent disorders in the development of movement and posture causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication and behaviour; by epilepsy and by secondary musculoskeletal problems. The result is a lack of co-ordination, muscle imbalance and an increase in muscle tone or paresis. These issues can be addressed by the use of orthoses to change the wy the foot works and provide cushioning and support.
Ankle Foot Orthoses (AFO’s) are prescribed in a wide range of gait pathologies, including CP in an attempt to influence the kinetics and kinematics of gait and to manipulate the GRF bringing it closer to the joints and thus reducing energy expenditure. There are a wide variety of AFO’s used in clinical practice, they are characterised by their design, the material used and the stiffness of that material. Changing any of these 3 components will alter the control the AFO has on the patient’s gait.
Whilst, previous research demonstrates a positive effect of AFO’s on certain gait parameters, they are not all in agreement as to which gait parameters are improved with the use of an AFO. The primary aim of the work at Staffordshire University is to determine the effects of tuning ankle foot orthoses (AFO) in combination with footwear (AFO-FC) compared to an un-tuned AFO-FC on the gait parameters of children with cerebral palsy. Our current experimental work involves the use of ultrasound to measure structure and function of the muscles in addition to physiological and biomechanical measurements involved gait assessment.
We are hoping to develop a more practical way to enable clinicians to effectively tune AFO-FC’s in a clinical setting without the use of three dimensional (3D) Gait analysis.
(This work on The effect of “tuning” in ankle foot orthoses on the gait parameters of children with cerebral palsy, is conducted by Nicola Eddison, who is a principle orthotist at the Royal Wolverhampton NHS trust under the supervision of Professor Nachiappan Chockalingam at the Biomechanics Facility within the Faculty of Health Sciences, Staffordshire University).
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