- Original article
- Open Access
Effect of walking aids and foot orthoses on energy expenditure in children with cerebral palsy: a systematic review
Bulletin of Faculty of Physical Therapy volume 24, pages 99–112 (2019)
Walking aids and ankle–foot orthoses (AFOs) are designed to address gait problems. These devices are common among children with cerebral palsy (CP), as those children’s ability to ambulate is a big concern for their parents, and its improvement is considered primary focus of therapeutic modalities addressing motor disorders of this population. However, empirical support for walking aids and AFO is limited. The aim of this review was to assess the quality of research on the effect of walking aids and AFO on energy expenditure in children with CP.
Materials and methods
Four electronic databases using predefined terms were searched by two independent reviewers. All study designs except case reports were included. Nineteen studies involving 509 participants met inclusion criteria and were involved in this review.
Heterogeneity was observed across included studies in measurement, implementation, and study rigor.
There is a need for high-quality studies to draw a clear conclusion on the effect of walking aids and AFO on energy expenditure in children with CP; the typical flaws of existing studies included weak experimental designs, insubstantial treatment outcomes, and high risk of bias.
Berker N, Yalcin S. The help guide to cerebral palsy. 2nd ed. Seattle, WA: Global Help; 2010. pp. 7–32.
Radtka S, Skinner S, Johanson M. A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy. Gait Posture 2005; 21:303–310.
Lam W, Leong JC, Li YH, Hu Y, Lu WW. Biomechanical and electromyographic evaluation of ankle foot orthosis and dynamic ankle foot orthosis in spastic cerebral palsy. Gait Posture 2005; 22:189–197.
Buckon CE, Thomas SS, Jakobson-Huston S, Moor M, Sussman M, Aiona M. Comparison of three ankle foot orthosis configurations for children with spastic diplegia. Dev Med Child Neurol 2004; 46:590–598.
Rose J, Ralston H, Gamble J. Energetics of walking. Chapter 3. In: Rose J, Gamble JG, editors. Human walking. 2nd ed. Baltimore: William and Wilkins; 1994. pp. 47–71.
Axtel LA, Yasuda YL. Assistive devices and home modifications in geriatric rehabilitation. Clin Geriatr Med 1993; 9:803–821.
Raja K, Joseph B, Benjamin S, Minocha V, Rana B. Physiological cost index in cerebral palsy: its role in evaluating the efficiency of ambulation. J Pediatr Orthop 2007; 27:130–136.
Liao H, Jeng S, Lai J, Cheng C, Hsia-Hu M. The relation between standing balance and walking function in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 1997; 39:106–112.
Rose J, Medeiros J, Parker R. Energy cost index as an estimate of energy expenditure of cerebral-palsied children during assisted ambulation. Dev Med Child Neurol 1985; 27:485–489.
Palisano R, Shimmell LJ, Stewart D, Lawless JJ, Rosenbaum PL, Russell DJ. Mobility experiences of adolescents with cerebral palsy. Phys Occup Ther Pediatr 2009; 29:135–155.
Piccinin L, Cimolin V, Galli M, Berti M. Quantification of energy expenditure during gait in children affected by cerebral palsy. Eura Medicophys 2007; 43: 7–12.
Figueiredo E, Ferreira G, Maia Moreira R, Kirkwood R, Fetters L. Efficacy of ankle-foot orthoses on gait of children with cerebral palsy: systematic review of literature. Pediatr Phys Ther 2008; 20:207–223.
Poole M, Simkiss D, Rose A, Li F. Anterior or posterior walkers for children with cerebral palsy? A systematic review. Disabil Rehabil 2017; 13:1748–3107.
Bhise S, Bane J, Parab S, Ghodey S. Comparison between physiological cost index in healthy normal children as against ambulatory spastic diplegic cerebral palsy (with and without orthosis) in the age group 6 to 18 years. Int J Physiother 2016; 3:395–400.
Kerkum Y, Harlaar J, Buizer A, Noort J. An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion. Gait Posture 2016; 46:104–111.
Kerkum Y, Buizer A, van den Noort J, Becher J, Harlaar J, Brehm M. The effects of varying ankle foot orthosis stiffness on gait in children with spastic cerebral palsy who walk with excessive knee flexion. PLoS One 2015; 10:1–19.
Uckun A, Celik C, Ucan H, Ordu G. Comparison of effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy. Dev Neurorehabil 2014; 17:388–392.
Brehm M, Harlaar J, Schwartz M. Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy. J Rehabil Med 2008; 40:529–534.
Balaban B, Yasar E, Dal U, Yazicioglu K, Mohur H, Kalyon TA. The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy. Disabil Rehabil 2007; 29:139–144.
Smiley S, Jacobsen F, Mielke C, Johnston R, Park C, Ovaska G. A comparison of the effects of solid, articulated, and posterior leaf-spring ankle-foot orthoses and shoes alone on gait and energy expenditure in children with spastic diplegic cerebral palsy. Orthopedics 2002; 25:411–415.
Buckon C, Thomas S, Jakobson-Huston S, Sussman M, Aiona M. Comparison of three ankle foot orthosis configurations for children with spastic hemiplegia. Dev Med Child Neurol 2001; 43:371–378.
Maltais D, Bar-Or O, Galea V, Pierrynowski M. Use of orthoses lowers the O2 cost of walking in children with spastic cerebral palsy. Med Sci Sports Exerc 2001; 33:320–325.
Mossberg K, Linton K, Friske K. Ankle-foot orthoses: effect on energy expenditure of gait in spastic diplegic children. Arch Phys Med Rehabil 1990; 71:490–494.
El-Shamy S, Abdelaal A. WalkAide efficacy on gait and energy expenditure in children with hemiplegic cerebral palsy: a randomized controlled trial. Am J Phys Med Rehabil 2016; 95:629–638.
Peri E, Biffi E, Maghini C, Marzorati M. An ecological evaluation of the metabolic benefits due to robotassisted gait training. Conf Proc IEEE Eng Med Biol Soc 2015; 2015:3590–3593.
Marcucci A, Edouard P, Loustalet E, d’Anjou MC, Gautheron V, Degache F. Efficiency of flexible derotator in walking cerebral palsy children. Annals of Physical and Rehabilitation Medicine 2011; 54:337–347.
Konop K, Strifling K, Wang M, Cao K. Upper extremity kinetics and energy expenditure during walker-assisted gait in children with cerebral palsy. Acta Orthop Traumatol Turc 2009; 43:156–164.
Strifling K, Lu N, Wang M, Cao K, Ackman JD, Klein JP, et al. Comparison of upper extremity kinematics in children with spastic diplegic cerebral palsy using anterior and posterior walkers. Gait Post 2008; 28:412–419.
Toms B, Harrison B, Bower E. A pilot study to compare the use of prototypes of multipositional paediatric walking sticks and tripods with conventional sticks and tripods by children with cerebral palsy. Child Care Health Dev 2006; 33:96–105.
Park E, Park C, Kim J. Comparison of anterior and posterior walkers with respect to gait parameters and energy expenditure of children with spastic diplegic cerebral palsy. Yonsei Med J 2001; 42:180–184.
Mattsson E, Andersson C. Oxygen cost, walking speed, and perceived exertion in children with cerebral palsy when walking with anterior and posterior walkers. Dev Med Child Neurol 1997; 39:671–676.
De Morton N. The PEDro scale is a valid measure of the methodo logical quality of clinical trials: a demographic study. Aust J Physiother 2009; 55:129–133.
Foley N, Teasell R, Bhogal S, Speechley M. Stroke rehabilitation evidence-based review: methodology. Top Stroke Rehabil 2003; 10:1–7.
Straus S, Richardson W, Glasziou P, Haynes R. Evidence-based medicine: how to practice and teach EBM. 3. Toronto: Elsevier Churchill Livingstone; 2005.
Levin K. Study design III: cross-sectional studies. Evid Based Dent 2006; 7:24–25.
Grossman J, Mackenzie F. The randomized controlled trial: gold standard, or merely standard? Perspect Biol Med 2005; 48:516–534.
Logan L, Byers-Hinkley K, Ciccone C. Anterior versus posterior walkers: a gait analysis study. Dev Med Chid Neurol 1990; 32:1044–1048.
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
El-Hakiem Abd El-Nabie, W., Abd El Aziz, H. & Elshennawy, S. Effect of walking aids and foot orthoses on energy expenditure in children with cerebral palsy: a systematic review. Bull Fac Phys Ther 24, 99–112 (2019). https://doi.org/10.4103/bfpt.bfpt_3_19
- cerebral palsy
- energy expenditure
- systematic review
- walking aids