title: The effects of orthoses, footwear, and walking aids on the walking ability of children and adolescents with spina bifida: A systematic review using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a reference framework.
abstract: BACKGROUND
  To date no review has been published that analyzes the efficacy of assistive devices on the walking ability of ambulant children and adolescents with spina bifida and, differentiates between the effects of treatment on gait parameters, walking capacity, and walking performance.
  
  
  OBJECTIVE
  To review the literature for evidence of the efficacy of orthotic management, footwear, and walking aids on gait and walking outcomes in ambulant children and adolescents with spina bifida.
  
  
  METHODS
  Systematic literature review.
  
  
  METHODS
  A systematic literature search was performed to identify studies that evaluated the effect of any type of lower limb orthoses, orthopedic footwear, or walking aids in ambulant children (≤18 years old) with spina bifida. Outcome measures and treatment results for gait parameters, walking capacity, and walking performance were identified using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as the reference framework.
  
  
  RESULTS
  Six case-crossover studies met the criteria and were included in this systematic review. Four studies provided indications of the efficacy of the ankle-foot orthosis in improving a number of kinematic and kinetic properties of gait, stride characteristics, and the oxygen cost of walking. Two studies indicated that walking with forearm crutches may have a favorable effect on gait. The evidence level of these studies was low, and none of the studies assessed the efficacy of the intervention on walking capacity and walking performance.
  
  
  CONCLUSIONS
  Some data support the efficacy of using ankle-foot orthosis and crutches for gait and walking outcomes at the body functions and structures level of the ICF-CY. Potential benefits at the activities and participation level have not been investigated.
  
  
  CONCLUSIONS
  This is the first evidence-based systematic review of the efficacy of assistive devices for gait and walking outcomes for children with spina bifida. The ICF-CY is used as a reference framework to differentiate the effects of treatment on gait parameters, walking capacity, and walking performance.
authors.affiliation: Department of Rehabilitation Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands b.ivanyi-roelfsema@amc.uva.nl.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ivanyi
authors.affiliation: Child Development and Exercise Center, University Children's Hospital and Medical Center, Utrecht, The Netherlands.
authors.forename: Marja
authors.initials: M
authors.lastname: Schoenmakers
authors.affiliation: Dutch Association of Medical Specialists, Utrecht, The Netherlands.
authors.forename: Natasja
authors.initials: N
authors.lastname: van Veen
authors.affiliation: Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Karel
authors.initials: K
authors.lastname: Maathuis
authors.affiliation: Department of Rehabilitation Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
authors.affiliation: Roessingh Centre for Rehabilitation, Roessinghsbleekweg, Enschede, The Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Nederhand
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003446:Crutches; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification / Q000534:rehabilitation; D019317:Evidence-Based Medicine; D005260:Female; D061826:Foot Orthoses; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009426:Netherlands; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012656:Self-Help Devices; D012775:Shoes; D016135:Spinal Dysraphism / Q000175:diagnosis / Q000534:rehabilitation*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: Lower limb orthotics; gait; gait analysis; orthotics