title: A randomized controlled trial studying efficacy and tolerance of a knee-ankle-foot orthosis used to prevent equinus in children with spastic cerebral palsy.
abstract: OBJECTIVE
  To examine whether using a knee-ankle-foot orthosis helps maintain ankle-foot dorsiflexion range of motion over time.
  
  
  METHODS
  A multicentre randomized controlled trial.
  
  
  METHODS
  Two hospitals and one rehabilitation centre in the Netherlands and the USA.
  
  
  METHODS
  Children (4-16 years old) with spastic cerebral palsy who were able to walk.
  
  
  METHODS
  Use of a knee-ankle-foot orthosis, equipped with an Ultraflex ankle power unit, for at least 6 hours every other night for one year.
  
  
  METHODS
  
  
  
  METHODS
  ankle-foot dorsiflexion range of motion.
  
  
  METHODS
  ankle-foot and knee angle in gait and gross motor function. Wearing time was also measured. Measurements were taken at baseline and at 3, 6, 9 and 12 months.
  
  
  RESULTS
  28 children (experimental group: n=15, control group: n=13) participated in the study. 11 participants (experimental: n=4, control: n=7) did not complete all five measurements, as they needed additional treatment. No significant difference was found in the decrease of ankle-foot dorsiflexion range of motion between the experimental and control groups (difference: -1.05°, 95% confidence interval: -4.71° - 2.61°). In addition, secondary outcome measures did not show differences between groups. Despite good motivation, knee-ankle-foot orthosis wearing time was limited to a mean±SD of 3.2±1.9 hours per prescribed night due to discomfort.
  
  
  CONCLUSIONS
  Knee-ankle-foot orthosis with dynamic ankle and fixed knee are poorly tolerated and are not beneficial in preventing a reduction in ankle-foot dorsiflexion range of motion in children with spastic cerebral palsy, at least with limited use.
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam and the EMGO+ Institute for Health and Care Research, VU University Medical Center, the Netherlands.
authors.forename: Jc
authors.initials: J
authors.lastname: Maas
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam and the EMGO+ Institute for Health and Care Research, VU University Medical Center, the Netherlands.
authors.forename: Aj
authors.initials: A
authors.lastname: Dallmeijer
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, the Netherlands.
authors.forename: Pa
authors.initials: P
authors.lastname: Huijing
authors.affiliation: Departments of Neurology and Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA.
authors.forename: Je
authors.initials: J
authors.lastname: Brunstrom-Hernandez
authors.affiliation: Medical Rehabilitation Center Groot Klimmendaal, the Netherlands.
authors.forename: Pj
authors.initials: P
authors.lastname: van Kampen
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam and the EMGO+ Institute for Health and Care Research, VU University Medical Center, the Netherlands.
authors.forename: Eam
authors.initials: E
authors.lastname: Bolster
authors.affiliation: Departments of Neurology and Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA.
authors.forename: C
authors.initials: C
authors.lastname: Dunn
authors.affiliation: Departments of Neurology and Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA.
authors.forename: K
authors.initials: K
authors.lastname: Herndon
authors.affiliation: MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, the Netherlands.
authors.forename: Rt
authors.initials: R
authors.lastname: Jaspers
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam and the EMGO+ Institute for Health and Care Research, VU University Medical Center, the Netherlands jg.becher@vumc.nl.
authors.forename: Jg
authors.initials: J
authors.lastname: Becher
mesh_terms: D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation*; D002648:Child; D004863:Equinus Deformity / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D035002:Lower Extremity / Q000502:physiology / Q000503:physiopathology*; D008297:Male; D055361:Multilevel Analysis; D009426:Netherlands; D009989:Orthotic Devices / Q000009:adverse effects / Q000706:statistics & numerical data*; D016059:Range of Motion, Articular / Q000502:physiology*; D013997:Time Factors; D014481:United States / Q000208:ethnology
keywords: Orthotic devices; ankle; cerebral palsy; contracture; equinus deformity; foot; gait; knee; randomized controlled trial; range of motion