title: Beneficial effects of ankle-foot orthosis daytime use on the gait of Duchenne muscular dystrophy patients.
abstract: Orthosis use prevents muscle contracture and prolongs ambulation in patients with Duchenne muscular dystrophy (DMD). However, its biomechanical effects on gait are unclear. This study assessed the effects of daytime and night-time use of Articulated Ankle Foot Orthosis (AFO) on kinematic, kinetic and spatial/temporal gait parameters of DMD patients.
  
  
  
  Twenty ambulatory patients (4-12years of age) were assigned to one of three groups: no orthosis (NoO; n=7), night-time orthosis (NiO; n=7), day-time orthosis (DO; n=6). All subjects were evaluated once (Ev1) and five of them were re-evaluated between five and seven months after Ev1 (Ev2).
  
  
  
  Cross-sectional analysis with linear mixed-effects models (ANOVA) showed increased peak dorsiflexion angle and dorsiflexor moment and decreased plantar flexion angle and ankle joint power generation for the DOwith group when compared to the NoO group (P<0.05). The DOwith group also showed decreased peak hip flexion angle, hip power absorption, plantar flexion angle and increased peak dorsiflexion moment when compared to the NoO group (P<0.05). Analysis of gait cycle curves showed significant and clinically relevant changes in kinematic and kinetic parameters for the DOwith group when compared to the other experimental groups. Longitudinal analysis suggest that night-time use of Articulated AFO can promote positive changes in gait parameters of DMD patients, when used before the functional deficit is too advanced.
  
  
  
  Early daytime and night-time use of Articulated AFO changed gait and minimized typical compensations seen in DMD patients, thus it is recommended in order to prolong gait ability.
authors.affiliation: Ribeirao Preto Medical School, University of Sao Paulo, Bandeirantes Av., 3500, 14049-900 Ribeirao Preto, Sao Paulo, Brazil.
authors.forename: Mariana Angélica
authors.initials: MA
authors.lastname: de Souza
authors.affiliation: Ribeirao Preto Medical School, University of Sao Paulo, Bandeirantes Av., 3500, 14049-900 Ribeirao Preto, Sao Paulo, Brazil.
authors.forename: Marisa Maia Leonardi
authors.initials: MM
authors.lastname: Figueiredo
authors.affiliation: Ribeirao Preto Medical School, University of Sao Paulo, Bandeirantes Av., 3500, 14049-900 Ribeirao Preto, Sao Paulo, Brazil.
authors.forename: Cyntia Rogean de Jesus Alves
authors.initials: CR
authors.lastname: de Baptista
authors.affiliation: Rehabilitation Center of the Hospital of Clinics, Ribeirão Preto Medical School, University of Sao Paulo, Bandeirantes Av., 3500, 14048-900 Ribeirao Preto, Sao Paulo, Brazil.
authors.forename: Robson Devanir
authors.initials: RD
authors.lastname: Aldaves
authors.affiliation: Ribeirao Preto Medical School, University of Sao Paulo, Bandeirantes Av., 3500, 14049-900 Ribeirao Preto, Sao Paulo, Brazil. Electronic address: acms@fmrp.usp.br.
authors.forename: Ana Claudia
authors.initials: AC
authors.lastname: Mattiello-Sverzut
mesh_terms: D000704:Analysis of Variance; D000843:Ankle Joint / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D061826:Foot Orthoses; D005684:Gait / Q000502:physiology*; D006621:Hip Joint / Q000502:physiology; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D020388:Muscular Dystrophy, Duchenne / Q000534:rehabilitation*; D016059:Range of Motion, Articular / Q000502:physiology
keywords: Duchenne muscular dystrophy; Gait; Orthosis