Comparing gait biomechanics and function in children with bilateral spastic cerebral palsy when wearing OSKAR AFO-footwear combination versus standard AFO-footwear combination: An exploratory study

A majority of ambulatory children with cerebral palsy (CP) wear ankle foot orthoses (AFOs) when walking. Current literature recommends a segmental approach to orthotic prescriptions that optimizes foot, ankle, and lower leg alignment to achieve optimal kinetics and kinematics during stance and gait. However, there is little evidence to support this approach. The purpose of this exploratory study was to compare gait biomechanics and function in children with spastic CP when wearing ankle foot orthoses-footwear combinations (AFOFCs) fabricated using the Optimal Segment Kinematic and Alignment Approach to Rehabilitation, or OSKAR, versus standard AFOFCs. Ten participants, ages 7 to 13 years, from local pediatric clinics in a large suburban area participated in the study. Each participant wore both types of orthoses in a randomized order and biomechanical data was collected with three-dimensional gait analysis. Function was assessed for each condition using the Pediatric Balance Scale (PBS), Standardized Walking Obstacle Course (SWOC), and the Six-Minute Walk Test (6MWT). Satisfaction with the different orthoses was evaluated with the Orthotic and Prosthetic User Survey (OPUS). Peak knee extension improved in eight of ten participants; however, values were not significantly different between the two orthotic conditions. Participants with a hyperextended gait pattern exhibited peak knee extension values closer to typical in the OSKAR condition compared to participants with crouch gait. Pediatric Balance Scale scores were significantly higher when wearing the OSKAR AFOFCs but all other functional scores (SWOC, 6MWT) were comparable between conditions. Although not statistically significant, mean participant satisfaction scores on the OPUS were slightly higher in the OSKAR condition. Generalizations of study results are limited due to the small sample size and future studies with more participants are needed to evaluate the effectiveness of OSKAR AFOFCs. When examining gait variables, grouping participants based on gait pattern could provide more useful information. Findings from this exploratory study suggest that functional balance may be improved when wearing AFOFCs designed using the OSKAR method.