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Introduction: The article presents the case of a five-year-old child with cerebral palsy. Due to a walking pattern with toe walking and knee hyperextension (type 3 according to the Amsterdam classification) the child needed an ankle foot orthosis (AFO). We wanted to check how the pattern of walking with AFO with a dual pneumatic discs spring joint for dorsal and plantar flexion control (ddsAFO) differs from walking with the dynamic AFO (dAFO) with mobile elastomere joint in ankle and limited plantar flexion. Methods: We fitted the child with both AFO models and performed clinical gait evaluation, walking tests at 10 m and 6 minutes, and a computerised gait analysis using the same shoes. During the following six months the child used only the ddsAFO, then all tests and analyses were repeated with both models of AFO. We did not change any characteristics of AFO after the initial fitting. Results: The gait with ddsOGS was slightly faster and more fluid at the initial assessment. The computer analysis showed slightly better kinematic characteristics of the gait, although differences in walking distance and speed were small. After six months the gait pattern with ddsOGS was more symmetrical, with better alignment of the feet in the transverse and longitudinal plane, but with knee hyperextension still present. Conclusions: Clinical gait analysis showed that the use of ddsAFO is slightly more favourable compared to dAFO in terms of symmetry of gait pattern. For more reliable recommendations for ddsAFO use, a further study should be carried out on a larger sample of children with cerebral palsy, with more precise application and adjustment protocol, additional comparison to bare feet gait pattern and extended observation period for possible long-term effects. Uvod: V prispevku predstavljamo primer petletnega otroka s cerebralno paralizo, ki smo ga zaradi vzorca hoje z dostopom na sprednji del stopala in hiperekstenzijo v kolenu v fazi opore (tip 3 po Amsterdamski klasifikaciji) opremili z ortozo za gleženj in stopalo (OGS). Preveriti smo želeli, kako se vzorec hoje z OGS s sklepom z dvojno diskasto tlačno vzmetjo za nadzor navora in obsega giba dorzalne in plantarne fleksije (ddvOGS) razlikuje od hoje z dinamično OGS z gibljivim elastomernim sklepom v gležnju in omejeno plantarno fleksijo. Metode: Otroka smo opremili z obema modeloma OGS in opravili klinično analizo hoje, teste hoje na 10 m in 6 minut ter računalniško analizo hoje. Otrok je pri analizi hoje z obema OGS uporabljal isto obutev. Po začetni analizi je naslednjih šest mesecev uporabljal le ddvOGS. Nato smo ponovili vse teste in analize hoje z obema OGS. Nastavitev ddvOGS po začetni nastavitvi nismo več spreminjali. Rezultati: Hoja z ddvOGS v primerjavi z dOGS je bila ob začetni oceni nekoliko hitrejša in bolj tekoča. Računalniška analiza hoje z ddvOGS je pokazala nekoliko boljše kinematične značilnosti hoje, čeprav so razlike glede na hojo z dOGS majhne. Šest mesecev po začetku uporabe je bila hoja z ddvOGS bolj simetrična, z boljšo obremenitvijo stopala v prečni in vzdolžni ravnini, blaga hiperekstenzija v kolenu pa je še ostala. Zaključki: Rezultati klinične analize hoje so pokazali, da uporaba ddvOGS v primerjavi z dOGS nekoliko bolj ugodno vpliva na vzorec hoje. Za bolj trdna priporočila uporabe ddvOGS bi bilo potrebno opraviti študijo na večjem vzorcu otrok s CP, natančneje opisati protokol namestitve in morebitnih prilagoditev OGS ter ob tem analizirati tudi vzorec hoje brez ortoze in eventualno podaljšati obdobje opazovanja.

Background: Because we did not find any study on influence of posterior leaf spring (PLS) ankle-foot orthosis (AFO) on cognitive demand during walking in the existing literature, we decided to study it. Methods: We included all patients with drop foot due to peripheral ankle dorsiflexor paresis visiting our outpatient clinic for orthotic management who had functional PLS AFO, appropriate shoes and no other impairments, and were willing to participate. All of them performed the 10-meter walking test with and without AFO in random order first without and then while performing a cognitive task (subtracting three form 100 during walking). Results: On average, the participants (8 men and 2 women) walked faster with the orthosis than without it (p

Background: The review of available literature shows no conclusive evidence of impact of the ankle-foot orthosis on balance. The purpose of the study was to determine the immediate impact of two different types of ankle-foot orthoses on the dynamic balance in persons with disabilities. Methods: 24 subjects who have visited the outpatient clinic for prosthetics due to the difficulties in walking were included in the study. Those expressing the will to participate were provided with an ankle-foot orthosis (either the first orthosis or a replacement). Using the Postural Response Assessment Device that artificially generates balance disorder, or perturbations,the participants dynamic balance was assessed with and without orthoses and compared with normative responses obtained from a healthy unaffected population. Results: All the participants demonstrated problems with maintaining balance. The serial ankle-foot orthosis made of polypropylene acted as a rear flexible spring and enabled a postural response more compliant with the norm after the forward and forward-lateral and backward and backward lateral perturbation in both the anterior-posterior and the mediolateral direction. The orthosis also had a minimum impact on the delay of the response. Custom-made orthosis from polypropylene enabled postural response with amplitudes within the norm, especially during perturbations on the affected side. Conclusion: Partial results indicate that the ankle-foot orthosis acting as a flexible rear spring can improve balance capabilities of the participants (immediately after or several years after the occurrence of the disorder), who tend to have difficulties with maintaining balance. The custom-made ankle-foot orthoses also demonstrated a positive impact on balance capabilities. Izhodišča: V literaturi ni trdnih dokazov o vplivu ortoz za gleženj in stopalo na ravnotežje. Namen študije je bil ugotoviti takojšen vpliv dveh različnih tipov ortoz za gleženj in stopalo na dinamično ravnotežje pri osebah z različnimi okvarami. Metode: Vključili smo 24 oseb, ki so obiskale ambulanto za ortotiko zaradi težav pri hoji in smo jih oskrbeli z ortozo za gleženj in stopalo (prvič ali ponovno) ter so bile pripravljene sodelovati. Z napravo Postural Response Assessment Device, ki umetno generira motnje ravnotežja ali perturbacije, smo izmerili njihovo dinamično ravnotežje z ortozo in brez nje ter ga primerjali z normativnimi odzivi pri zdravi, neprizadeti populaciji. Rezultati: Vse vključene osebe so imele težave z ravnotežjem. Serijska ortoza za gleženj in stopalo iz polipropilena, ki deluje kot zadnja prožna vzmet, je omogočala bolj normalno amplitudo odziva na perturbacijo naprej ter naprej in na stran okvare ter nazaj in nazaj na stran okvare tako v anteriornoposteriorni kot v mediolateralni smeri. Ortoza tudi minimalno vpliva na zakasnitev odziva. Individualno narejena ortoza iz polipropilena je omogočala amplitudo odziva znotraj normativa, predvsem pri perturbacijah na stran okvare. Zaključki: Delni rezultati nakazujejo, da ortoze za gleženj in stopalo, ki delujejo kot zadnja prožna vzmet, izboljšajo ravnotežje pri vseh vključenih osebah (takoj po nastanku okvare in tudi več let pozneje), ki imajo splošne težave z vzdrževanjem ravnotežja. Kaže se tudi pozitiven učinek individualno narejenih ortoz za gleženj in stopalo na ravnotežje.

Introduction: Displacement or dislocation of the hip is a common complication in children with cerebral palsy, particularly in children who are classified as level IV or V of the Gross Motor Function Classification System (GMFCS). We found little evidence of the potential effectiveness of Sitting, Walking and Standing Hip (SWASH) orthosis in the literature. We therefore wanted to check how many children were prescribed with a SWASH orthosis in the period from 2007 to 2012 at our Institute, what their GMFCS level was and whether they had hips position evaluated by X-ray. We also wanted to check whether any of the children had to be operated because of hip dislocation after being fitted with a SWASH orthosis. Methods: A retrospective analysis of patient records was performed for all children with prescribed SWASH orthosis in the period from 2007 to 2012, including data on their GMFCS level, results of hip X-ray and data on surgeries required because of hip dislocation. Results: SWASH orthosis was prescribed to 30 children, 26 with cerebral palsy. Of these, 19 children were classified as GMFCS level V and 10 children as level IV. Only 10 children had been examined by X-ray. Of these, one half had a good position of the hips or partial dislocation whereas the other half had already been operated because o fhip dislocation. In only one of the children surgery was required subsequently. After fitting the SWASH orthosis, physiotherapists reported a better sitting position in 11children; other four children had more appropriate alignment of lower extremities when sitting. Izhodišča: Delni ali popolni izpah kolka je pogost zaplet pri otrocih s cerebralno paralizo. Predvsem je pogost pri tistih otrocih, ki spadajo v četrto in peto stopnjo lestvice za razvrščanje glede na grobe gibalne sposobnosti (GMFCS). V literaturi smo našli le malo podatkov o morebitni učinkovitosti ortoze za kolk z medenično košaro (SWASH), zato smo želeli preveriti, koliko otrokom smo od leta 2007 do 2012 sploh predpisali ortozo, kakšne so bile njihove sposobnosti gibanja in ali so imeli opravljeno rentgensko slikanje kolkov. Želeli smo tudi preveriti, ali se je pri katerem izmed otrok, ki smo mu predpisali ortozo, zgodilo, da je bila potrebna operativna korekcija zaradi zelo slabega položaja glave stegnenice v kolku ali pa celo izpaha kolka. Metode: Retrospektivno smo iz dokumentacije zbrali podatke o vseh predpisanih ortozah za kolk z medenično košaro od leta 2007 do 2012, o sposobnostih gibanja in rezultatih rentgenskega slikanja medenice s kolki ter podatke o morebitnih operativnih posegih zaradi izpaha kolka. Rezultati: Od leta 2007 do 2012 je ortozo dobilo 30 otrok, od tega 26 s cerebralno paralizo. Od teh jih je 19 spadalo v V. stopnjo GMFCS, 10 otrok pa v IV. stopnjo. Le 10 otrok je po podatkih iz dokumentacije opravilo rentgensko slikanje medenice s kolki. Izmed teh jih je polovica imela dober položaj kolkov ali pa delni izpah, druga polovica pa je bila zaradi izpaha kolka že pred opremo z ortozo operirana. Le pri enem izmed otrok je bil zaradi slabega položaja glave stegnenice v kolčnem sklepu pozneje potreben operativni poseg. Po namestitvi ortoze SWASH je bilo v dokumentaciji pri 11 otrocih zapisano, da so zmogli bolje sedeti, pri štirih je bilo zapisano, da so imeli spodnje ude pri sedenju primerneje poravnane.Zaključek: Vloga ortoze SWASH pri zadrževanju slabšanja položaja kolkov ali pa celo izboljšanja položaja ostaja nejasna.

Background: Ankle-foot orthosis (AFO) is the most commonly prescribed kind of lower limb orthoses. Such orthoses are used for various lower limb impairments. Some patients are not satisfied with a thermoplastic AFO as it is difficult to fit into normal shoes. Custom-made carbon-fibre orthosis may relieve or diminish this problem. Methods: Three types of orthoses were made for the patient, who used AFO for a long time: 1) prefabricated, 2) custom-made thermoplastic (polypropylene) and 3) custom-made carbon-fibre orthosis. The process of fabrication of orthoses was compared in detail. Post Stroke Ankle-Foot Orthosis Fitting/Review Tool was filled in for all three orthoses. Orthoses were weighted on a high-precision scale. Foot pressures during walking were measured with the F-scan system with all three orthoses. Results: Prefabricated AFO entails the simplest, and carbonfibre AFO the most demanding fabrication process. Prefabricated AFO is the lightest, and carbon-fibre orthosis is the heaviest. Foot drop was prevented with all three types of AFO. Varus heel position was best corrected with the polypropylene AFO, and worst with the prefabricated AFO. The prefabricated AFO was assessed as the most, and the polypropylene AFO as the least comfortable. The most adequate plantar pressure redistribution was achieved with the carbon-fibre AFO. Conclusion: The advantages of a custom-made carbon-fibre ankle-foot orthosis over a prefabricated or a polypropylene custommade one were not confirmed in our case. Izhodišča: Ortoze za gleženj in stopalo so najpogosteje predpisane ortoze za spodnje ude. Uporabljamo jih pri osebah z različnimi okvarami in poškodbami spodnjih udov. Nekateri pacienti niso zadovoljni z ortozo za gleženj in stopalo, izdelano iz termoplastičnih materialov, predvsem zaradi težav z nameščanjem v običajno obutev. Predvidevali smo, da bi z ortozo iz ogljikovih vlaken, izdelano individualno, te težave odpravili oziroma zmanjšali. Metode: Osebi, ki že dalj časa uporablja ortozo za gleženj in stopalo, smo izdelali tri nove: serijsko, individualno izdelano iz visoko temperaturnega termoplastičnega materiala (polipropilen) in individualno izdelano iz ogljikovih vlaken. Primerjali smo postopke izdelave vseh treh ortoz, njihovo težo in funkcionalnost. Slednjo smo ocenili z vprašalnikom o kakovosti ortoze ob prevzemu in z meritvami stopalnih pritiskov med hojo. Rezultati: Najbolj preprosta za izdelavo je serijska, najzahtevnejša pa ortoza iz ogljikovih vlaken. Najlažja je serijsko izdelana ortoza, malo težja individualno narejena iz polipropilena (PP), najtežja pa je ortoza iz ogljikovih vlaken. Z vsemi tremi ortozami smo preprečili padanje stopala. Z ortozo iz polipropilena smo najbolj popravili varusni položaj petnice, s serijsko pa najmanj. Pacient je ocenil, da je najbolj udobna serijska ortoza, najmanj pa individualno izdelana iz PP. Najustreznejšo razporeditev stopalnih pritiskov med hojo smo dosegli z ortozo iz ogljikovih vlaken. Zaključek: V našem primeru nismo potrdili prednosti ortoze iz ogljikovih vlaken v primerjavi s preostalima testiranima ortozama.