1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-06
THE EFFECT OF SHOES ON GAIT IN CHILDREN WITH CEREBRAL PALSY
Janneke de Groot. 1 , Van Rooijen D. 1 , Harlaar J., PhD 1,2 , Shortland A.P., PhD 3 .
1 Faculty of Human Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
2 VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam, the
Netherlands
3 One Small Step Gait Laboratory, Guy’s Hospital, London, England
Summary/conclusions
The effect of shoes on gait was evaluated for a group of children with spastic cerebral palsy
(SCP) by comparing shod and barefoot walking. Walking with shoes significantly increased
the stride length of children with CP, but did not significantly alter walking speed. Amongst
the selected gait variables, shoes had a minor but significant effect on maximum hip extension
and hip range of motion. Shoes had similar effects on gait to those reported in the literature for
ankle foot orthoses (AFOs). Our results suggest that the effect of shoes on an individual
patient’s gait should be considered before AFOs are prescribed as a gait improvement measure.
Introduction
Children with CP demonstrate abnormal movement patterns secondary to a cerebral lesion
acquired in their early development. Clinical gait analysis can be used to quantify
abnormalities of the gait pattern. Although children in Western society normally wear shoes,
common data collection in the laboratory is performed with the subjects walking barefoot. Any
influence of shoes on their gait pattern is neglected in the analysis. Effects of AFOs have been
reported on speed, stride length and cadence, whereas only minor changes have been shown on
the kinematics [1-5]. But since AFOs can only be used in combination with shoes, the shoes
may have contributed to the reported changes. The objective of this study was to assess the
effect of shoes on spatio-temporal parameters, kinematics and muscle activity in children with
cerebral palsy.
Statement of clinical significance
Shoes, worn without AFOs, contribute to an improved gait pattern in children with CP. Since
the size of improvement is similar to those reported for AFOs, our results suggest that the role
of AFOs as a gait improvement measure should be reconsidered.
Methods
Thirteen children with SCP (9 diplegia, 3 hemiplegia and 1 quadriplegia), aged between 7 and
16 years (mean 11.6 years) were recruited for this study. Walking was assessed in barefoot and
in shoes in a randomised order using a 7-camera 3D motion analysis system. Surface EMG was
recorded from m. rectus femoris, medial hamstrings, m. gastrocnemius medialis and m. tibialis
anterior using surface EMG electrodes. In the trials with shoes, children wore their own
(unmodified) shoes. N shod trials and N barefoot trials were selected for analysis. Cadence,
speed stride length and step length were calculated from each trial, as well as maximum and
minimum flexion angles of the knee and hip. The coactivation index between antagonist
muscles was calculated according to Winter [6]. We used paired t-tests to ascertain if there
were differences between the shod and barefoot groups (NS p>0.05).
Results
Significant increases in stride length (p=0.0004) and step length (p