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Walking, orthoses and physical effort in a Swedish population with arthrogryposis.

Eriksson M, Villard L, Bartonek A - J Child Orthop (2014)

Bottom Line: The net non-dimensional oxygen cost (NNcost) was lower in TD (0.308) than in AMC2 (0.455, n = 10) (p = 0.002).In the 6MWT, both AMC2 (402.7, n = 11) and AMC3 (476.8, n = 10) walked shorter distances (m) than TD (565.1) (p < 0.001 and p = 0.043, respectively).Children with AMC using open KAFOs or AFOs (AMC2) had higher energy effort represented by significantly higher NNcost than TD, whereas AMC children requiring only shoes (AMC3) did not differ significantly from TD.

View Article: PubMed Central - PubMed

Affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, marie.eriksson@ki.se.

ABSTRACT

Purpose: Excessive movements during walking have been observed by gait analysis in children with arthrogryposis (AMC) using orthoses compared to children using only shoes. The aim of this study was to evaluate energy expenditure and functional exercise capacity in children with AMC.

Methods: Twenty-four children with AMC and 25 typically developing (TD) children underwent oxygen measurement and the 6-minute walk test (6MWT). Children were divided into AMC1 using knee-ankle-foot orthoses with locked knee joints (KAFO-LK); AMC2 KAFOs with open knee joints (KAFO-O) or ankle-foot orthoses (AFO); and AMC3 using shoes.

Results: The net non-dimensional oxygen cost (NNcost) was lower in TD (0.308) than in AMC2 (0.455, n = 10) (p = 0.002). There were no differences in the net non-dimensional consumption (NNconsumption) or normalised walking velocity. The lowest NNconsumption (0.082), NNcost (0.385) and normalised walking velocity (0.214) were found in AMC1 (n = 3), but no statistical calculation was performed. In the 6MWT, both AMC2 (402.7, n = 11) and AMC3 (476.8, n = 10) walked shorter distances (m) than TD (565.1) (p < 0.001 and p = 0.043, respectively). AMC2 (0.435) had lower normalised walking velocity than TD (0.564) (p < 0.001).

Conclusions: Children with AMC using open KAFOs or AFOs (AMC2) had higher energy effort represented by significantly higher NNcost than TD, whereas AMC children requiring only shoes (AMC3) did not differ significantly from TD. To maintain the NNconsumption at an acceptable level, children using locked KAFOs (AMC1) slowed down their walking velocity. Compared to TD, the exercise capacity was lower in children with AMC using open KAFOs or AFOs and shoes, represented by lower walking velocity and shorter distance walked during the 6MWT.

No MeSH data available.


Related in: MedlinePlus

Ankle–foot orthosis with carbon fibre spring ankle joint (AFO-C)
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Related In: Results  -  Collection


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Fig3: Ankle–foot orthosis with carbon fibre spring ankle joint (AFO-C)

Mentions: The children were divided into three groups based on orthosis use, as has been described in a previous study [11]: AMC1 (n = 3) wore KAFOs with locked knee joints (KAFO-LK); in AMC2 (n = 11), 3/11 children wore KAFOs with open knee joints (with an extension stop) (KAFO-O), 7/11 wore AFOs of different types and 1/11 wore KAFO-LK with compensation for limb length discrepancy and a foot orthosis (FO); and AMC3 (n = 10) used shoes. The distributions of gender, age, height and weight are shown in Table 1. Prescriptions of orthoses were based on the presence of muscle weakness, joint contractures and deformities according to the orthotic programme of Karolinska University Hospital. In AMC1, the locked knee joints were prescribed due to knee extensor weakness. In this group, two children used carbon fibre springs (Fig. 1). In AMC2, KAFO-Os with free flexion were prescribed in one child with hyperextension and in two children to control foot and thigh alignment, all of them with carbon fibre springs (Fig. 2). AFOs with carbon fibre springs (Fig. 3) were prescribed in two children with plantarflexor weakness. Five children had various AFO types (two solid, two hinged and one flexible carbon fibre) to stabilise the foot and ankle joint based on material criteria due to weight and acceptance of orthoses (Table 2). All children used their orthoses for 8 h or more daily.Table 1


Walking, orthoses and physical effort in a Swedish population with arthrogryposis.

Eriksson M, Villard L, Bartonek A - J Child Orthop (2014)

Ankle–foot orthosis with carbon fibre spring ankle joint (AFO-C)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4128944&req=5

Fig3: Ankle–foot orthosis with carbon fibre spring ankle joint (AFO-C)
Mentions: The children were divided into three groups based on orthosis use, as has been described in a previous study [11]: AMC1 (n = 3) wore KAFOs with locked knee joints (KAFO-LK); in AMC2 (n = 11), 3/11 children wore KAFOs with open knee joints (with an extension stop) (KAFO-O), 7/11 wore AFOs of different types and 1/11 wore KAFO-LK with compensation for limb length discrepancy and a foot orthosis (FO); and AMC3 (n = 10) used shoes. The distributions of gender, age, height and weight are shown in Table 1. Prescriptions of orthoses were based on the presence of muscle weakness, joint contractures and deformities according to the orthotic programme of Karolinska University Hospital. In AMC1, the locked knee joints were prescribed due to knee extensor weakness. In this group, two children used carbon fibre springs (Fig. 1). In AMC2, KAFO-Os with free flexion were prescribed in one child with hyperextension and in two children to control foot and thigh alignment, all of them with carbon fibre springs (Fig. 2). AFOs with carbon fibre springs (Fig. 3) were prescribed in two children with plantarflexor weakness. Five children had various AFO types (two solid, two hinged and one flexible carbon fibre) to stabilise the foot and ankle joint based on material criteria due to weight and acceptance of orthoses (Table 2). All children used their orthoses for 8 h or more daily.Table 1

Bottom Line: The net non-dimensional oxygen cost (NNcost) was lower in TD (0.308) than in AMC2 (0.455, n = 10) (p = 0.002).In the 6MWT, both AMC2 (402.7, n = 11) and AMC3 (476.8, n = 10) walked shorter distances (m) than TD (565.1) (p < 0.001 and p = 0.043, respectively).Children with AMC using open KAFOs or AFOs (AMC2) had higher energy effort represented by significantly higher NNcost than TD, whereas AMC children requiring only shoes (AMC3) did not differ significantly from TD.

View Article: PubMed Central - PubMed

Affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, marie.eriksson@ki.se.

ABSTRACT

Purpose: Excessive movements during walking have been observed by gait analysis in children with arthrogryposis (AMC) using orthoses compared to children using only shoes. The aim of this study was to evaluate energy expenditure and functional exercise capacity in children with AMC.

Methods: Twenty-four children with AMC and 25 typically developing (TD) children underwent oxygen measurement and the 6-minute walk test (6MWT). Children were divided into AMC1 using knee-ankle-foot orthoses with locked knee joints (KAFO-LK); AMC2 KAFOs with open knee joints (KAFO-O) or ankle-foot orthoses (AFO); and AMC3 using shoes.

Results: The net non-dimensional oxygen cost (NNcost) was lower in TD (0.308) than in AMC2 (0.455, n = 10) (p = 0.002). There were no differences in the net non-dimensional consumption (NNconsumption) or normalised walking velocity. The lowest NNconsumption (0.082), NNcost (0.385) and normalised walking velocity (0.214) were found in AMC1 (n = 3), but no statistical calculation was performed. In the 6MWT, both AMC2 (402.7, n = 11) and AMC3 (476.8, n = 10) walked shorter distances (m) than TD (565.1) (p < 0.001 and p = 0.043, respectively). AMC2 (0.435) had lower normalised walking velocity than TD (0.564) (p < 0.001).

Conclusions: Children with AMC using open KAFOs or AFOs (AMC2) had higher energy effort represented by significantly higher NNcost than TD, whereas AMC children requiring only shoes (AMC3) did not differ significantly from TD. To maintain the NNconsumption at an acceptable level, children using locked KAFOs (AMC1) slowed down their walking velocity. Compared to TD, the exercise capacity was lower in children with AMC using open KAFOs or AFOs and shoes, represented by lower walking velocity and shorter distance walked during the 6MWT.

No MeSH data available.


Related in: MedlinePlus