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Beneficial effects of ankle–foot orthosis daytime use on the gait of Duchenne muscular dystrophy patients

      Highlights

      • Early and continuous use of night ankle-foot orthoses apparently minimized spatiotemporal and kinematic compensations.
      • Night ankle–foot orthoses can induce positive changes in gait when used before the advance of functional deficit.
      • Day and night ankle–foot orthoses use be prescribed early on and maintained during the course of the disease.

      Abstract

      Background

      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.

      Methods

      Twenty ambulatory patients (4–12 years 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).

      Findings

      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.

      Interpretation

      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.

      Keywords

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      References

        • Bakker J.P.
        • de Groot I.J.
        • Beckerman H.
        • de Jong B.A.
        • Lankhorst G.J.
        The effects of knee–ankle–foot orthoses in the treatment of Duchenne muscular dystrophy: review of the literature.
        Clin. Rehabil. 2000; 14 (Internet, Aug, 1, cited 2014 Jun 19, Available from: http://cre.sagepub.com/cgi/doi/10.1191/0269215500cr319oa): 343-359
        • Bushby K.
        • Finkel R.
        • Birnkrant D.J.
        • Case L.E.
        • Clemens P.R.
        • Cripe L.
        • et al.
        Diagnosis and management of Duchenne muscular dystrophy, part 2 : implementation of multidisciplinary care.
        Lancet Neurol. 2010; 9 (Internet, Elsevier Ltd, Available from: http://dx.doi.org/10.1016/S1474-4422(09)70272–8): 177-189
        • Carvalho J.A.
        Órtestes—Um Recurso Terapêutico Complememtar.
        2006
        • D'Angelo M.G.
        • Berti M.
        • Piccinini L.
        • Romei M.
        • Guglieri M.
        • Bonato S.
        • et al.
        Gait pattern in Duchenne muscular dystrophy.
        Gait Posture. 2009; 29 (Internet, Jan, cited 2014 Jun 19, Available from: http://www.ncbi.nlm.nih.gov/pubmed/18656361): 36-41
        • Doglio L.
        • Pavan E.
        • Pernigotti I.
        • Petralia P.
        • Frigo C.
        • Minetti C.
        Early signs of gait deviation in Duchenne muscular dystrophy.
        Eur. J. Phys. Rehabil. Med. 2011; 47 (Internet, Dec, cited 2014 Jun 20, Available from: http://www.ncbi.nlm.nih.gov/pubmed/21912365): 587-594
        • Eagle M.
        Report on the Muscular Dystrophy Campaign workshop: exercise in neuromuscular diseases.
        Neuromuscul. Disord. 2002; 12: 975-983
        • Fernandes N.
        • Troise D.
        • Fávero F.
        • Fontes S.
        • Oliveira A.
        A importância das órteses de membros inferiores na distrofia muscular de duchenne—revisão.
        Rev. Neurosci. 2012; 20 (Internet, Jan 21, cited 2014 Jun 19, Available from: http://www.revistaneurociencias.com.br/edicoes/2012/RN2004/revisao2004/701 revisao.pdf): 584-587
        • Garralda M.E.
        • Muntoni F.
        • Cunniff A.
        • Caneja A.D.
        Knee–ankle–foot orthosis in children with duchenne muscular dystrophy: user views and adjustment.
        Eur. J. Paediatr. Neurol. 2006; 10 (Internet, Jul, cited 2014 May 28, Available from: http://www.ncbi.nlm.nih.gov/pubmed/16931076): 186-191
        • Gaudreault N.
        • Gravel D.
        • Nadeau S.
        Evaluation of plantar flexion contracture contribution during the gait of children with Duchenne muscular dystrophy.
        J. Electromyogr. Kinesiol. 2009; 19 (Internet, Elsevier Ltd, Jun, cited 2014 Jun 19, Available from: http://www.ncbi.nlm.nih.gov/pubmed/17977021): e180-e186
        • Gaudreault N.
        • Gravel D.
        • Nadeau S.
        • Houde S.
        • Gagnon D.
        Gait patterns comparison of children with Duchenne muscular dystrophy to those of control subjects considering the effect of gait velocity.
        Gait Posture. 2010; 32 (Internet, Elsevier B.V., Jul, cited 2014 Jun 12, Available from: http://www.ncbi.nlm.nih.gov/pubmed/20599384): 342-347
      1. Hsu JD, J. Furumasu. Gait and posture changes in the Duchenne muscular dystrophy child. Clin. Orthop. Relat. Res. 1993; (288): 122–5. (Internet, Mar, cited 2014 Jun 20, Available from: http://www.ncbi.nlm.nih.gov/pubmed/8458124).

        • Humbertclaude V.
        • Hamroun D.
        • Bezzou K.
        • B??rard C.
        • Boespflug-Tanguy O.
        • Bommelaer C.
        • et al.
        Motor and respiratory heterogeneity in Duchenne patients: implication for clinical trials.
        Eur. J. Paediatr. Neurol. 2012; 16 (Internet, Mar, cited 2014 Jun 19, Available from: http://www.ncbi.nlm.nih.gov/pubmed/21920787): 149-160
        • Hyde S.A.
        • Scott O.M.
        • Goddard C.M.
        • Dubowitz V.
        Prolongation of ambulation in Duchenne muscular dystrophy by appropriate orthoses.
        Physiotherapy. 1982; 68 (Internet, Apr, cited 2014 Jun 20, Available from: http://www.ncbi.nlm.nih.gov/pubmed/7111464): 105-108
        • Iwabe C.
        • Miranda-Pfeilsticker B.
        • Nucci A.
        Medida da função motora: versão da escala para o português e estudo de confi abilidade.
        Rev. Bras. Fis. 2008; 12: 417-424
        • Kadaba M.P.
        • Ramakrishnan H.K.
        • Wootten M.E.
        Measurement of lower extremity kinematics during level walking.
        J. Orthop. Res. 1990; 8 (Internet, May, cited 2014 May 23, Available from: http://www.ncbi.nlm.nih.gov/pubmed/2324857): 383-392
        • Marques A.P.
        Manole Manual de goniometria. 2a ed. Editora Manole Ltda, Barueri—SP, Brazil2003
        • Perry J.
        Manole Análise de Marcha. Marcha patológica. vol. 2. 2005 (210 pp.)
        • Rodillo E.B.
        • Fernandez-Bermejo E.
        • Heckmatt J.Z.
        • Dubowitz V.
        Prevention of rapidly progressive scoliosis in Duchenne muscular dystrophy by prolongation of walking with orthoses.
        J. Child Neurol. 1988; 3 (Internet, Oct 1, cited 2014 Jun 19, Available from: http://jcn.sagepub.com/cgi/doi/10.1177/088307388800300407): 269-274
        • Scott O.M.
        • Hyde S.A.
        • Goddard C.
        • Dubowitz V.
        Prevention of deformity in Duchenne muscular dystrophy. A prospective study of passive stretching and splintage.
        Physiotherapy. 1981; 67 (Internet, Jun, cited 2014 Jun 20, Available from: http://www.ncbi.nlm.nih.gov/pubmed/7301976): 177-180
        • Siegel I.M.
        Kinematics of gait in Duchenne muscular dystrophy: implications for orthotic management.
        Neurorehabil. Neural Repair. 1997; 11 (Internet, Jan 1, cited 2014 Jun 20, Available from: http://nnr.sagepub.com/content/11/3/169.abstract): 169-173
        • Siegel I.M.
        • Glantz R.H.
        Orthopedic rehabilitation for standing and walking in selected neuromuscular diseases..
        Neurorehabil. Neural Repair. 1988; 2: 131-136
        • Spencer G.E.
        • Vignos P.J.
        Bracing for ambulation in childhood progressive muscular dystrophy.
        J. Bone Joint Surg. Am. 1962; 44-A (Internet, Mar, cited 2014 Jun 20, Available from: http://www.ncbi.nlm.nih.gov/pubmed/14039442): 234-242
        • Stevens P.M.
        Lower Limb Orthotic Management of Duchenne Muscular Dystrophy: A Literature Review.
        J Prosthet Orthot. 2006; 18: 111-119
        • Thomas S.S.
        • Buckon C.E.
        • Nicorici A.
        • Bagley A.
        • McDonald C.M.
        • Sussman M.D.
        Classification of the gait patterns of boys with Duchenne muscular dystrophy and their relationship to function.
        J. Child Neurol. 2010; 25 (Internet, Sep, cited 2014 Jun 19, Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3794706&tool=pmcentrez&rendertype=abstract): 1103-1109
        • Townsend E.L.
        • Tamhane H.
        • Gross K.D.
        Effects of AFO use on walking in boys with Duchenne muscular dystrophy: a pilot study.
        Pediatr. Phys. Ther. 2015; 27: 24-29
        • Vignos P.J.
        • Wagner M.B.
        • Kaplan J.S.
        • Spencer G.E.
        Predicting the success of reambulation in patients with Duchenne muscular dystrophy.
        J. Bone Joint Surg. Am. 1983; 65 (Internet, Jul, cited 2014 Jun 20, Available from: http://www.ncbi.nlm.nih.gov/pubmed/6863354): 719-728
        • Vuillerot C.
        • Girardot F.
        • Payan C.
        • Fermanian J.
        • Iwaz J.
        • De lattre C.
        • et al.
        Monitoring changes and predicting loss of ambulation in Duchenne muscular dystrophy with the Motor Function Measure.
        Dev. Med. Child Neurol. 2010; 52 (Jan, Internet, cited 2014 Jun 19, Available from: http://www.ncbi.nlm.nih.gov/pubmed/19453691): 60-65
        • Williams E.A.
        • Read L.
        • Ellis A.
        • Morris P.
        • Galasko C.S.
        The management of equinus deformity in Duchenne muscular dystrophy.
        J. Bone Joint Surg. (Br.). 1984; 66 (Internet, Aug, cited 2014 Jun 20, Available from: http://www.ncbi.nlm.nih.gov/pubmed/6746690): 546-550