Newstead A.1,2
1West Coast University, Physical Therapy, Los Angeles, United States, 2Restorative Pediatrics, San Antonio, United States
Background: There is little information reported about physical therapy management of children born prematurely with hypotonia and ataxia. One complement to physical therapy interventions is the use of orthotic devices to provide distal stability for developmental activities such as balance and locomotion.
Purpose: The purpose of this case study was to investigate balance and locomotor outcomes during barefoot walking compared with using supramalleolar (SMOs) or solid ankle foot orthotics (AFO´s) in a child with ataxia and hypotonia. The secondary purpose was to discuss the clinical decision making process for determination of orthotic devices.
Methods: BC was 40-month-old male who was born prematurely at 23 weeks gestation with developmental delay, ataxia and hypotonia. He had 19% ejection fraction and wears glasses. Gait parameters were measured using the GAIT Rite system at a self-selected walking velocity during barefoot, walking with SMOs or solid AFOs. Gross Motor Function Measure was 21% in Dimensions D and E; GMFCS Level III. The Peabody Developmental Scale was approximately at a 12-month age equivalent. BC was seen for five weeks of physical therapy twice weekly using a functional based, task specific approach with and without orthotics. BC attended 60% of his scheduled sessions.
Results: During the five weeks of treatment intervention, BC showed no change in his gross motor function or balance testing. BC had improved walking velocity (32 cm/s barefoot vs. 36 cm/s AFOs and SMOs) and step length (35 cm barefoot vs. 41 cm AFOs vs. 35 cm SMOs) during locomotion testing when walking barefooted compared with using the AFOs or SMOs.
Conclusion(s): Ankle foot orthotics provided distal stability and protection from knee hyperextension with reduction in his base of support that may decrease future musculoskeletal problems. Speed, cadence and step width using SMOs were similar to the AFOs. During barefoot and SMOs walking, support for locomotor activities at the ankle and knee were not sufficient as demonstrated by increased knee hyperextension.
Implications: The AFOs provided distal stability and protection from knee hyperextension in the case study. Consideration for the child´s balance and locomotor capabilities important to determine the appropriate type of orthotic device. BC demonstrated change primarily in his narrowed base of support with bilateral AFOs compared with SMOS. Our findings agree with previous studies where BC demonstrated increased walking velocity and increased stride using AFOs.
Funding acknowledgements: None
Topic: Human movement analysis
Ethics approval: Written consent was provided by the child´s parents and approved through the University of Montana - Missoula, USA.
All authors, affiliations and abstracts have been published as submitted.
