Skirmont Elena Ivanovna, senior researcher, Department of orthopedic shoes and special clothing for the disabled of the Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Center of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; е-mail: firstname.lastname@example.org; https://orcid.org/ 0000-0002-7924-2445.
Golubeva Yulia Borisovna, Head of the Department of orthopedic shoes and special clothing for the disabled of the Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Center of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; е-mail: email@example.com.
Zimina Elena L’vovna, senior researcher, Department of orthopedic shoes and special clothing for the disabled of the Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Center of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; е-mail: firstname.lastname@example.org; https://orcid.org/0000-0003-3121-6237.
Lade Aleksandra Sergeyevna, junior researcher, Department of orthopedic shoes and special clothing for the disabled of the Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Center of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; е-mail: email@example.com.
Pitkin Mark Rafailovich, Dr. Tech. Sci., Prof., Tufts University, Boston, MA 02111, USA. Phone 617-636-7000, e-mail: firstname.lastname@example.org.
In the heading: Rewiews
Year: 2023 Volume: 5 Journal number: 2
Article type: scientific and practical
Introduction. Cerebral palsy (CP) is the leading cause of childhood disability, representing a non-progressive encephalopathy before, during, or after childbirth. The most common consequence is spastic diplegia leading to frequent walking problems. The need for early rehabilitation treatment stems from the characteristics of the child’s brain — its plasticity and universal ability to compensate for impaired functions. A special role belongs to the early correction of the pathology of the child’s functional system of antigravity by methods of orthopedic rehabilitation. Without the correct design and prescription of orthopedic shoes and other orthopedic products, the opportunity to timely develop a more normal gait to reduce compensatory movements and spasticity, which in turn would increase the effectiveness of other types of treatment, can be missed.
Aim. To identify the design features of orthoses and orthopedic shoes in accordance with the medical and technical requirements for technical means of rehabilitation, which are prescribed for children and adolescents with spastic forms of cerebral palsy.
Materials and methods. In this paper, we consider the role of the design of orthoses and orthopedic shoes in the normalization of the basic characteristics of balance and walking in children with cerebral palsy. Particular attention is drawn to the possibility of fitting the device to such an extent and with such frequency that it would meet medical requirements as the child grows, and takes into account the results of various types of treatment. Data are given on the evaluation of the effectiveness of supplying orthopedic equipment with orthoses and shoes.
Results. The results of a comparative analysis of the biomechanical characteristics of the range of orthopedic products for cerebral palsy, as well as an expert assessment of orthoses and orthopedic shoes, confirmed the timeliness of studying the principles of prescribing and manufacturing orthoses and orthopedic shoes for this pathology.
Discussion. The study of the assortment of products prescribed for this pathology and presented on the market of orthopedic services is carried out on the basis of the classification of various forms of cerebral palsy, reflecting visible pathological abnormalities in the lower extremities. When developing and creating prosthetic and orthopedic products, it is necessary to take into account the type and severity of deformities that occur with this pathology. The algorithm for prescribing orthopedic shoes depends on the severity of anatomical and functional disorders of the lower limb. Innovative technologies make it possible to supplement the mentioned traditional methods of orthopedic support with fundamentally new approaches.
Conclusion. It is shown that technical means of rehabilitation prescribed for children with spastic forms of cerebral palsy must be manufactured in strict accordance with the medical and technical requirements and parameters specified in the regulatory and technological documentation. To do this, the design of the products must provide the possibility of their repeated adjustment following changes in the biomechanical status of the child in the course of biological growth and the therapy used.
1. Semyonova КА. Vosstanovitel’noye lecheniye bol’nykh s rezidual’noy stadiyey detskogo tserebral’nogo paralicha [Recovering Treatment of Patients with Residual Stage of Cerebral Palsy]. Antidor [Antidor].1999. (In Russian).
2. Semyonova КА. Problema vosstanovitel’nogo lecheniya detskogo tserebral’nogo paralicha [Problems of Recovering Treatment of Cerebral Palsy]. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova [The Journal of Neurology and Psychiatrics Named After S.S. Korsakov] 2012;112(7-2):9-13. (In Russian).
3. Kane KJ, Musselman KE, Lanovaz J. Effects of solid ankle-foot orthoses with individualized ankle angles on gait for children with cerebral palsy and equinus: J Pediatr Rehabil Med. 2020;13(2):169-83. DOI: 10.3233/PRM-190615.
4. Eddison N, Healy A, Needham R, Chockalingam N. The effect of tuning ankle foot orthoses-footwear combinations on gait kinematics of children with cerebral palsy: A case series: Foot (Edinb). 2020;43:1016-60. DOI: 10.1016/j.foot.2019.101660.
5. Altschuck N, Bauer C, Nehring I, Bohm H et al. Efficacy of prefabricated carbon-composite ankle foot orthoses for children with unilateral spastic cerebral palsy
exhibiting a drop foot pattern: J Pediatr Rehabil Med. 2019;12(2):171-80. DOI: 10.3233/PRM-170524.
6. Betancourt JP, Eleeh P, Stark S, Jain NB. Impact of Ankle-Foot Orthosis on Gait Efficiency in Ambulatory Children With Cerebral Palsy: A Systematic Review and Meta-analysis: American journal of physical medicine & rehabilitation: Association of Academic Physiatrists. 2019;98(9):759-70. DOI: 10.1097/PHM.0000000000001185.
7. Pasin Neto H, Grecco LAC, Ferreira LAB, Duarte NAC et al. Postural insoles on gait in children with cerebral palsy: Randomized controlled double-blind clinical trial: J Bodyw Mov Ther. 2017;21(4):890-95.
8. Eek MN, Zugner R, Stefansdottir I, Tranberg R. Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole. Gait Posture. 2017;55:150-6. DOI: 10.1016/j.gaitpost.2017.04.022.
9. Kerkum YL, Harlaar J, Buizer AI, van den Noort JC et al. An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion: Gait Posture. 2016;46:104-11. DOI: 10.1016/j.gaitpost.2016.03.001.
10. Kerkum YL, Buizer AI, van den Noort JC, Becher JG et al. The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion: PLoS One. 2015;10(11):0142878. DOI: 10.1371/journal.pone.0142878.
11. Neto HP, Grecco LA, Duarte NA, Christovao TC et al. Immediate Effect of Postural Insoles on Gait Performance of Children with Cerebral Palsy: Preliminary Randomized Controlled Double-blind Clinical Trial: J Phys Ther Sci. 2014;26(7):1003-7. DOI: 10.1589/jpts.26.1003.
12. EddisonN, Chockalingam N. The effect of tuninganklefoot orthoses-footwear combination on the gait parameters of children with cerebral palsy. Prosthet Orthot Int. 2013;37(2):95-107. DOI: 10.1177/0309364612450706.
13. Mancinelli C, Patel S, Deming LC, Schmid M et al. Assessing the feasibility of classifying toe-walking severity in children with cerebral palsy using a sensorized shoe, Annu Int Conf IEEE: Eng Med Biol Soc. 2009;51:63-6. DOI: 10.1109/IEMBS.2009.5332733.
14. Jagadamma KC, Coutts FJ, Mercer TH, Herman J et al. Effects of tuning of ankle foot orthoses-footwear combination using wedges on stance phase knee hyperextension in children with cerebral palsy -preliminary results, Disabil Rehabil Assist Technol. 2009;4(6):406-13. DOI: 10.3109/17483100903104774.
15. Smiley SJ, Jacobsen FS, Mielke C, Johnston R et al. A comparison of the effects of solid, articulated, and posterior leaf-spring ankle-foot orthoses and shoes alone on gait and energy expenditure in children with spastic diplegic cerebral palsy: Orthopedics. 2002;25(4):411-5. DOI: 10.3928/0147-7447-20020401-16.
16. Davoudi M, Khosravi M, Farsani, Babaee T et al. The Effects of Combining High-Top Shoes with Twister Wrap Orthoses on Balance Parameters of Children with Spastic Diplegic Cerebral Palsy: J Biomed Phys Eng. 2022;12(1):91-100. DOI: 10.31661/jbpe.v0i0.2106-1358.
17. Maharaj JN, Barber L, Walsh HPJ, Carty CP. Flipflops do not alter the neuromuscular function of the gastrocnemius muscle and tendon during walking in children: Gait Posture. 2020;77:83-8. DOI: 10.1016/j.gaitpost.2019.12.032.
18. Bartonek A, Lidbeck CM, Pettersson R, Weidenhielm EB et al. Influence of heel lifts during standing in children with motor disorders: Gait Posture. 2011;34(3):426-31. DOI: 10.1016/j.gaitpost.2011.06.015.
19. Murri A, Zechner G. Corrective dynamic shoe fitting of the functional clubfoot in patients with infantile cerebral palsy: Z Orthop Ihre Grenzgeb. 1994;132(3):214-20. DOI: 10.1055/s-2008-1039965.
20. Mendelevic IA, Pitkin MP, Arzanikovova EE. Clinical-biomechanical Aspects of the Production Orthopaedic Shoes for Children until the Age 3 Years with Cerebral Palsy: Acta Chir Orthop Traumatol Cech. 1992;59(2):96-8. (In Russian).
21. Baumann JU. Treatment of pediatric spastic foot deformities: Orthopade. 1986;15(3):191-198.
22. Wesdock KA, Edge AM. Effects of wedged shoes and ankle-foot orthoses on standing balance and knee extension in children with cerebral palsy who crouch: Pediatric Physical Therapy. 2003;15(4):221-31. DOI: 10.1097/01.PEP.0000096383.80789.A4.
23. Cobeljic G, Bumbasirevic M, Lesic A, Bajin Z. The management of spastic equinus in cerebral palsy: Orthopaedics and trauma. 2009;23(3):201-9. DOI:10.1016/j.mporth.2009.05.003.
24. Mironov SP, Kotel’nikov GP, Ortopedia. Natsional’noye rukovodstvo, 2-е izd. [Orthopedics. A national guideline, 2nd edition] Moskva: GEОTАR-Media [Moscow: GEOTARMedia], 2013. (In Russian).
25. Belova L, Bekk N, Zakhozhaya T, Belousova O et al. Tehnologicheskiye resheniya proektirovaniya ortopedicheskoy obuvi s uch’otom biomehaniki dvizheniy [Technological design solutions of orthopedic footwear considering biomechanics of movement], Vestnik Kazanskogo tehnologicheskogo universiteta [The Messenger of Kazan National Research Technological University]. 2015;18(5):112-4. (In Russian).
26. Klinika i reabilitatsionnaya detskih cerebral’nyh paralichey [Clinic and Rehabilitation Therapy of Cerebral Palsy]. Available at: https://libarch.nmu.org.ua/handle/GenofondUA/70498/. (accessed 16.03.2023). (In Russian).
27. Rose J, Cahill-Rowley K, Butler EE. Artificial walking technologies to improve gait in cerebral palsy: multichannel neuromuscular stimulation: Artificial organs. 2017;41(11):233-9. DOI: 10.1111/aor.13058.
28. Golubeva YB, Gorelova IK, Zimina EL, Skirmont EI et al. Slozhnaya ortopedicheskaya obuv’ s individual’nymi parametrami izgotovleniya, Prakticheskoye posobiye [Complex orthopedic footwear with custom manufacturing options, A guide to practice] — SPb.: Izd-vo FGBU FNTsRI im. G.A. Albrehta [Saint-Petersburg: Published by Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht]. — 23-38 p.: ISBN 978-5-6046285-5-3 (2021). (In Russian).
29. Yesakov S, Vozrastnaya anatomiya i fiziologiya (kurs lektsiy) [Age anatomy and physiology (course of lecture)]/ UdGU, Izhevsk [Udmurt State University, Izhevsk], 2010. 196 p. (In Russian).
30. Ma X., Luximon A. Design and manufacture of shoe lasts, Handbook of footwear design and manufacture, Elsevier 2013, pp. 177-196.
31. Golubeva YB, Skirmont EI, Gorelova IK, Zimina EL et al. Kolodka bertsovaya ortopedicheskaya [Orthopedic tibia shoe last]. Patent RU N 2737475, 2020. (In Russian).
32. Mendelevich IA, Pitkin MR, Arzanikovova EE. Ortopedicheskaya kolodka [Orthopedic shoe last]. Patent SU N 1560077, 1990. (In Russian).
33. Pitkin MR, Mendelevich IA. Ortopedicheskaya obuv’ [Orthopedic footwear]. Patent SU N 820822, 1981. (In Russian).
34. Arzhannikova EE, Pelevina IL, Skirmont EI, Biktimirova FM. Ortopedicheskaya obuv’ [Orthopedic footwear]. Patent RU 2021791, 1994. (In Russian).
35. Ponomarenko GN. Reabilitatsiya invalidov: natsional’noye rukovodstvo [Rehabilitation of the disabled: A national guidline]. Moskva: GEОTАR-Media [Moscow: GEOTAR-Media], 2018. (In Russian).
36. Golubeva YB, Gorelova IK, Zimina EL, Skirmont EI. Botinki ortopedicheskiye dlya detei s deformatsiyami stop [Orthopedic shoes for children with deformities of feet]. Patent RU 125033, 2013. (In Russian).
37. Golubeva YB, Arzanikovova EE, Gorelova IK et al. Konstruirovaniye i tehnologii ortopedicheskoi obuvi: prakticheskoe rukovodstvo [Designing and technologies of orthopedic shoes: a practical guide] / (pod red. EE Arzhannikovoi, IK Gorelovoi). SPb.: FGBUSPb NTsEPR im. G.A. Albrehta [Edited by Arzanikovova EE, Gorelova IK, Saint-Petersburg: Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht]. 2016. P. 111-2. (In Russian).
38. Aboutorabi A, Arazpour M, Bani MA, Saeedi H et al. Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review: Annals of physical and rehabilitation medicine. 2017;60(6):393-402. DOI: 10.1016/j.rehab.2017.05.004.
39. Contini BG, Bergamini E, Alvini M, Di Stanislao E et al. A wearable gait analysis protocol to support the choice of the appropriate ankle-foot orthosis: A comparative assessment in children with Cerebral Palsy: Clinical Biomechanics.2019:70;177-185.
40. Moseley AM, Elkins MR, Van der Wees PJ, Pinheiro MB. Using research to guide practice: the physiotherapy evidence database (PEDro): Brazilian journal of physical therapy. 2020;24(5):384-391. DOI: 10.1016/j.bjpt.2019.11.002.
41. Law MC, MacDermid J. Evidence-based rehabilitation: A guide to practice: Slack Incorporated. 2008.
42. Dalvand H, Dehghan L, Feizi A, Hosseini SA et al. The impacts of hinged and solid ankle-foot orthoses on standing and walking in children with spastic diplegia: Iran J Child Neurol. 2013;7(4):12-9.