Portal de Periódicos da CAPES

USE OF THE ANTERIOR FLOOR REACTION ORTHOSIS IN PATIENTS WITH CEREBRAL PALSY

1984; Lippincott Williams & Wilkins; Volume: 4; Issue: 4 Linguagem: Inglês

10.1097/01241398-198408000-00086

1539-2570

E. D. Harrington, Roxane Lin, James R. Gage,

Nerve Injury and Rehabilitation

T h e knee jo in t that is uns tab le in the sagit tal p lane can b e control led b y us ing one of three types o f o r thoses : k n e e , k n e e ankle-foot , or an ter ior floor reac t ion or tho­ sis . If the ankle mor t i se is unaffected, a knee or thos is a lone , wi th a mechan ica l locking m e c h a n i s m , can effectively guard agains t inadver tent knee f lexion. The re are m a n y des igns of knee o r thoses that wi l l accompl i sh this as long as su spens ion can b e ach ieved and tolerated. T h i s form o f ambu la t ion wi th locked knees lends for a r ig id , energyinef f ic ient gai t pat tern . T h i s s ame gait pat tern is demons t ra ted w h e n the pa t ien t wi th an uns tab le ex t rem­ ity uses the knee-anklefoot or thosis and drop lock m e c h a n i s m . Al though the K A F O solves the suspens ion p rob lem and con­ trols an uns tab le ankle mor t i s e , it still of­ fers an energyinef f ic ient gait pat tern, in­ terferes wi th ba lance m e c h a n i s m s , and is heav ie r than the knee or thos is . In pa t ien ts w i th cerebra l palsy, l abored gai t assoc ia ted wi th excess ive knee f lexion in s tance phase has p resen ted the o r tho­ paedis t and orthot is t wi th s ignif icant dif­ ficult ies in t rea tment . Crouch gait c o m ­ m e n c e s w i th overac t iv i ty of the h a m ­ s t r ings , w h i c h increases knee f lexion, and thus requi res large increases in quadr iceps force to s tabi l ize the k n e e 2 (Figure 1 ) . Cal­ caneus deformity, a k n o w n compl ica t ion o f ove r l eng thened hee lcords fo l lowing tendo-Achilles l e n g t h e n i n g s , also s igni f i ­ cant ly adds to further p rogress ion of c rouch gai t . R e a s o n s c i ted for th is compl i ­ ca t ion inc lude overcor rec t ion , failure to protect the heelcords postoperat ively , and l eng then ing of the t endo-Achi l l es w h e n s ignif icant h ip and kneef lex ion deformi­ t ies r ema in uncor rec ted (Figure 2 ) .