Neuroscience Poster Session

Re: Effect Of Hinged Ankle Foot Orthoses On The Oxygen Cost Of Walking

Desiree Maltais

Hello Michel

>Thank you for your poster on the effect of an hinged AFO.

You are welcome and thank you for your interest in the work.

>I would like to know if any studies have been done on the >modification of this orthosis effect with time?

To the best of my knowledge, most studies have looked at the effect of the orthoses after the child has been habituated to the brace, the rationale being that the effects are likely to be stable only after the child is familiar with the brace. In our study, for example, all children had been wearing hinged AFO for at least 2 years (avg. 5 years)and children wore their braces for about 8 hrs per day during the week. I agree with you that it would be interesting to see the effects of habituation to the AFO. Given that many children are under 5 yrs old when they receive their first pair of hinged AFO, I think much would need to worked out in terms of a feasible protocol. Younger chldren as you may know, are more of a challenge to test.

>I would be curious in knowing this effect since in my field (use of a >common peroneal stimulator for FES-assisted walking) I have shown >that eventhough the orthodic effect is minimal at best (as seen in >your study)

First, I am hesistant to use the word minimal. The reduction in oxygen uptake we found due to the brace was the same as that found with orthopedic surgery, which is the only other effect that we could find in the literature (with a protocol that was sufficiently well defined) that used oxygen uptake during treadmill walking as an outcome measure.  So, while we know that the oxygen cost of walking is up to 2.5 times higher in these children compared to healthy peers, we do not know enough about the extent it can be affected by any intervention; therefore we really do not have sufficient data to quanitfy any change as minimal or maximal. Moreover, we do not know enough yet about how such changes translate into changes in daily function.

Now I have a question for you.
What do you mean by an orthotic effect? Are you comparing the effect of using FES to a brace? What did you measure?  Was this with children with cerebral palsy?

> in a greater period of time this orthotic effect is modulated and is >also present concurently with a therapeutic effect.

Now I am interested in what you term a therapeutic effect and how this is different from an orthotic effect.

Thank you again for your interest in this study and good luck with your own work.



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