Exploratory investigation into energy expenditure using tuned versus non-tuned ankle foot orthoses- footwear combinations in children with cerebral palsy.

tudy Design: Within-subjects design.
Background: Children with cerebral palsy (CP) commonly expend two to three times as much energy to walk as typically developing children. Research shows that the effects of non-tuned ankle-foot orthoses (AFOs) on energy expenditure is inconclusive. Tuning of an ankle-foot orthosis-footwear combination (AFO-FC) has demonstrated an improvement in the kinetics and kinematics of athological gait, particularly knee flexion during stance phase, which are key determinants of an energy efficient gait.
Objective: To compare the submaximal energy expenditure via indirect calorimetry, speed and distance walked, of tuned and non-tuned AFO-FCs and barefoot gait, in children with cerebral palsy (CP). Methods: Performance assessment of four children aged between 7-10 years with a diagnosis of CP (one hemiplegic and three diplegic participants, two female, two male, with a Gross Motor Function Classification System (GMFCS) of 2) at a Gait Analysis Laboratory.
Results: There was a reduction in gross submaximal energy expenditure and energy efficiency index (EEI) based on O2, in three out of the four participants tested when wearing tuned compared to a non-tuned AFO-FC, the reduction ranged from 9.2% to 33.7%. Speed and distance covered also showed improvement in the tuned condition.
Conclusions: Tuning the AFO-FC of children with cerebral palsy has the potential to decrease energy expenditure and increase speed and distance compared to providing a nontuned AFO-FC.
Clinical Relevance: There is a lack of research on the effect of using a tuned compared to a non-tuned AFO-FC on energy expenditure. This paper provides a comparison of energy expenditure in children with CP, during Barefoot, Non-tuned and Tuned AFO-FC walking, intending to inform clinical practice.