Effects of Using Dynamic Elastomeric Fabric Orthoses
Condition: Cerebral Palsy; Movement Disorders; Neurologic Disorder
MeSH terms: Cerebral Palsy; Movement Disorders; Nervous System Diseases
Study type: Interventional

Summary: 
      Purpose: The aim of this study was to investigate the effects of dynamic elastomeric fabric
      orthoses (DEFOs) used for lower trunk and pelvis on balance, gait parameters, and pelvis
      symmetry in children with cerebral palsy.

      Materials and Methods: Twenty-two children (7 girls, 15 boys) in an age range of 4-10 years,
      with spastic type cerebral palsy, and at gross motor function classification system levels 1
      or 2 were included in the study. Children who met the inclusion criteria were randomly
      divided into two groups. Ten children were included in the control group (Group I) and 12
      children were included in the orthosis group (Group II). Both groups received a physiotherapy
      and rehabilitation program twice a week for 8 weeks in accordance with neurodevelopmental
      treatment approaches. Children in Group II were treated with DEFOs in lower body and pelvis
      in addition to physiotherapy and rehabilitation sessions. The use frequency of the orthosis
      was extended over the course of the week during which they were active for 8 hours a day.
      After the demographic data of the children were recorded, the Pediatric Balance Scale and the
      Timed Up and Go Test were used for balance assessment. Gait parameters and kinematic values
      of the pelvis were evaluated using the BTS G-Walk®, a wireless mini digital gait analysis
      system.
    

Detailed description: 
      All groups received a physiotherapy and rehabilitation program two sessions per week, for 45
      minutes, for a total of 8 weeks. The program was administered by a physiotherapist and
      prepared in accordance with neurodevelopmental treatment approaches. At other times, families
      continued to practice the exercises. An appropriate treatment plan was developed according to
      the needs and characteristics of each participant. Ensuring proper posture in different
      positions, increasing body awareness, and facilitating trunk extension were included in the
      treatment plan. For the development of postural control in standing and walking without
      support, weight transfer studies on the affected and less affected sides with trunk
      elongation were emphasized. Step up/down exercises were performed on both the affected and
      less affected sides. Supported by appropriate hand gripping, two-feet forward jumping,
      one-foot forward jumping, and weight transfer on one leg exercises were performed. Providing
      sensory inputs during all exercises was given importance. Exercises were conducted
      particularly to strengthen the antagonists of the spastic muscles. Stretching exercises were
      carried out in functional positions with active participation of the child as much as
      possible. The home program was shown to the family in detail in parallel with the
      physiotherapist's practices and the program was revised regularly. While Group I continued
      physiotherapy and rehabilitation sessions, the children in Group II wore DEFOs with a focus
      on the lower body and pelvis in addition to the physiotherapy and rehabilitation sessions.
      The frequency of the use of the orthosis was planned to extend through the week and they had
      the orthosis during their active hours during the day about 8 hours a day. In order to reduce
      the loosening of the fabric caused by extensive use, it was recommended that the orthosis be
      removed and reworn at two-hour intervals. The children wore the DEFOs for 8 weeks with this
      frequency. The frequency of use was monitored using a chart. Children were evaluated at the
      beginning of the study and after 8 weeks. An assessment environment was created for each
      child when they felt energetic and well. In order to prevent fatigue, short breaks were
      given. All evaluations were performed in the same environment in standardized conditions and
      without orthosis. Gait analysis was performed with bare feet.
    

Intervention name(s): dynamic elastomeric fabric orthoses
Intervention type(s): Other
Intervention description(s): Wore dynamic elastomeric fabric orthoses with a focus on the lower body and pelvis in addition to the physiotherapy and rehabilitation sessions. The frequency of the use of the orthosis was planned to extend through the week and they had the orthosis during their active hours during the day about 8 hours a day.
Allocation: Randomized
Intervention model: Sequential Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: cerebral palsy; dynamic orthoses; gait analysis; movement; neoprene; rehabilitation