Page 37 - Maximizing the efficacy of ankle foot orthoses in children with cerebral palsy

The AFO-CP protocol
calculate KEpk
calculate KEpk differences
calculate SMC-EC
Sort configurations by KEpk
check for differences >5o
sort remaining configurations
KEpk K1
KEpk K2
KEpk K3
if difference with KEpk K1 >5o
SMC-EC K1
II
exclude KEpk K2
Figure 2.2. Flowchart of the optimal FRO stiffness selection procedure. After sorting the different stiffness configurations based on peak knee extension angle in single support (KEpk), absolute differences in peak knee extension angle will be calculated. KEpk of K2 and/or KEpk of K3 will be excluded when more than five degrees. Otherwise, the remaining configurations will be sorted by net non-dimensional walking energy cost (this can be either two or three remaining configurations). The stiffness that results in the lowest walking energy cost will be selected as the subject’s optimal FRO.
Abbreviations: KEpk, peak knee extension angle during single support; SMC-EC, net non-dimensional walking energy cost relative to speed matched control cost; SS, single support. K1, K2 and K3 represent either rigid, stiff, or flexible FRO stiffness configurations.
[14mm] and ±1.0 Nm·deg-1 [16mm]), respectively. The spring force towards plantar flex- ion will be very compliant (i.e. ±0.01 Nm·deg-1 [14mm] and ±0.04 Nm·deg-1 [16mm]) for both configurations.
Accommodation procedures
The accommodation period for all three FRO configurations will include a gradual increase in the length of time the FRO is worn each day, in order to minimise the risk of adverse events. Patients will be contacted one week after setting each new FRO con- figuration, to check for adverse events such as pain, discomfort, or pressure sores. If the patient has no complaints, the accommodation period will continue until the next visit (four to eight weeks later). When adverse events are reported, the investigator will identify the causes and make an appropriate decision according to protocol. The accom- modation period will not start until all complaints are resolved.
SMC-EC K2
optimal FRO selection
exclude KEpk K3
SMC-EC K3
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