Page 39 - Maximizing the efficacy of ankle foot orthoses in children with cerebral palsy

The AFO-CP protocol
Mean steady-state breath-by-breath oxygen uptake values and respiratory exchange ratios will be computed. Using these values, gross and net energy consumption will be calculated and normalised according to the net non-dimensional scheme of Schwartz et al.[47]. The primary outcome measures will be expressed as net EC and as SMC-EC. Fur- thermore, non-dimensional walking speed (N_speed) (a secondary outcome measure) will be calculated.
II
EC measurements in children with CP are sufficiently sensitive, as shown by Brehm et al.[48]. The net non-dimensional normalisation scheme of Schwartz et al.[47] is suggested to be the preferred method for reporting oxygen consumption data for subjects who have not reached their full stature, since it is largely independent of mass, height and age.
Secondary outcome
Secondary outcome measures include daily activity, gait biomechanics, walking speed (N_speed) and diversity, intensity and enjoyment of participation (assessed with the Children’s Assessment of Participation and Enjoyment [CAPE]). Two of these out- come measures (daily activity and gait biomechanics) are further explained below.
Daily activity
Daily activity will be measured for one week with a StepWatch3TM Activity Monitor 3.0 (SAM) (Cyma Corporation Seattle, WA, USA), which is an ankle worn accelerometer that measures the average amount of steps per minute over a broad spectrum of cadences. The SAM will be attached to the ankle of the dominant leg. Subjects will be instructed not to remove the SAM at any time, except when taking a bath or shower or when swim- ming. For adequate interpretation of the data, subjects will be asked to keep a diary of their activity program during each day of the week.
Daily activity will be determined as 1) average total steps per day, 2) percentage of time children were active, 3) percentage of time children were inactive, 4) ratio of me- dium to low activity levels and 5) percentage of time children show high activity levels. A calibrated SAM has been shown to be an accurate tool for recording daily steps in children with CP [49,50].
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