The effects of the norsk funktion-walking orthosis on the walking ability of children with cerebral palsy and severe gait impairment

摘要

The purpose of this study was 1) to test whether an orthosis, which provides postural stability of the trunk and guides the leg movements during walking (Norsk Funktion-walker orthosis [NFWO]), would enable nonambulant children with cerebral palsy with poor or no leg coordination and with little or no trunk control to walk on their own, 2) to investigate if there is an increase in motor function and activity while using a NFWO, and 3) defining requirements for a successful provision. Ninety-three children (39 girls, 54 boys; mean age 7.6 years; 67 with bilateral spastic, 10 with dyskinetic, 10 with mixed, 6 with ataxic cerebral palsy; Gross Motor Function classification System level 4: 45, level 5: 48) were provided with a NFWO. The following assessments were carried out immediately before and 3 months after using the NFWO: WeeFIM walking score; independence rating by parents or caregivers; aims or expectations of parents or caregivers; at a mean interval of 265 days after provision: mean daily walking distance (meters). With the NFWO, 78 children (84%) became ambulatory, 10 children (11%) used it exclusively as a dynamic standing frame only, and 5 children (5%) returned the NFWO. The mean daily walking distance was 99 m (2-463 m). The mean WeeFIM walking score of 1.99 (SD 0.83) without the NFWO increased to 4.42 (SD 1.00) with the NFWO indoors and to 3.71 (SD 1.24) (p < 0.001) outdoors. Independence rating by parents or caregivers reflected a highly significant increase in independent mobility with the NFWO compared with locomotion without ambulatory aides (p < 0.001) and of bilateral hand function (p < 0.001). No significant increase in the mobility was found when comparing former mobility aides (wheelchair, tricycle) with the NFWO. The ability to cross obstacles did neither significantly increase with the NFWO. Successful indication for a NFWO depends on 1) the child's motivation to walk and the support of the environment to achieve independent walking mobility through the use of this assistive tool, 2) the ability for selective reciprocal leg movements, and 3) no flexion contractures of hips and knees above 20°and a foot dorsiflexion of at least neutral-0°. The NFWO proved to be a useful ambulatory aid in the children with cerebral palsy with severe gait impairment to increase independent mobility.