How does the operating length of the gastrocnemius vary with different common AFOs in children with cerebral palsy?
Background: Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation.
Objectives: This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy.
Study design: Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses.
Methods: We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis.
Results: Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait.
Conclusion: Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life.
Clinical relevance: Determining whether ankle foot orthoses stretch tight muscles can inform future orthotic design and potentially provide a platform for integrating therapy into daily life. However, stretching tight muscles must be balanced with other goals of orthoses such as improving gait and preventing bone deformities.
Our very own Hwan Choi will be giving a presentation on his PhD research at the Co-Motion MakerSpace at the University of Washington. Join us on Tuesday, January 26th 3:30pm-4:30pm to learn more about his research “Optimizing Orthoses”, and how to modify 3D scanned files in Meshmixer in order to make a mechanically driven device for yourself. This event is collaboration with UW’s WOOF3D club. See below for additional details.
Using musculoskeletal modeling to evaluate the effect of ankle foot orthosis tuning on musculotendon dynamics: a case study.
This case study examines the influence of an ankle foot orthosis footwear combination (AFO-FC) on musculotendon lengths and gait kinematics and kinetics after right thrombotic stroke resulting in left hemiplegia. Methods: Gait analysis was performed over three visits where the subject walked with an AFO-FC with two shank-to-vertical angle (SVA) alignments, a posterior leaf spring AFO (PLS AFO), and shoes alone. Biomechanical and musculoskeletal modeling was used to evaluate musculotendon lengths, kinematics, and kinetics for each condition. Results: The AFO-FC improved walking speed and non-paretic kinematics compared to the PLS AFO and shoes alone. The operating length of the paretic gastrocnemius decreased with the AFO-FC improving knee kinematics in swing, but not stance. As the SVA of the AFO-FC was reduced from 15° to 12°, internal ankle plantar flexor moment increased. Conclusions: Musculoskeletal modeling demonstrated that the AFO-FC altered gastrocnemius operating length during post-stroke hemiplegic gait. Using these tools to evaluate muscle operating lengths can provide insight into underlying mechanisms that may improve gait and guide future AFO-FC design. PDF
Paper accepted at ASME Dynamics Systems and Control Conference:
Using dynamic musculoskeletal simulation to evaluate altered muscle properties in cerebral palsy
Abstract: Cerebral palsy is caused by an injury to the brain, but also causes many secondary changes in the musculoskeletal system. Altered muscle properties such as contracture, an increased passive resistance to stretch, are common but vary widely between individuals and between muscles. Quantifying these changes is important to understand pathologic movement and create patient-specific treatment plans. Musculoskeletal modeling and simulation have increasingly been used to evaluate pathologic movement in CP; however, these models are based upon muscle properties of unimpaired individuals. In this study, we used a dynamic musculoskeletal simulation of a simple motion, passively moving the ankle, to determine (1) if a model based upon unimpaired muscle properties can accurately represent individuals with cerebral palsy, and (2) if an optimization can be used to adjust passive muscle properties and characterize magnitude of contracture in individual muscles. We created musculoskeletal simulations of ankle motion for nine children with cerebral palsy. Results indicate that the unimpaired musculoskeletal model cannot accurately characterize passive ankle motion for most subjects, but adjusting tendon slack lengths can reduce error and help identify the magnitude of contracture for different muscles.