The effect of orthotic tuning on the energy cost of walking in children with cerebral palsy

Evans, Helen (2018) The effect of orthotic tuning on the energy cost of walking in children with cerebral palsy. PhD thesis, University of Nottingham.

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Children with cerebral palsy (CP) often have to wear orthoses to help them walk. There is a growing body of evidence that orthotic tuning, that is, optimisation of the ground reaction forces in the lower limbs during walking, is recommended to ensure the maximum potential benefit for each child. Research demonstrates that orthoses can reduce the energy cost of walking for children with CP, but to-date there is no evidence as to whether this tuning process results in further energy efficiency or not [1].


The aim of this research programme was to validate a method that would help to determine when an orthosis was optimised for each child; and then to investigate whether the use of orthoses that were optimally tuned for each child allowed a further reduction in energy cost during walking, compared with orthoses that had not been optimally tuned.


A video vector system was used to allow visualisation of the alignment of ground reaction forces in relation to the lower limbs during walking. A simple measurement tool was validated that allowed quantification of the moment arm at the knee in stance, which was used to confirm when optimal alignment had occurred following orthotic tuning. The energy cost of walking was measured using the Total Heart Beat Index (THBI). Data were collected barefoot, with the original ‘un-tuned’ orthosis and with the final ‘tuned’ orthosis.


Analysis of energy cost showed that for some children, energy cost was further reduced through orthotic tuning, but that this was not the case for all children. Preliminary findings suggest the influence of underlying level of disability, as determined by the GMFCS.


Orthotic tuning may help to reduce the energy cost of walking for some children with CP, especially those with greater levels of disability. Further studies with large participant numbers are warranted to further investigate this area.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Pinnington, Lorraine
Keywords: Walking; Cerebral palsy; Splints; Gait; Orthoses; Energy cost
Subjects: W Medicine and related subjects (NLM Classification) > WS Pediatrics
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 51746
Depositing User: Evans, Helen
Date Deposited: 07 Sep 2018 14:27
Last Modified: 01 Jun 2022 04:30

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