Effect of foot orthoses on the standing balance of a child with spastic diplegic cerebral palsy : A case report

摘要

The purpose of this study was to evaluate the effect of foot orthoses on the standing balance of a child with spasticdiplegic cerebral palsy (CP). Subject: A 12-year-old girl was diagnosed with spastic diplegic CP with level II of the gross motor function using the gross motor function classification system. Her feet were pronated while walking and crouching. Foot orthoses were prescribed to correct the foot alignment. Standing balance was evaluated in a three-dimensional motion analysis lab at Sirindhorn National Medical Rehabilitation Centre (SNMRC). The movement of the centres of pressure (CoP) of left foot, right foot and whole body, and the centre of mass (CoM) were investigated by using a dual forceplate approach. The subject was instructed to stand barefoot and with the foot orthoses, with her eyes open, for 30 s. This procedure was repeated until there were 3 successful trials for each standing condition. The patient had a crouching posture throughout the trials, irrespective of the standing condition. Moments at the hips, the knees, and the ankles, observed during two conditions were similar; the range of the internal rotation of the hip alone was slightly smaller when standing with the foot orthoses than when standing barefoot. The magnitude of vertical component of the ground reaction force on the left foot was greater than that on the right foot. The anteroposterior sways of both limbs were smaller when standing with the orthoses than when standing barefoot; however, the mediolateral sways were larger when standing with the orthoses than when standing barefoot and tended toward the left foot. In addition, the 95% confidence ellipse areas of CoP and CoM when standing with the insoles were smaller than those observed when the patient stood barefoot. Although the 95% confidence ellipses for whole body CoP and CoM were reduced when wearing insoles implying better balance, the CoP of the right leg moved in wider area than the CoP of the left leg. Also the left side became dominant, as indicated by the higher proportion of the total vertical load over this limb. The reason for the asymmetrical weight distribution cannot be deducted from the available data. The use of orthoses reduces the range of internal hip rotation improving the stability during quiet standing in the case. Also, asymmetrical weight distribution over the feet may result in better balance.