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19-09-2011 | Physical rehabilitation | Article

Flexible derotator improves walking ability in cerebral palsy children

Abstract

Free abstract

MedWire News: Study results suggest that use of a flexible derotator, an orthotic device designed to prevent excessive bone and limb rotation during walking, significantly improves gait in in children with cerebral palsy (CP).

The flexible derotator was recently designed to replace older rigid derotators, which are no longer used due to the constraints they placed on the child in terms of limiting joint amplitude and impairing gait development.

The current study tested the efficacy of the flexible derotator, which takes the form of a customized piece of clothing comprising a neoprene abdominal belt and "shorts," for improving excessive femoral anteversion and internal hip rotation during walking in 30 walking children with CP aged 6 to 9 years. All the children had significant rotational disorders.

Half the children were treated with the flexible derotator for 1 year and half were left untreated (controls) over this period.

The researchers compared changes in bone-related parameters (femoral and tibial torsion) and functional parameters (mean speed and distance of walking and energy expenditure index [EEI]) between baseline and 1 year.

As reported in the Annals of Physical and Rehabilitation Medicine, Anais Marcucci (Hôpital de Bellevue, Saint-Étienne, France) and colleagues found that at 1 year right femoral anteversion and right external tibial torsion had improved significantly more in the group using the derotator than in the control group. Left external tibial torsion had improved significantly from baseline in the in the derotator group, but not in comparison with the controls.

Functional parameters improved in the derotator group, but not in the control group, as both mean speed and distance of walking increased (by 5.5 vs 0.4 m/min and 27.4 vs -4.6 m, respectively) and EEI decreased (-0.1 vs 1.3 beats/m) significantly over the year.

The team notes that the improvements in bone parameters were slight compared with the functional improvements observed with the derotator.

"These results suggest that the derotator has a positive functional impact in walking cerebral palsy children but do not enable us to affirm that there were reductions in spasticity-induced excessive femur and tibia torsions," write the authors.

"The flexible derotator's efficacy merits further investigation in a prospective study of a larger number of children, with a qualitative analysis of dynamic gait parameters and the orthosis' impact on long-term improvements in quality of life," they conclude.

By Helen Albert

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