Comparative effects of bilateral and unilateral ankle-foot orthoses on balance and gait in children with spastic unilateral cerebral palsy.

BACKGROUND

Ankle-foot orthoses (AFOs) are commonly prescribed to improve gait mechanics and postural stability in children with spastic unilateral cerebral palsy (CP). While unilateral AFO use is well studied and widely accepted clinically, evidence comparing unilateral and bilateral AFO use -particularly regarding balance control-remains limited. This study compared the effects of unilateral and bilateral AFOs on static balance and spatiotemporal gait parameters in children with spastic unilateral CP.

METHODS

Nineteen children with spastic unilateral CP (aged 4-12 years) who were habitual bilateral AFO users participated. Assessments were conducted under three conditions: no orthosis, unilateral AFO, and bilateral AFOs. Static balance was evaluated using force platform (Bertec Corporation), and spatiotemporal gait parameters were measured using GAITRite® electronic walkway. A randomized crossover design minimized order effects.

RESULTS

Bilateral AFOs significantly reduced lateral sway amplitude on firm surface with both eyes open (p = 0.020) and eyes closed (p = 0.022) compared with no orthosis, indicating improved static balance. No significant differences were observed in anterior-posterior sway across conditions. Bilateral AFOs also significantly reduced cadence (p < 0.001) while increasing step and stride times on both the affected and unaffected sides, suggesting longer stance and support phases and more controlled gait pattern. Unilateral AFO use produced shorter step time on the affected side.

CONCLUSION

Bilateral AFOs promote more balanced foot placement and safer gait strategy in children with spastic unilateral CP by increasing lateral stability and reducing cadence. These findings support bilateral AFOs as preferred clinical option for improving gait and balance in children with spastic unilateral CP.