Lower Limb Orthosis in Pediatric - the importance of a motion knee

Abstract

The ability to walk upright is a defining characteristic of man.Walking is a complex process where body segments need to move in a coordinated manner. The lower bodyextremity must have the ability to support body weight during the stance phase of the locomotion cycle, rotateand coordinate the joints to achieve forward progression, adjust limb length during the swing phase of gait, andfurther smooth the trajectory of the centre of mass for energy conservation.Some of the therapeutic strategies adopted in paediatrics ortotraumatologic and/or neuromuscular pathology,involve walking with a blocked knee, for example knee arthrodesis, transfemoral amputation or kneedisarticulation with a non-articulated prosthesis, or a Knee-Ankle-Foot Orthosis (KAFO), that generally doesn’tarticulate. Patients who walk with a knee blocked in full extension clear the foot during swing phase by adoptingcompensatory movements and such compensations result in decreased efficiency and increased energeticconsumption.KAFOs are prescribed for individuals who, due to significant weakness of the knee extensor musculature or deformity, need a mechanical control of the knee during stance, trough blockage in extension. More recently, theintroduction of Stance-Control Knee-Ankle-Foot Orthoses (SCKAFO) has been designed to allow swing phasefreedom for the knee joint while automatically providing stance phase stability. However, commercially availablesolutions are not available to the paediatric population, and this stage is essential for the development andacquisition of a definitive corporal scheme and activation of motor patterns.The aim of this paper is to highlight the importance of lower limb orthoses with articulated knee, for thepaediatric population. The authors have split this article into three sections: the first section reviews the gait cycle,describing the changes resulting from the blocked knee in extension; the second section presents lower limborthoses available with assistance during the support phase, setting out its faults; in the third section, by way ofconclusion, the authors propose guidelines for future research solutions adaptable to the paediatric population.

Keywords: Child; Knee Joint ; Knee Prosthesis; Walking