3.2. Case Series
Data for each of the eight retained participants is presented below as individual cases.
Participant 1: Four-year-old male child with spastic diplegic CP, GMFCS III. The participant mobilises with a reverse walker. Participant 1 (
Figure 1) demonstrated better scores in TUG, GMFM-88 and EVGS when in SMotO, likely due to the dynamic nature of the SMotOs being used in dynamic outcome measures (
Table 2). Participant 1 displayed a better score in the BBS when in AFOs, likely due to the bracing effect of AFOs.
As per response from the Q’AIRE, the participant’s mother reported that “I have been advised by some of our health care professionals that (my) son’s gait is better in his AFOs than in Piedro (supportive disability shoe) with SMotO”. This statement is contradicted by the EVGS results (
Table 2). The mother of participant 1 did not give consent for video images of his gait.
Participant 2: Eight-year-old male child with spastic quadriplegic CP, GMFCS III. The participant mobilises with a reverse walker. Participant 2 (
Figure 2) performed better in the TUG, GMFM-88 and EVGS when wearing SMotOs, likely due to the dynamic nature of the SMotOs being used in dynamic outcome measures (
Table 3). Interestingly, the BBS reported the same score for both orthoses. Correlating videos (in DropBox folder link below) highlighting the participant’s gait in SMotO, AFO and barefoot (as labelled) for ‘Participant 2’ have been provided for reference.
The participant’s mother reported, as per the Q’AIRE, that “the SMotOs have been great for the stepping, sit to stand, pull to stand. Anything where he gets to feel the ground with the ankle movement has been the biggest bonus. Once I get some more supportive shoes to go with these then this will be the best. His Piedros still weren’t helpful but we are looking at custom made ones to help this”.
Participant 3: Four-year-old boy with spastic diplegic CP, GMFCS II. Participant 3 (
Figure 3) demonstrated improved scores in the BBS, GMFM-88 and EVGS when wearing SMotOs compared to AFOs (
Table 4). The GMFM-88 demonstrates a change of 6%, which is reported as a clinically important change in score. Correlating videos (in DropBox folder link below) highlighting the participant’s gait in SMotO, AFO and barefoot (as labelled) for ‘Participant 3’ have been provided for reference.
The mother of Participant 3 reported, as per the Q’AIRE, that her “son is much more comfortable in SMotOs and finds it easier to manoeuvre his body and is much more willing to get up and try new things with them on because they’re not as bulky”.
Participant 4: Thirteen-year-old girl with spastic quadriplegic CP, GMFCS II. Participant 4 (
Figure 4) visually appeared to walk well in AFOs, but the results of the EVGS (
Table 5) demonstrated a notable difference in the quality of her gait pattern when wearing AFOs compared to SMotO. Her GMFM-88 total score did not display a large difference in scores between orthoses, indicating that neither orthosis demonstrates an increased effect on gross motor skills compared to the other. Correlating videos (in DropBox folder link below) highlighting the participant’s gait in SMotO, AFO and barefoot (as labelled) for ‘Participant 4’ have been provided for reference. Participant 4 did not complete the Q’AIRE.
Participant 5: Four-year-old boy with dystonic quadriplegic CP, GMFCS IV. The participant mobilises with a supportive reverse walker. Participant 5 (
Figure 5) was physically affected by his dystonia and used a gait trainer to mobilise. He was unable to participate in any other outcome measures. Despite this limitation, the video images and EVGS both demonstrated the clear differences in his gait between barefoot, AFO and SMotOs. The qualitative evidence highlighting the participant’s gait in the three conditions (correlating videos in DropBox folder link below) is supported by the results from the EVGS (
Table 6).
Participant 6: Five-year-old boy with spastic quadriplegic CP, GMFCS IV. The participant mobilises with a reverse walker and hip abduction brace. Participant 6 (
Figure 6) struggled to walk without the support of his orthoses, walking frame and abduction brace. The results from the GMFM-88 (
Table 7) showed a mild difference in scores between orthoses. Both the quantitative measure (EVGS) and qualitative images (video as per link below) demonstrated a difference in the quality of movement between orthoses and barefoot.
Correlating videos (in DropBox folder link below) highlighting the participant’s gait in SMotO, AFO and barefoot (as labelled) for ‘Participant 6’ have been provided for reference. Participant 6 did not complete the Q’AIRE.
Participant 7: Twelve-year-old boy with spastic dystonic quadriplegic CP, GMFCS I. Participant 7 (
Figure 7) was independently mobile with and without shoes. Participant 7 demonstrated improved alignment and stability when he wore SMotO as per EVGS score (
Table 8) compared to barefoot. The images from the pedographs (
Figure 8 and
Figure 9) demonstrated weightbearing changes pre-SMotO and one year after using SMotO, especially through the right foot.
Correlating videos (in DropBox folder link below) highlighting the participant’s gait in SMotO and barefoot (as labelled) for ‘Participant 7’ have been provided for reference. Participant 7 did not complete any other outcome measures.
Participant 8: Six-year-old boy with dystonic quadriplegic CP, GMFCS IV. The participant mobilises with assistance in a supported walker. Participant 8 (
Figure 10) was originally prescribed SAFOs then HAFOs despite not having any restriction in his ankle range of motion. He was able to bear weight with support and walks in a walker. He uses SMotOs in a Piedro shoe. Participant 8 was unable to complete any of the quantitative outcome measures due to his severe dystonia. From the Q’AIRE, mother reported “for children with CP—it appears there is a standard practice/framework for which children are expected to have/need. AFOs are one of these. I had to suggest my child transition from SAFO to HAFO. It was not suggested to us. They provide better support and ankle flexibility”.
Figure 11 and
Figure 12 demonstrate the changes seen (over a seven-month period) in the muscle activation of his foot when wearing the SMotOs. These pedograph images corroborate the theory of the muscles learning to activate and support the foot, despite his CP diagnosis.