Initiation of reaching when standing with and without DAFOs in children with spastic diplegia

We investigated whether the use of dynamic ankle foot orthoses (DAFOs) can improve the coordination between standing posture and a reaching movement. We investigated the temporal sequence between onset of center of pressure (CoP) displacement and onset of hand displacement by means of two AMTI force plates and a two-camera optoelectronic system (ELITE). The task was to reach for a cup. Reflective markers were placed on hand, trunk and the cup. Four children with spastic diplegia and eight control children (aged 5-12) participated. They were tested wearing DAFOs (diplegia) and the results were compared with wearing shoes (diplegia and control). The children with spastic diplegia were able to make use of anticipatory changes in CoP displacement. The results indicated that more trials in children with spastic diplegia had CoP onset preceding hand onset while wearing DAFOs (18/20) than when wearing only shoes. More trials (27/40) during the 20% reaching condition in the control group had CoP onset preceding hand onset than during the 10% reaching condition (18/40). In spite of different amounts of assistance, anticipatory postural adjustments were found in the diplegia group. Use of anticipatory postural adjustments was not consistent in the control group. Practice of reaching during standing can be carried out with DAFOs and/or hand support, and can promote motor learning of anticipatory postural adjustments.