human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose To identify the characteristics of static st and ing balance and its postural control mechanisms during quiet side-by-side st and ing and the changes in these measures whilst wearing hinged ankle-foot orthoses ( AFOs ) in children with bilateral spastic cerebral palsy ( CP ) . Material s and Methods Twenty-one children with bilateral spastic CP ( 6.10 ± 1.09 year-old ) and 22 typically developing ( TD ) children ( 5.64 ± 0.49 year-old ) were recruited .  Pressure data were recorded while subjects with or without AFOs stood on dual force platforms and net body center of pressure ( CoP ) coordinates were calculated from this data . Net body CoP was traced for measuring mediolateral ( ML ) and anteroposterior ( AP ) displacement and path length per second . Correlation coefficients between parameters representing ankle , hip , and transverse body rotation strategies were also analyzed . Results ML and AP displacement and path length per second of the CoP trajectory were higher in children with CP compared to TD children ( p < 0.05 ) . There were no significant improvements in these parameters whilst wearing hinged AFOs . Compared to TD children , children with CP used less ankle strategy though more hip and transverse rotation strategies for postural control during quiet st and ing . Whilst wearing hinged AFOs , the contribution of ankle strategy was significantly increased for ML balance control in children with CP ( p < 0.05 ) . Conclusion Hinged AFOs for children with CP may be helpful in improving the postural control mechanisms but not the postural stability in quiet side-by-side st and ing This study compared the functional efficacy of three commonly prescribed ankle-foot orthosis ( AFO ) configurations ( solid [ SAFO ] , hinged [ HAFO ] , and posterior leaf spring [ PLS ] ) . Sixteen independently ambulatory children ( 10 males , six females ; mean age 8 years 4 months , SD 2 years 4 months ; range 4 years 4 months to 11 years 6 months ) with spastic diplegia participated in this study . Four children were classified at level I of the Gross Motor Function Classification System ( GMFCS ; Palisano et al. 1997 ) ; the remaining 12 were at level II . Children were assessed  barefoot ( BF ) at baseline ( baseline assessment of energy consumption was performed with shoes on , no AFO ) and in each orthotic configuration after three months of use , using gait analysis , oxygen consumption , and functional outcome measures . AFO use did not markedly alter joint kinematics or kinetics at the pelvis , hip , or knee . All AFO configurations normalized ankle kinematics in stance , increased step/stride length , decreased cadence , and decreased energy cost of walking . Functionally , all AFO configurations improved the execution of walking/running/jumping skills , upper extremity coordination , and fine motor speed/dexterity . However , the quality of gross motor skill performance and independence in mobility were unchanged . These results suggest that most children with spastic diplegia benefit functionally from AFO use . However , some children at GMFCS level II demonstrated a subtle but detrimental effect on function with HAFO use , shown by an increase in peak knee extensor moment in early stance , excessive ankle dorsiflexion , decreased walking velocity , and greater energy cost . Therefore , constraining ankle motion by using a PLS or SAFO should be considered for most , but not all , children with spastic diplegia Purpose : To examine the effect of ankle-foot orthoses ( AFO ) on walking activity in children with cerebral palsy ( CP ) . Methods : We used a r and omized cross-over design with 11 children with bilateral CP , mean age 4.3 years . Subjects were r and omized to current AFO-ON or AFO-OFF for 2 weeks and then crossed over . Walking activity ( average total steps/day ) , intensity , and stride rate curves were collected via an ankle accelerometer . Group effects were examined with the Wilcoxon signed-rank test and within-subject effects examined for more than 1 st and ard deviation change . Results : No significant group difference was found in average total daily step count between treatment conditions ( P = .48 ) . For the AFO-ON condition , 2 subjects ( 18 % ) increased total steps/day ; 4 ( 36 % ) increased walking time ; 2 ( 18 % ) had more strides at a rate of more than 30 strides/min ; and 2 ( 18 % ) reached higher peak intensity . Conclusions : Clinical ly prescribed AFO/footwear did not consistently enhance walking activity levels or intensity . Larger studies are warranted Twenty-one subjects with spastic diplegic cerebral palsy were studied to quantify the effects of fixed and articulated ankle-foot orthoses ( AFOs ) on gait and delineate criteria for their use . Children underwent gait analysis under three conditions , fixed AFOs ( FAFOs ) , articulated AFOs ( AAFOs ) , and shoes alone . Greater dorsiflexion occurred at initial contact with both FAFOs and AAFOs than shoes alone . Dorsiflexion at terminal stance was greatest in AAFOs . Plantarflexor power generation at preswing was preserved in AAFOs . No differences were found in knee position during stance . Knee-extensor strength was positively related to knee extension during stance . No relationships were found between dorsiflexion range of motion , calf spasticity and strength , and peak dorsiflexion during stance .  AAFOs are appropriate for subjects with varying degrees of calf spasticity , as long as adequate passive range of motion is available . These findings can be applied primarily to children who do not have a preexisting tendency to crouch The purpose of this study was to examine the effectiveness of the hinged ankle-foot orthosis ( HAFO ) , posterior leaf spring ( PLS ) , and solid ankle-foot orthosis ( SAFO ) , in preventing contracture , improving efficiency of gait , and enhancing performance of functional motor skills in 30 children ( 21 male , 9 female ; mean age 9 years 4 months ; age range 4 to 18 years , ) with spastic hemiplegia . Following a 3-month baseline period of no ankle-foot orthosis ( AFO ) use , each AFO was worn for 3 months after which ankle range of motion , gait analysis , energy consumption , and functional motor skills were assessed . The HAFO and PLS increased passive ankle dorsiflexion and normalization of ankle rocker function during gait . Normalization of knee motion in stance was dependent upon the knee abnormality present and AFO configuration . The HAFO was the most effective in controlling knee hyperextension in stance , while PLS was the most effective in promoting knee extension in children with > 10 degree knee flexion in stance . Energy efficiency was improved in 21 of the children , with 13 of these children demonstrating the greatest improvement in HAFO and PLS . Improvements in functional mobility were greatest in the HAFO and PLS BACKGROUND AND PURPOSE This study compared the effects of dynamic ankle-foot orthoses ( DAFOs ) with a plantar-flexion stop , polypropylene solid ankle-foot orthoses ( AFOs ) , and no AFOs on the gait of children with cerebral palsy ( CP ) . These orthoses were used to reduce the excessive ankle plantar flexion during the stance phase of gait . SUBJECTS AND METHODS Ten children with spastic CP ( 6 with diplegia and 4 with hemiplegia ) were tested after wearing no AFOs for an initial 2-week period , solid AFOs for 1 month , no AFOs for an additional 2 weeks , and DAFOs for 1 month . The effects of the two orthoses and no AFOs on lower-extremity muscle timing , joint motions , and temporal-distance characteristics were compared . RESULTS Both orthoses  increased stride length , decreased cadence , and reduced excessive ankle plantar flexion when compared with no orthoses . No differences were found for the gait variables when comparing the two orthoses . CONCLUSION AND DISCUSSION Based on the data , the authors believe that although both orthoses would be recommended for children with spastic CP and excessive ankle plantar flexion during stance , additional individual factors should be considered when selecting either orthosis Purpose : To compare dynamic ankle-foot orthoses ( DAFOs ) and adjustable dynamic response ( ADR ) ankle-foot orthoses ( AFOs ) in children with cerebral palsy . Methods : A total of 10 children with cerebral palsy ( 4 - 12 years ; 6 at Gross Motor Function Classification System level I , 4 at Gross Motor Function Classification System level III ) and crouch and /or equinus gait wore DAFOs and ADR-AFOs , each for 4 weeks , in r and omized order . Laboratory-based gait analysis , walking activity monitor , and parent-reported question naire outcomes were compared among braces and barefoot conditions . Results : Children demonstrated better stride length ( 11 - 12 cm ) , hip extension ( 2 ° -4 ° ) , and swing-phase dorsiflexion ( 9 ° -17 ° ) in both braces versus barefoot . Push-off power ( 0.3 W/kg ) and knee extension ( 5 ° ) were better in ADR-AFOs than in DAFOs . Parent satisfaction and walking activity ( 742 steps per day , 43 minutes per day ) were higher for DAFOs . Conclusions : ADR-AFOs  produce better knee extension and push-off power ;  DAFOs produce more normal ankle motion , greater parent satisfaction , and walking activity . Both braces provide improvements over barefoot Dynamic ankle-foot orthoses ( DAFOs ) , with free plantarflexion , are frequently prescribed to facilitate the gross motor skills of children with cerebral palsy . Employing a r and omized crossover design , this project documents the short-term effect of DAFOs in 23 ambulatory children with cerebral palsy aged 1.9 to 7.3 years . Significant improvements in crawling/kneeling , st and ing , and walking/running and jumping skills , as measured by using the Gross Motor Function Measure ( GMFM ) 88 and 66 , were documented ( P < 0.001 ) . Increased motor skills with the use of DAFOs were mildly correlated with the leg length of the participants . Increasing age was negatively correlated with st and ing skill improvement while wearing the DAFOs .  Young children who are independent walkers seem to benefit greater from the DAFOs with free plantarflexion than do children using assistive devices . Future research needs to clarify the long-term influence of the use of DAFOs on gross motor skill acquisition in young children with cerebral palsy OBJECTIVE To investigate the effectiveness of the hinged ankle-foot orthosis ( AFO ) on sit-to-st and ( STS ) transfers in children with spastic cerebral palsy . DESIGN Before-after trial . SETTING University-affiliated hospital . PARTICIPANTS Nineteen spastic diplegic children ( age range , 2 - 6 y ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The transitional movement of STS was tested in r and om order with children while wearing the barefoot and hinged AFOs . The temporal , kinematic , and kinetic data during the task were collected by using a motion analyzer ( with 6 infrared cameras ) . Statistical comparison between barefoot and hinged AFO was done with the Wilcoxon signed-rank test . RESULTS Total duration of STS transfer was significantly shortened with the hinged AFO ( P < .05 ) . The initial knee flexion , the initial angle , and the final angle of ankle dorsiflexion were increased with the AFO , compared with when barefoot ( P < .05 ) . However , the increased pelvic tilt and hip flexion while barefoot was not reduced with the AFO . The maximal moment and power of hip and knee joints were significantly increased with the AFO ( P < .05 ) , whereas the maximal moment and power of the ankle joint were not significantly changed when wearing the AFO . CONCLUSIONS Although proximal compensatory strategy of increased pelvic tilt and hip flexion did not change with the hinged AFO , some improvements of temporal , kinematic , and kinetic parameters were identified during the task . These findings suggest that a hinged AFO is beneficial for STS transfer activity for children with spastic diplegia Several studies indicated that walking with an ankle foot orthosis ( AFO ) impaired third rocker . The purpose of this study was to evaluate the effects of two types of orthoses , with similar goal setting s , on gait , in a homogeneous group of children , using both barefoot and shoe walking as control conditions . Fifteen children with hemiplegia , aged between 4 and 10 years , received two types of individually tuned AFOs : common posterior leaf-spring ( PLS ) and Dual Carbon Fiber Spring AFO ( CFO ) ( with carbon fibre at the dorsal part of the orthosis ) . Both orthoses were expected to prevent plantar flexion , thus improving first rocker , allowing dorsiflexion to improve second rocker , absorbing energy during second rocker , and returning it during the third rocker . The effect of the AFOs was studied using objective gait analysis , including 3D kinematics , and kinetics in four conditions : barefoot , shoes without AFO , and PLS and CFO combined with shoes . Several gait parameters significantly changed in shoe walking compared to barefoot walking ( cadence , ankle ROM and velocity , knee shock absorption , and knee angle in swing ) . The CFO produced a significantly larger ankle ROM and ankle velocity during push-off , and an increased plantar flexion moment and power generation at pre-swing compared to the PLS ( < 0.01 ) . The results of this study further support the findings of previous studies indicating that orthoses improve specific gait parameters compared to barefoot walking ( velocity , step length , first and second ankle rocker , sagittal knee and hip ROM ) . However , compared to shoes , not all improvements 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose To identify the characteristics of static st and ing balance and its postural control mechanisms during quiet side-by-side st and ing and the changes in these measures whilst wearing hinged ankle-foot orthoses ( AFOs ) in children with bilateral spastic cerebral palsy ( CP ) . Material s and Methods Twenty-one children with bilateral spastic CP ( 6.10 ± 1.09 year-old ) and 22 typically developing ( TD ) children ( 5.64 ± 0.49 year-old ) were recruited .  Pressure data were recorded while subjects with or without AFOs stood on dual force platforms and net body center of pressure ( CoP ) coordinates were calculated from this data . Net body CoP was traced for measuring mediolateral ( ML ) and anteroposterior ( AP ) displacement and path length per second . Correlation coefficients between parameters representing ankle , hip , and transverse body rotation strategies were also analyzed . Results ML and AP displacement and path length per second of the CoP trajectory were higher in children with CP compared to TD children ( p < 0.05 ) . There were no significant improvements in these parameters whilst wearing hinged AFOs . Compared to TD children , children with CP used less ankle strategy though more hip and transverse rotation strategies for postural control during quiet st and ing . Whilst wearing hinged AFOs , the contribution of ankle strategy was significantly increased for ML balance control in children with CP ( p < 0.05 ) . Conclusion Hinged AFOs for children with CP may be helpful in improving the postural control mechanisms but not the postural stability in quiet side-by-side st and ing This study compared the functional efficacy of three commonly prescribed ankle-foot orthosis ( AFO ) configurations ( solid [ SAFO ] , hinged [ HAFO ] , and posterior leaf spring [ PLS ] ) . Sixteen independently ambulatory children ( 10 males , six females ; mean age 8 years 4 months , SD 2 years 4 months ; range 4 years 4 months to 11 years 6 months ) with spastic diplegia participated in this study . Four children were classified at level I of the Gross Motor Function Classification System ( GMFCS ; Palisano et al. 1997 ) ; the remaining 12 were at level II . Children were assessed  barefoot ( BF ) at baseline ( baseline assessment of energy consumption was performed with shoes on , no AFO ) and in each orthotic configuration after three months of use , using gait analysis , oxygen consumption , and functional outcome measures . AFO use did not markedly alter joint kinematics or kinetics at the pelvis , hip , or knee . All AFO configurations normalized ankle kinematics in stance , increased step/stride length , decreased cadence , and decreased energy cost of walking . Functionally , all AFO configurations improved the execution of walking/running/jumping skills , upper extremity coordination , and fine motor speed/dexterity . However , the quality of gross motor skill performance and independence in mobility were unchanged . These results suggest that most children with spastic diplegia benefit functionally from AFO use . However , some children at GMFCS level II demonstrated a subtle but detrimental effect on function with HAFO use , shown by an increase in peak knee extensor moment in early stance , excessive ankle dorsiflexion , decreased walking velocity , and greater energy cost . Therefore , constraining ankle motion by using a PLS or SAFO should be considered for most , but not all , children with spastic diplegia Purpose : To examine the effect of ankle-foot orthoses ( AFO ) on walking activity in children with cerebral palsy ( CP ) . Methods : We used a r and omized cross-over design with 11 children with bilateral CP , mean age 4.3 years . Subjects were r and omized to current AFO-ON or AFO-OFF for 2 weeks and then crossed over . Walking activity ( average total steps/day ) , intensity , and stride rate curves were collected via an ankle accelerometer . Group effects were examined with the Wilcoxon signed-rank test and within-subject effects examined for more than 1 st and ard deviation change . Results : No significant group difference was found in average total daily step count between treatment conditions ( P = .48 ) . For the AFO-ON condition , 2 subjects ( 18 % ) increased total steps/day ; 4 ( 36 % ) increased walking time ; 2 ( 18 % ) had more strides at a rate of more than 30 strides/min ; and 2 ( 18 % ) reached higher peak intensity . Conclusions : Clinical ly prescribed AFO/footwear did not consistently enhance walking activity levels or intensity . Larger studies are warranted Twenty-one subjects with spastic diplegic cerebral palsy were studied to quantify the effects of fixed and articulated ankle-foot orthoses ( AFOs ) on gait and delineate criteria for their use . Children underwent gait analysis under three conditions , fixed AFOs ( FAFOs ) , articulated AFOs ( AAFOs ) , and shoes alone . Greater dorsiflexion occurred at initial contact with both FAFOs and AAFOs than shoes alone . Dorsiflexion at terminal stance was greatest in AAFOs . Plantarflexor power generation at preswing was preserved in AAFOs . No differences were found in knee position during stance . Knee-extensor strength was positively related to knee extension during stance . No relationships were found between dorsiflexion range of motion , calf spasticity and strength , and peak dorsiflexion during stance .  AAFOs are appropriate for subjects with varying degrees of calf spasticity , as long as adequate passive range of motion is available . These findings can be applied primarily to children who do not have a preexisting tendency to crouch The purpose of this study was to examine the effectiveness of the hinged ankle-foot orthosis ( HAFO ) , posterior leaf spring ( PLS ) , and solid ankle-foot orthosis ( SAFO ) , in preventing contracture , improving efficiency of gait , and enhancing performance of functional motor skills in 30 children ( 21 male , 9 female ; mean age 9 years 4 months ; age range 4 to 18 years , ) with spastic hemiplegia . Following a 3-month baseline period of no ankle-foot orthosis ( AFO ) use , each AFO was worn for 3 months after which ankle range of motion , gait analysis , energy consumption , and functional motor skills were assessed . The HAFO and PLS increased passive ankle dorsiflexion and normalization of ankle rocker function during gait . Normalization of knee motion in stance was dependent upon the knee abnormality present and AFO configuration . The HAFO was the most effective in controlling knee hyperextension in stance , while PLS was the most effective in promoting knee extension in children with > 10 degree knee flexion in stance . Energy efficiency was improved in 21 of the children , with 13 of these children demonstrating the greatest improvement in HAFO and PLS . Improvements in functional mobility were greatest in the HAFO and PLS BACKGROUND AND PURPOSE This study compared the effects of dynamic ankle-foot orthoses ( DAFOs ) with a plantar-flexion stop , polypropylene solid ankle-foot orthoses ( AFOs ) , and no AFOs on the gait of children with cerebral palsy ( CP ) . These orthoses were used to reduce the excessive ankle plantar flexion during the stance phase of gait . SUBJECTS AND METHODS Ten children with spastic CP ( 6 with diplegia and 4 with hemiplegia ) were tested after wearing no AFOs for an initial 2-week period , solid AFOs for 1 month , no AFOs for an additional 2 weeks , and DAFOs for 1 month . The effects of the two orthoses and no AFOs on lower-extremity muscle timing , joint motions , and temporal-distance characteristics were compared . RESULTS Both orthoses  increased stride length , decreased cadence , and reduced excessive ankle plantar flexion when compared with no orthoses . No differences were found for the gait variables when comparing the two orthoses . CONCLUSION AND DISCUSSION Based on the data , the authors believe that although both orthoses would be recommended for children with spastic CP and excessive ankle plantar flexion during stance , additional individual factors should be considered when selecting either orthosis Purpose : To compare dynamic ankle-foot orthoses ( DAFOs ) and adjustable dynamic response ( ADR ) ankle-foot orthoses ( AFOs ) in children with cerebral palsy . Methods : A total of 10 children with cerebral palsy ( 4 - 12 years ; 6 at Gross Motor Function Classification System level I , 4 at Gross Motor Function Classification System level III ) and crouch and /or equinus gait wore DAFOs and ADR-AFOs , each for 4 weeks , in r and omized order . Laboratory-based gait analysis , walking activity monitor , and parent-reported question naire outcomes were compared among braces and barefoot conditions . Results : Children demonstrated better stride length ( 11 - 12 cm ) , hip extension ( 2 ° -4 ° ) , and swing-phase dorsiflexion ( 9 ° -17 ° ) in both braces versus barefoot . Push-off power ( 0.3 W/kg ) and knee extension ( 5 ° ) were better in ADR-AFOs than in DAFOs . Parent satisfaction and walking activity ( 742 steps per day , 43 minutes per day ) were higher for DAFOs . Conclusions : ADR-AFOs  produce better knee extension and push-off power ;  DAFOs produce more normal ankle motion , greater parent satisfaction , and walking activity . Both braces provide improvements over barefoot Dynamic ankle-foot orthoses ( DAFOs ) , with free plantarflexion , are frequently prescribed to facilitate the gross motor skills of children with cerebral palsy . Employing a r and omized crossover design , this project documents the short-term effect of DAFOs in 23 ambulatory children with cerebral palsy aged 1.9 to 7.3 years . Significant improvements in crawling/kneeling , st and ing , and walking/running and jumping skills , as measured by using the Gross Motor Function Measure ( GMFM ) 88 and 66 , were documented ( P < 0.001 ) . Increased motor skills with the use of DAFOs were mildly correlated with the leg length of the participants . Increasing age was negatively correlated with st and ing skill improvement while wearing the DAFOs .  Young children who are independent walkers seem to benefit greater from the DAFOs with free plantarflexion than do children using assistive devices . Future research needs to clarify the long-term influence of the use of DAFOs on gross motor skill acquisition in young children with cerebral palsy OBJECTIVE To investigate the effectiveness of the hinged ankle-foot orthosis ( AFO ) on sit-to-st and ( STS ) transfers in children with spastic cerebral palsy . DESIGN Before-after trial . SETTING University-affiliated hospital . PARTICIPANTS Nineteen spastic diplegic children ( age range , 2 - 6 y ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The transitional movement of STS was tested in r and om order with children while wearing the barefoot and hinged AFOs . The temporal , kinematic , and kinetic data during the task were collected by using a motion analyzer ( with 6 infrared cameras ) . Statistical comparison between barefoot and hinged AFO was done with the Wilcoxon signed-rank test . RESULTS Total duration of STS transfer was significantly shortened with the hinged AFO ( P < .05 ) . The initial knee flexion , the initial angle , and the final angle of ankle dorsiflexion were increased with the AFO , compared with when barefoot ( P < .05 ) . However , the increased pelvic tilt and hip flexion while barefoot was not reduced with the AFO . The maximal moment and power of hip and knee joints were significantly increased with the AFO ( P < .05 ) , whereas the maximal moment and power of the ankle joint were not significantly changed when wearing the AFO . CONCLUSIONS Although proximal compensatory strategy of increased pelvic tilt and hip flexion did not change with the hinged AFO , some improvements of temporal , kinematic , and kinetic parameters were identified during the task . These findings suggest that a hinged AFO is beneficial for STS transfer activity for children with spastic diplegia Several studies indicated that walking with an ankle foot orthosis ( AFO ) impaired third rocker . The purpose of this study was to evaluate the effects of two types of orthoses , with similar goal setting s , on gait , in a homogeneous group of children , using both barefoot and shoe walking as control conditions . Fifteen children with hemiplegia , aged between 4 and 10 years , received two types of individually tuned AFOs : common posterior leaf-spring ( PLS ) and Dual Carbon Fiber Spring AFO ( CFO ) ( with carbon fibre at the dorsal part of the orthosis ) . Both orthoses were expected to prevent plantar flexion , thus improving first rocker , allowing dorsiflexion to improve second rocker , absorbing energy during second rocker , and returning it during the third rocker . The effect of the AFOs was studied using objective gait analysis , including 3D kinematics , and kinetics in four conditions : barefoot , shoes without AFO , and PLS and CFO combined with shoes . Several gait parameters significantly changed in shoe walking compared to barefoot walking ( cadence , ankle ROM and velocity , knee shock absorption , and knee angle in swing ) . The CFO produced a significantly larger ankle ROM and ankle velocity during push-off , and an increased plantar flexion moment and power generation at pre-swing compared to the PLS ( < 0.01 ) . The results of this study further support the findings of previous studies indicating that orthoses improve specific gait parameters compared to barefoot walking ( velocity , step length , first and second ankle rocker , sagittal knee and hip ROM ) . However , compared to shoes , not all improvements 
    Output:
    