Open Access Highly Accessed Study protocol

Splint: the efficacy of orthotic management in rest to prevent equinus in children with cerebral palsy, a randomised controlled trial

Josina C Maas1*, Annet J Dallmeijer1, Peter A Huijing2, Janice E Brunstrom-Hernandez3, Petra J van Kampen4, Richard T Jaspers2 and Jules G Becher1

  • * Corresponding author: Josina C Maas

  • † Equal contributors

Author Affiliations

1 Department of Rehabilitation Medicine and the EGMO+ Institute for Health and Care Research and Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

2 Faculty of Human Movement Sciences and Research Institute MOVE, VU University, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

3 Departments of Neurology and Pediatrics, Washington University School of Medicine, St, Louis Children's Hospital, St. Louis, MO MO 63110, USA

4 Medical Rehabilitation Center 'Groot Klimmendaal', Heijenoordseweg 5, 6813 GG Arnhem, The Netherlands

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BMC Pediatrics 2012, 12:38  doi:10.1186/1471-2431-12-38

Published: 26 March 2012



Range of motion deficits of the lower extremity occur in about the half of the children with spastic cerebral palsy (CP). Over time, these impairments can cause joint deformities and deviations in the children's gait pattern, leading to limitations in moblity. Preventing a loss of range of motion is important in order to reduce secondary activity limitations and joint deformities. Sustained muscle stretch, imposed by orthotic management in rest, might be an effective method of preventing a decrease in range of motion. However, no controlled study has been performed.


A single blind randomised controlled trial will be performed in 66 children with spastic CP, divided over three groups with each 22 participants. Two groups will be treated for 1 year with orthoses to prevent a decrease in range of motion in the ankle (either with static or dynamic knee-ankle-foot-orthoses) and a third group will be included as a control group and will receive usual care (physical therapy, manual stretching). Measurements will be performed at baseline and at 3, 6, 9 and 12 months after treatment allocation. The primary outcome measure will be ankle dorsiflexion at full knee extension, measured with a custom designed hand held dynamometer. Secondary outcome measures will be i) ankle and knee flexion during gait and ii) gross motor function. Furthermore, to gain more insight in the working mechanism of the orthotic management in rest, morphological parameters like achilles tendon length, muscle belly length, muscle fascicle length, muscle physiological cross sectional area length and fascicle pennation angle will be measured in a subgroup of 18 participants using a 3D imaging technique.


This randomised controlled trial will provide more insight into the efficacy of orthotic management in rest and the working mechanisms behind this treatment. The results of this study could lead to improved treatments.

Trial Registration Number

Nederlands Trial Register NTR2091

Cerebral Palsy; Orthotic management in rest; Knee-ankle-foot orthoses; Ankle dorsiflexion range of motion; Prevention; Gastrocnemius muscle; Muscle morphology; Growth