Efficacy of Solid Versus Ground Reaction Ankle Foot Orthosis on Muscular Activity in Children with Spastic Diplegic Cerebral Palsy

Mohamed El Sayed Madbouly1,2*, Khaled Ahmed Olama1, Mahmoud Samir Mohamed1

1Physical Therapy for Pediatrics Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
2Physical Therapy for Pediatrics Department, Faculty of Physical Therapy, Al Salam University in Egypt, Kafr Al-Zayyat, Egypt.

Received: 16th Dec, 2025; Revised: 8th Feb 2026; Accepted: 12th Feb, 2026; Available Online: 28th Feb, 2026

ABSTRACT

Background: The most prevalent cause of motor disability in infants is cerebral palsy (CP). Physiotherapy and orthotic interventions are regarded as essential components of multimodal management for CP. We aimed to detect the impact of solid ankle foot orthosis (SAFO) and ground reaction ankle foot orthosis (GRAFO) on muscle activity in spastic diplegic CP Gross Motor Function Classification Scale (GMFCS) II children.

Methods: A cross-sectional study was started in February 2024 and it was conducted on 60 children aged 6 to 12 years, both sexes, with spastic diplegic CP and postural instability, GMFCS level II, spasticity level II in lower limb muscles according to the Modified Ashworth Scale, There are no fixed contractures, and passive range of motion (ROM) is preserved., mild spasticity in the gastrocnemius, and able to follow simple instructions. All children were subjected to full history taking and the following scales: Modified Ashworth Scale (MAS) and GMFCS used to rate muscle spasticity. Surface electromyography data were obtained from four muscles on both sides of the body, (Rectus Femoris, Semitendinosus, Medial Gastrocnemius, and Tibialis Anterior) during three ankle-foot conditions: barefoot during quiet standing, quiet standing wearing SAFO, and quiet standing wearing GRAFO.

Results: There was a significant difference in electromyography (EMG) amplitude between barefoot (BF), wearing SAFOs, and wearing GRAFOs (p = 0.001). There was a significant decrease in EMG amplitude across multiple muscle groups when wearing SAFOs compared with BF, between BF and GRAFOs, and when GRAFOs were compared with SAFOs (p = 0.001).

Conclusions: The use of GRAFOs significantly reduces EMG amplitude across multiple muscle groups compared to SAFOs.

Keywords: Spastic Diplegic Cerebral Palsy, Ground Reaction Ankle Foot Orthosis, Solid Ankle Foot Orthosis, Muscular Activity, Electromyography.

How to cite this article: Madbouly MES, Olama KA and Mohamed MSM, Efficacy of Solid Versus Ground Reaction Ankle Foot Orthosis on Muscular Activity in Children with Spastic Diplegic Cerebral Palsy. Int J Drug Deliv Technol. 2026;16(5s): 47-52. DOI: 10.25258/ijddt.16.5s.6