A case series on the effect of dynamic neoprene orthosis on lower limb kinematic variables in children with cerebral palsy.

PURPOSE: This study examined the effects of a dynamic neoprene orthosis on kinematic variables of gait in children with spastic bilateral cerebral palsy (CP). METHODS: Five children (whose median age was 9.6 years and who ranged in age from six to 12) with spastic bilateral CP and flexed knee at levels I-III of the Gross Motor Function Classification System were examined using kinematic gait analysis in three different conditions: 1) with dynamic neoprene orthosis; 2) without dynamic neoprene orthosis (immediate effect); and 3) without orthosis after six weeks of intervention. RESULTS: The comparison between condition one (with dynamic neoprene orthosis) and condition two (without dynamic neoprene orthosis) demonstrated the existence of improvements in minimum hip and knee flexion variables. Moreover, the results indicated that the improvements remained constant in several key gait variables after six weeks. CONCLUSION: The results varied from subject to subject, and there were signs of improvement in some of the subjects. Therefore, it was not possible to draw conclusions at a group level. Nonetheless, a number of individuals may benefit from this type of orthosis.

The Frequency and Manifestations of Ocular Causes of Abnormal Head Posture.

PURPOSE: To determine the frequency and manifestations of different ocular causes of abnormal head posture (AHP). METHOD: This prospective, consecutive case series study was performed on 149 patients with ocular AHP at Farabi hospital, Iran, from February 2020 to June 2021. All patients underwent routine ophthalmic examinations. The manifestation of AHP was determined by direct observation from three viewing angles, while the patient read the smallest line on the vision chart that they could see. In front, above, and lateral gazes, observations were performed to find head tilt, head turn, and chin abnormal position, respectively. A picture with habitual AHP was taken from all patients. The amount of head tilt was measured by calculating the angle between the line that connects the lips center to the center of the eyebrows and the vertical line using the Corel Draw X7 computer software. RESULTS: The mean age of 149 patients with ocular AHP [101 (67.8%) males and 48 (32.2%) females] was 16.2 ± 12.2 (range, 2-57) years. The most common ocular sources of AHP were found to be superior oblique palsy (SOP) in 66 (44.3%) patients, 54 (36.2%) cases with Duane's retraction syndrome (DRS), and 12 (8.1%) patients with nystagmus. Other frequent causes of ocular AHP were dissociated vertical deviation (DVD) in 5 (3.4%), A and V pattern strabismus in 3 (2.0%), and 2 cases (1.3%) in each of Brown syndrome, inferior rectus (IR) palsy, and congenital fibrosis of the extraocular muscles (CFEOM). The most common manifestations of AHP in all cases were "pure head turn" (48.3%), followed by "pure head tilt" (24.8%), "simultaneous head tilt and head turn" (20.8%), and "chin up" (6.0%). The mean head tilt among all patients with head tilt was 10.4° ± 8.9° (range, 5.0°-31.7°). CONCLUSION: The most frequent ocular sources of AHP were SOP, DRS, and nystagmus, followed by DVD, A and V pattern strabismus, IR palsy, CFEOM, and Brown syndrome. In addition, pure head turn and pure head tilt were the most common manifestations of ocular AHP but were not always seen in the same direction or combination as previously reported with these etiologies.

The effect of online visual games on visual perception, oculomotor, and balance skills of children with developmental dyslexia during the COVID-19 pandemic.

PURPOSE: To evaluate the effect of online visual games on the balance, visual perception, and oculomotor skills of children with developmental dyslexia during the COVID-19 pandemic. METHODS: In this single-blind randomized clinical trial, 50 children with developmental dyslexia, aged 7 to 11 years, were recruited from rehabilitation centers in Tehran, Iran, using a convenience sampling strategy. Participants were randomly divided into two groups: intervention (25) and control (25), with close matching based on sex, age, IQ, and type of disease. The interventions consisted of web-based online computer games focusing on visual perception and oculomotor skills. Outcome measures included the Test of Visual Perception Skills-Revised, the Pediatric Balance Scale, and videonystagmography. The Wechsler Intelligence Scale for Children-IV and the Reading and Dyslexia Test were used to evaluate IQ and reading skills, respectively. RESULTS: The intervention group exhibited significant post-intervention improvements in the Test of Visual Perception Skills-Revised, tracking gain, saccade latency, and saccade velocity scores (all P < 0.001). In contrast, the control group showed no significant differences in these tests in pre- and post-intervention (all P > 0.05). Notably, post-intervention comparisons between the groups revealed significant differences in smooth pursuit eye movements (P < 0.001), saccade latency (P = 0.027), and saccade velocity (P < 0.001). The Pediatric Balance Scale scores remained unchanged in both groups post-intervention (intervention: P = 0.317; control: P = 0.999). Game face validity was affirmed with impact scores above 1.5 for all items, suggesting that the games were straightforward, clear, and relevant. CONCLUSION: Online visual games enhanced oculomotor and visual perception skills in children with dyslexia but did not influence balance skills.

Glottal Function Index: Validity and Reliability of the Persian Language Version in Patients With Voice Disorders.

OBJECTIVE: To translate and cross-culturally adapt the Glottal Function Index into the Persian language (GFIp) and validate it in patients with voice disorders. STUDY DESIGN: A cross-sectional and prospective validation design was adopted. METHOD: The GFI was translated and culturally adapted into Persian language according to the methodology of standard forward-backward translations to obtain semantic, idiomatic, and conceptual equivalence. One hundred patients with voice disorders (53 men; mean age: 41.4 ± 13.6 years) and 40 healthy volunteers (21 women; mean age: 36.7 ± 10.0 years) completed the GFIp. Patients with voice disorders also completed the Persian Voice Handicap Index (VHIp) to assess the construct validity. RESULTS: There were no floor and ceiling effects. Evidence for construct validity was found with a significant very good correlation between the GFIp and the VHIp total scores (r = 0.70; P < 0.001). Differences of GFIp scores between the patients and healthy participants were statistically significant (P < 0.001) confirming discriminant validity. The internal consistency reliability was acceptable for GFIp (Cronbach's α = 0.74). Absolute reliability measures of Standard Error of Measurement and the Smallest Detectable Change for GFIp were 2.5 (confidence interval 95% = ±4.9) and 6.93, respectively. Factor analysis revealed the GFIp as a single factor instrument. CONCLUSION: The GFIp is a valid and reliable self-administered instrument for use in Persian-speaking patients with voice disorders.

Cognitive Orientation to Daily Occupational Performance (CO-OP) in Children with Cerebral Palsy: A Systematic Review with Meta-analysis.

Background: Cognitive orientation to daily occupational performance (CO-OP) is a client-centered treatment approach that was developed in the 1990s by occupational therapists. Purpose: Exploring current evidence about the effectiveness of CO-OP on children with cerebral palsy (CP). Method: Major electronic databases were searched. A narrative synthesis of current literature and meta-analyses on randomized control trials (RCTs) were conducted on changes in occupational performance. Findings: Seven studies with 103 participants were included. Four studies were RCTs with moderate levels of evidence, and three studies had single-subject designs. Although beneficial effects of CO-OP on goal achievement and transferring learned skills were reported, meta-analyses showed that CO-OP had no significant effect on the performance (WMD = 1.52, 95% CI = -1.58 to 4.63, P = .33) and satisfaction domains (WMD = 1.71, 95% CI = -1.14 to 4.57, P = .24) of Canadian Occupational Performance Measure scores compared to alternative interventions. Implications: CO-OP improves occupational performance but not more than alternative interventions. Results are inconclusive due to small sample sizes and heterogeneity of alternative interventions and participants. Therefore, research with a larger number of participants with sound RCT methods is needed.

Occupational Performance Outcome for Survivors of Childhood Cancer: Feasibility of the Canadian Occupational Performance Measure.

The aim of the study was to determine the feasibility of the Persian version of the Canadian Occupational Performance Measure (COPM) to assess self-reported occupational performance in a group of children with cancer at least one-year post-cancer diagnosis and intervention and to describe the self-reported occupational performance problems of children with cancer. Forty-three children with cancer (mean age 11.59 years; SD 4.94) participated in a cross-sectional study, using a convenience sampling approach. Performance and satisfaction were assessed through a validated Persian version of the COPM and feasibility and ease of administration were also considered. This study showed that feasibility was found to be adequate and this measurement was perceived as easy to understand; completion took from 20 to 51 minutes. Children with cancer prioritized 115 occupations within six of the nine COPM subcategories. Among the prioritized occupations, the highest number was found in self-care 61.7%, followed by productivity (26%), and leisure (12.1%). The mean ratings of performance varied from 3.7 to 8.4. The lowest mean rating was in the subgroup play/school (3.7). For satisfaction, the mean ratings were from 2.6 to 5.2, with functional mobility as the highest and play/school the lowest. The results support the use of the COPM in clinical practice for children with cancer. Based on these findings, children with cancer perceive problems with occupations related to all aspects of daily life. This underlines the need to provide rehabilitation services, especially occupational therapy services for these children.

Need to Perform Rehabilitation Exercises at Home by Parents of Children with Neurological Diseases to Maintain Performance During COVID-19 Lockdown.

With the outbreak of the novel pandemic coronavirus disease 2019 worldwide, numerous pediatric rehabilitation clinics have closed to support social and physical distancing, and therapists similar to other individuals are staying at their homes. There is a common concern of parents and caregivers that how and with what quality children's rehabilitation exercises should proceed. Most children with neurological diseases have problems, such as muscle spasticity, range of motion (ROM) limitation, muscle shortening, balance loss, and mobility and movement impairments. The normalization of muscle tone, preservation of ROM, muscle stretch, and improvement of fine and gross motor skills and balance are essential activities that need to be considered. Therefore, this study aimed to summarize the necessities of a home-based rehabilitation exercise program during the quarantine period.

The Relationship Between Functional Motor Status and Self-evaluation in Individuals With Cerebral Palsy: A Systematic Review.

Cerebral palsy (CP) is a common pediatric disorder that results in a wide range of motor and functional problems that impose mobility limitations, decrease the quality of movement, negatively affect physical activity participation, self-care, and academic performance, and ultimately result in social isolation and negative self-evaluation. Despite abundant evidence of motor function, very few studies investigated all aspects of self-evaluation or described the relationship between motor function and self in individuals with CP. The present study aimed at investigating the relationship between functional motor status and self-evaluation in individuals with CP. A systematic search was performed in six electronic databases (PubMed, Scopus, ProQuest, OTseeker, Web of Sciences, and Google Scholar) for English language articles from any date to May 2019. Screening, selection, and quality assessment were conducted by two authors independently. All studies recruiting individuals with CP and using functional motor status and self-evaluation tests were included. The AXIS checklist was used for the quality assessment of included studies. As all data sources were generated by published studies, ethical approval was not applicable to the present study. Seven articles met the inclusion criteria. These studies investigated the relationship between functional motor status and self-esteem and self-concept. Based on the AXIS, three articles were identified as high quality and four as low quality. The result of the present review showed that there was no relationship between self-concept and functional motor status in individuals with CP, while there was a significant relationship between self-esteem and functional motor status. More studies are required to shed light on other aspects of self and relationship of self-evaluation with motor function in individuals with CP.

Convention on the rights of persons with disabilities: Qualitative exploration of barriers to the implementation of articles 25 (health) and 26 (rehabilitation) in Iran.

Background: The International Convention on the Rights of Persons with Disabilities (CRPD) is the most important International Document for recognizing the rights of persons with disabilities, including the right to health and rehabilitation. Islamic Republic Iran acceded to the Convention in 2008, but still has a long way to go to achieve its desired status and in line with the objectives of the convention. This study aimed to identify the barriers to the implementation of articles 25 and 26 of the CRPD in Iran. Methods: This study was performed using conventional content analysis. Twenty-one individuals were recruited by purposive sampling with maximum variation and were continued until saturation. Data were gathered through in-depth, semi-structured interviews from June 2018 to May 2019. MAXQDA version 10 was used for analyzing data. Results: The resulting data analysis yielded 860 initial or open codes. The concepts were categorized into 27 subcategories and 7 categories. Main categories were included: "Structure inefficiency", "lack of comprehensive rehabilitation program", "inadequate awareness", "neglected economy of people with disabilities", "weak access to services", "cultural challenges" and "disregard for new technologies". Conclusion: The findings showed that the executive structures in the country have a lot of problems with health and rehabilitation programs for people with disabilities. It seems understanding the barriers to implementation of articles 25 and 26 of the international CRPD empowers officials in the field and improve services by providing a better view of the disabled. Nevertheless, it is recommended for policymakers to consider rehabilitation as a main element of the health system.

Comparison of the effect of foot reflexology and body massage on physiological indicators and bilirubin levels in neonates under phototherapy.

BACKGROUND: Hyperbilirubinemia is one of the most common problems in infancy in the world. The aim of this study was to compare the effect of foot therapy and body massage on physiological indicators and bilirubin levels in infants under phototherapy. METHODS: This study was a randomized clinical trial that conducted on 51 infants with jaundice at Imam Hussein Pediatrics' Medical Center, Goldis Hospital in Isfahan (Iran). The samples randomly assigned to first intervention (reflexology), second intervention (body massage) and control groups using the block randomization. In the reflexology group, the relevant area on each foot was massaged for 15 min in a relaxed position. In the massage body group, the limbs were massaged with circular motion. The massage was performed once a day for 15 min and the control group did not receive any intervention. Physiological indicators were monitored using vital sign monitoring tools, and blood bilirubin levels were measured photo metrically (intravenous blood samples from the wrist). Finally, the data were analyzed using descriptive and inferential statistics and SPSS software version 18. RESULTS: The results showed that before the intervention there was no significant difference in the mean of physiological indicators and bilirubin level between the three groups (p > 0.05), but after the intervention the average percentage of arterial oxygen saturation and bilirubin levels were significantly improved in the intervention groups compared to the control group (p < 0.05), while the mean of heart rate and respiration rate between the three groups were not significant (p > 0.05). CONCLUSION: The results showed that reflexology and massage therapy can be effective in improving the condition of physiological indicators and blood bilirubin levels.

Effect of Mirror Therapy on Dexterity and Hand Grasp in Children Aged 9-14 Years with Hemiplegic Cerebral Palsy.

OBJECTIVES: Mirror therapy using visual feedback is one of the non-invasive methods along with other commonly used rehabilitation treatments for neurological patients which therapeutic effects on the affected upper limb of children with hemiplegic cerebral palsy have also been studied. We aimed to examine the effect of mirror therapy on improving the dexterity and grasp of children with hemiplegic cerebral palsy. MATERIALS & METHODS: In this single-blind clinical trial, 30 children with hemiplegic cerebral palsy in rehabilitation centers and special schools of Tabriz, northwest of Iran were randomly divided into two intervention and control groups in 2017. The children of the intervention group were under mirror therapy for 6 weeks. Occupational therapy exercise was done routinely for both groups. The grasp with dynamometer and the dexterity with box and block was measured. Data were analyzed using independent t-test and paired t-test. RESULTS: The mean scores of the two groups in dexterity were significantly different after the intervention (P=0.008). However, there was no significant difference between the two groups in grasp. CONCLUSION: Mirror therapy in hemiplegic children is useful in improving the dexterity but not in improving of the grasp.

Occupational performance of individuals with Multiple Sclerosis based on disability level in Iran.

Background: Multiple sclerosis (MS) is a common disease across the world as well as in Iran. Individuals with MS usually experience occupational performance problems that result in limitations in their daily life. This study aimed to determine the occupational performance of individuals with MS based on the disability level in Iran. Methods: In this cross-sectional study, 50 individuals with MS (20 to 50 years old) were recruited through a convenience sampling strategy from different clinics in Arak City, Iran, during 2016-2017. The Persian versions of Canadian Occupational Performance Measure (COPM) and Expanded Disability Status Scale (EDSS) were used to assess the status of occupational performance and level of disability. The data were analyzed using chi-square, Spearman's rank correlation, and Mann-Whitney U tests. Results: The total number of 248 occupations were identified as difficult to perform in the following areas: 125 (50.40%) in self-care, 58 (23.38%) in productivity, and 65 (26.20%) in leisure. In addition, the prioritized occupations (n = 149, median: 3, range: 1-4) had significant difference in the distribution of occupations compared with the non-prioritized occupations (P < 0.0001) and the ratings for performances and satisfactions were generally low. There were significant differences between the occupational performance and level of EDSS. Conclusion: The findings of current study suggest that individuals with MS suffer from widespread problems in the areas of occupational performance, particularly in self-care. The findings emphasize the need for identifying the problems of daily occupations in individuals with MS.

The Effect of Kinesio Taping on Handgrip and Active Range of Motion of Hand in Children with Cerebral Palsy.

OBJECTIVE: Kinesio taping is a relatively new technique, which uses in rehabilitation of neurologic diseases. The aim of this study was to investigate the effects of Kinesio taping on hand grip and active range of motion of hand in children with cerebral palsy (CP). MATERIALS AND METHODS: In this experimental study with pre-test and three post-tests, 32 children with CP randomly were placed in experimental (n=17) and control group (n=15).Kinesio taping was applied on dorsum of forearm and hand. Evaluation was performed initially, two days after taping and two days after tape removal. Goniometer was used to evaluate active range of motion of wrist extension. In addition, vigorimeter was used to evaluate of grip strength. RESULTS: In pre-test, there was no difference between groups but in post-tests; initially after application of taping with P<0.05, two days after application of taping with P<0.05 and follow-up (two days after removed taping) with P<0.05 were significant differences between trial and control group. CONCLUSION: Kinesio taping in neurorehabilitation of children with CP can be a useful option to promote power or grip strength and active range of motion of wrist and thumb.

Exploring perceptions of health caregivers on the causes of caregivers' occupational burnout in institutes of children with cerebral palsy: A qualitative study.

BACKGROUND: Providing care for children with cerebral palsy (CP) is hard, energy-consuming, and long-term. Consequently, occupational burnout is highly probable for caregivers. OBJECTIVE: This study aimed to explore the perception of health caregivers regarding the causes of caregivers' occupational burnout in institutes of children with CP. METHODS: This qualitative study was conducted using content analysis methodology during an eight-month period in 2016. Nine caregivers, two managers, and one physiotherapist participated in the study. Purposive sampling method was used to select participants. In depth, semi-structure interviews were used to gather the data. All interviews were conducted at their workplace, in Tehran, Iran. The interviews were recorded, transcribed verbatim, and overviewed. Constant comparative analyses were used to analyze the interviews. RESULTS: The results were categorized into three main categories and nine sub-categories. The main categories were as follows: care-related stress, nature of caring occupation, and organizational demands and resources. CONCLUSION: Results of this study showed that several factors are involved in creating burnout among caregivers. The exploration of these factors may help us in designing appropriate interventions for caregivers to correctly implement caring activities so that they less suffer from care-related pressures and also become able to allocate some time for their own activities of interest and for recreational, social, and family activities.

The effect of an android-based application on the knowledge of the caregivers of children with cerebral palsy.

Background: Mobile health and e-learning may have a significant impact on training patients, physicians, students and caregivers. This study aimed to evaluate the effect of using an educational mobile application on the knowledge of the caregivers of children with cerebral palsy (CP). Methods: We used a previously developed mobile application. The knowledge of 17 caregivers of children with CP (including parents) about the daily care of their children was evaluated through a self-assessment and a test with multiple-choice and true-false questions. Next, the application, which included several educational modules for the daily care of the children with CP, was given to the caregivers to use continually for two months. After this period, the knowledge of the caregivers was evaluated by the same tools. Data analysis was performed by SPSS-16, using paired-sample t-test or Wilcoxon test. Results: The effect of the use of this educational application on the knowledge of caregivers in all childcare domains, except for eating, was reported to be significant (p<0.05). Furthermore, the results of the multiplechoice test revealed that this application increased the knowledge of caregivers in all domains except playing (p<0.05). Conclusion: Training through novel technologies such as Smartphone along with their applications can improve the knowledge of caregivers about the daily care of children with cerebral palsy.

The impact of Kinesio taping technique on children with cerebral palsy.

Cerebral palsy (CP) is the most common movement disorder in children that is associated with life-long disability and multiple impairments. The clinical manifestations of CP vary among children. CP is accompanied by a wide range of problems and has a broad spectrum. Children with CP demonstrate poor fine and dross motor function due to psychomotor disturbances. Early rehabilitation programs are essential for children with CP and should be appropriate for the age and functional condition of the patients. Kinesio taping (KT) technique is a relatively new technique applied in rehabilitation programs of CP. This article reviews the effects of KT techniques on improving motor skills in children with CP. In this study, we used keywords "cerebral palsy, Kinesio Tape, KT and Taping" in the national and international electronic databases between 1999 and 2016. Out of the 43 articles obtained, 21 studies met the inclusion criteria. There are several different applications about KT technique in children with CP. Review of the literature demonstrated that the impact of this technique on gross and fine motor function and dynamic activities is more effective than postural and static activities. Also this technique has more effectiveness in the child at higher developmental and motor stages. The majority of consistent findings showed that KT technique as part of a multimodal therapy program can be effective in the rehabilitation of children with CP to improve motor function and dynamic activities especially in higher developmental and motor stages.

Quality of life in mothers of children with cerebral palsy: The role of children's gross motor function.

Four hundred and twenty-four Iranian mothers of children with cerebral palsy (CP) were recruited using the convenience sampling approach in a cross-sectional study. The researchers assessed the quality of life (QOL) in mothers according to the gross motor function levels and types of CP. The evaluation was done using a well-validated Persian version of the 36-item Short Form Health Survey (SF-36) questionnaire. In 2012, demographic data and clinical relevant information were also collected in rehabilitation clinics affiliated to Tehran University of Medical Sciences. The results indicated that the mean score for the study sample on physical component summary (PCS) and mental component summary (MCS) was 39.21 and 41.23, respectively. This suggests that participants considered themselves to have a low QOL (p < .05). The mean PCS scores for SF-36 were significantly different between mothers having CP children of different age, levels of motor function, and CP types (p < .05 and p < .01, respectively). The results indicate that mothers of children with CP suffer from poor physical and mental health. Therefore, particular attention should be paid to the QOL in mothers of children with CP, and rehabilitation professionals should offer supportive strategies to promote aspects of their QOL.

Social participation experiences of mothers of children with cerebral palsy in an Iranian context.

BACKGROUND/AIM: Social participation is increasingly of interest in research that investigates the impact of caring for a child with a disability. Little has been investigated about the social participation experiences of mothers of children with cerebral palsy (CP). This study explored social participation among Iranian mothers of children with CP. METHODS: The conventional qualitative content analysis method was utilised. Data were collected via in-depth semi-structured interviews with 14 mothers (aged 26-45 years) of children with CP with the gross motor function classification system expanded & revised levels III-V. Constant comparative analysis was deployed for data analysis. RESULTS: The results were identified and classified into three main themes: (i) polarisation of positive and negative feelings; (ii) challenges to mothers' social activity; and (iii) striving to engage in society. CONCLUSION: In the Iranian context, mothers of children with CP are facing many challenges to social participation and seem to have been neglected by the health-care system. One of the priorities of Iranian health policy makers may be developing, establishing and implementing social support to enable the mothers to participate in social activities. Furthermore, occupational therapists can contribute and guide mothers' social participation by creating programs to develop and utilise skills for them.

Occupational therapists and patients' rights: their level of Clinical knowledge.

Addressing patients' rights issues brings occupational therapists ethical and political responsibilities that involve patients' privileges and new facilitating factors which influence their needs. The goal of this study was to determine the level of occupational therapists' knowledge about patients' rights. The present research was a cross-sectional study which involved 125 occupational therapists chosen by a convenience sampling strategy in Tehran during the year of 2012. A four-part questionnaire was used for data collection, and the degree of the subjects' self-assessment of their knowledge was measured based on the obtained numbers of correct answers in the third part. The validity and reliability of this questionnaire were assessed prior to its being distributed among participants. The results demonstrated no significant association between the level of occupational therapists' knowledge about patients' rights and their existing experiences within their areas of occupational therapy (P>0.05). Based on the result, 53.6% of the respondents had high level of knowledge about patients' rights. Facilitating factors which influence the attainment of patients' rights were classified into three groups: organizations, therapists and clients. The results of the present research demonstrated that the level of occupational therapists' knowledge about patients' rights were high. Furthermore, this study showed that for optimal result, there is a need to provide milieu for observing the patients' rights in clinical occupational therapy services.

The impacts of hinged and solid ankle-foot orthoses on standing and walking in children with spastic diplegia.

OBJECTIVE: The purpose of this study was to examine the impacts of hinged and solid anklefoot orthoses (AFOs) on standing and walking abilities in children with spastic diplegia. MATERIALS & METHODS: In a quasi-experimental design, 30 children with spastic diplegia, aged 4-6 years were recruited. They were matched in terms of age, IQ, and level of GMFCS E&R. Children were randomly assigned into 3 groups: a hinged AFO group (n=10) plus occupational therapy (OT), a solid AFO group (n=10) plus OT, a control group who used only OT for three months. Gross motor abilities were measured using Gross Motor Measure Function (GMFM). RESULTS: We obtained statistically significant differences in the values between baseline and after treatment in all groups. The groups were also significantly different in total GMFM after intervention. Furthermore, there were differences between hinged AFOs and solid AFOs groups, and between hinged AFOs and control groups. CONCLUSION: We concluded that gross motor function was improved in all groups; however, hinged AFOs group appears to improve the gross motor function better than solid AFOs and control groups.