Innovative Design and Development of Personalized Ankle-Foot Orthoses for Survivors of Stroke With Equinovarus Foot: Protocol for a Feasibility and Comparative Trial.

BACKGROUND: Ankle-foot orthoses (AFOs) are vital in gait rehabilitation for patients with stroke. However, many conventional AFO designs may not offer the required precision for optimized patient outcomes. With the advent of 3D scanning and printing technology, there is potential for more individualized AFO solutions, aiming to enhance the rehabilitative process. OBJECTIVE: This nonrandomized trial seeks to introduce and validate a novel system for AFO design tailored to patients with stroke. By leveraging the capabilities of 3D scanning and bespoke software solutions, the aim is to produce orthoses that might surpass conventional designs in terms of biomechanical effectiveness and patient satisfaction. METHODS: A distinctive 3D scanner, complemented by specialized software, will be developed to accurately capture the biomechanical data of leg movements during gait in patients with stroke. The acquired data will subsequently guide the creation of patient-specific AFO designs. These personalized orthoses will be provided to participants, and their efficacy will be compared with traditional AFO models. The qualitative dimensions of this experience will be evaluated using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST) assessment tool. Feedback from health care professionals and the participants will be considered throughout the trial to ensure a rounded understanding of the system's implications. RESULTS: Spatial-temporal parameters will be statistically compared using paired t tests to determine significant differences between walking with the personalized orthosis, the existing orthosis, and barefoot conditions. Significant differences will be identified based on P values, with P<.05 indicating statistical significance. The Statistical Parametric Mapping method will be applied to graphically compare kinematic and kinetic data across the entire gait cycle. QUEST responses will undergo statistical analysis to evaluate patient satisfaction, with scores ranging from 1 (not satisfied) to 5 (very satisfied). Satisfaction scores will be presented as mean and SD values. Significant variations in satisfaction levels between the personalized and existing orthosis will be assessed using a Wilcoxon signed rank test. The anticipation is that the AFOs crafted through this innovative system will either match or outperform existing orthoses in use, with higher patient satisfaction rates. CONCLUSIONS: Embracing the synergy of technology and biomechanics may hold the key to revolutionizing orthotic design, with the potential to set new standards in patient-centered orthotic solutions. However, as with all innovations, a balanced approach, considering both the technological possibilities and individual patient needs, will be paramount to achieving optimal outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52365.

Comparison of the efficacy of thoracolumbosacral and lumbosacral orthosis for adolescent idiopathic scoliosis in patients with major thoracolumbar or lumbar curves: a prospective controlled study.

Introduction: Thoracolumbosacral orthosis (TLSO) is the most commonly used type of brace for the conservative treatment of adolescent idiopathic scoliosis (AIS). Although lumbosacral orthosis (LSO) is designed to correct single thoracolumbar or lumbar (TL/L) curves, its effectiveness remains underexplored. This novel article aims to compare the effectiveness of LSO with TLSO in treating AIS with main TL/L curves. Methods: This prospective controlled cohort study enrolled patients with AIS with main TL/L curves and minor thoracic curves who were treated with either TLSO or LSO. Demographic and radiographic data were compared between the two groups. Treatment outcomes were also assessed. Risk factors for minor curve progression were identified, and a cut-off value was determined within the LSO group. Results: Overall, 82 patients were recruited, including 44 in the TLSO group and 38 in the LSO group. The initial TL/L curves showed no difference between both groups. However, the baseline thoracic curves were significantly larger in the TLSO group compared to the LSO group (25.98° ± 7.47° vs. 18.71° ± 5.95°, P < 0.001). At the last follow-up, LSO demonstrated similar effectiveness to TLSO in treating TL/L curves but was less effective for thoracic curves. The initial magnitude of thoracic curves was identified as a risk factor for minor curve outcomes in the LSO group. The ROC curve analysis determined a cut-off value of 21° for thoracic curves to predict treatment outcomes. Discussion: In contrast to TLSO, LSO exhibits comparable effectiveness in treating main TL/L curves, making it a viable clinical option; however, it is less effective for thoracic minor curves. The initial magnitude of the minor thoracic curves may guide the selection of the appropriate brace type for patients with AIS with main TL/L curves.

Pragmatic Neurorehabilitation Approach for Improving Quality of Life in Duchenne Muscular Dystrophy: A Case Report.

This case report provides insights into the physiotherapy management of a 12-year-old male with Duchenne muscular dystrophy (DMD). DMD is a devastating genetic disorder characterized by progressive muscle degeneration and weakness. Skeletal muscle degeneration is induced by a genetic disorder. It is a common X-linked condition that causes hypertrophy of the calves and proximal muscular weakness in children. It frequently results in early mortality, wheelchair confinement, and delays in motor development. Physiotherapy interventions aim to optimize functional abilities and quality of life in individuals with DMD. This case report highlights the effectiveness of physiotherapy in managing DMD progression. This study presents a case exhibiting notable clinical symptoms, highlighting the urgency for advanced treatments to combat this debilitating disease. Outcome measures such as body mass index, spirometry, manual muscle testing, and the World Health Organization Quality-of-Life scale are used to report patient progress. The treatment plan was carried out for six weeks, five times a week. Physiotherapy strategies include diet management, stretching and splinting techniques, and pulmonary training. While current treatments focus on symptom management, ongoing research holds promise for the development of more effective therapies to improve outcomes and quality of life for affected individuals. Multidisciplinary care, including neurophysiotherapy rehabilitation, plays a crucial role in managing the symptoms and complications of DMD, emphasizing the importance of comprehensive support for patients and their families. At the end of our rehabilitation, the patient showed significant improvement in the outcome measures.

Posterior neck weighting an innovative and novel head orthosis for forward head posture correction: Randomized controlled trial.

Background: Muscle activity of the anterior and posterior elements of the cervical spine, both together actively contribute to the balance of the head position over the neck. Increasing muscular tension of the one cervical muscle group could induce poor motor control of cervical spine joints, this might contribute to the anterior position of the head with neck, known as forward head posture (FHP). We propose posterior neck weighting as an innovative orthosis to correct head posture within FHP participants and improve co-related mechanical neck pain. Methods: Sixty-one participants with FHP; were randomly assigned to one of two groups posterior cervical weighing orthosis (PCWO) or deep cervical flexion (DCF) exercise. Each participant has been assessed for change in Craniovertebral Angle (CVA) as an indicator for FHP severity, and neck disability index (NDI). Results: Wilcoxon Signed Rank Test showed a statistically significant change difference regarding the degree of CVA improvements, and the score of NDI of pre-and post-intervention of the PCWO group (p < 0.0001), (p < 0.0001), and of the DCF group (p < 0.0001), (p = 0.0039), respectively. Mann-Whitney Test, showed a statistically significant difference between groups for CVA improvement (p < 0.0001), and NDI (p = 0.045). No correlation between CVA and NDI scores within the PCWO group (r = 0.129, p = 0.473), and within the DCF exercise group (r = 0.073, p = 0.71). Conclusion: PCWO is a novel and innovative neck orthosis that is considered a promising intervention to correct FHP and improve correlated neck disability.

The impact of ankle-foot orthoses on mobility of dual-task walking in stroke patients? A cross-sectional two-factor factorial design clinical trial.

ABSTRACTTo assess the impact of ankle-foot orthoses (AFOs) on mobility and gait during dual-task walking in post-stroke survivors. In this cross-sectional, factorial design trial, stroke survivors performed four randomized tasks: (1) dual-task walking with AFOs, (2) single-task walking with AFOs, (3) dual-task walking without AFOs, and (4) single-task walking without AFOs. Primary outcome was the Timed Up and Go (TUG) test, with secondary outcomes including gait metrics, Tinetti scores, and auditory N-back tests. In the results, 48 subjects (38 males and 10 females; 19-65 years) completed the trial. Patients had a greater TUG score with AFOs compared with non-AFOs conditions (95% CI: 7.22-14.41, P < 0.001) in single-task and dual-task conditions. Secondary outcomes showed marked enhancement with AFOs during dual-task walking, with significant interaction effects in gait metrics, balance, and cognitive function (P < 0.05). Although not statistically significant, dual-task effects of TUG and walking speed were more pronounced during dual-task walking. In conclusion, AFOs enhance mobility and gait during both single and dual-task walking in post-stroke survivors.

Innovative Approaches to 3D Printing of PA12 Forearm Orthoses: A Comprehensive Analysis of Mechanical Properties and Production Efficiency.

This research paper aims to explore the mechanical characteristics of polyamide PA12 (PA12) as a 3D material printed utilizing Selective Laser Sintering (SLS) and HP MultiJet Fusion (HP MJF) technologies in order to design and manufacture forearm orthoses. The study assessed the flowability of the materials used and compared the mechanical performance of PA12 with each other using tensile, flexure, and impact tests in five different fabrication orientations: X, Y, Z, tilted 45° XZ, and tilted 45° YZ. The results of the study provide, firstly-the data for testing the quality of the applied polyamide powder blend and, secondly-the data for the design of the orthosis geometry from the aspect of its strength parameters and the safety of construction. The mechanical parameters of SLS specimens had less variation than MJF specimens in a given orientation. The difference in tensile strength between the 3D printing technologies tested was 1.8%, and flexural strength was 4.7%. A process analysis of the forearm orthoses revealed that the HP MJF 5200 system had a higher weekly production capacity than the EOS P396 in a production variance based on obtaining maximum strength parameters and a variance based on maximizing economic efficiency. The results suggest that medical device manufacturers can use additive manufacturing technologies to produce prototypes and small-batch parts for medical applications. This paper pioneers using 3D printing technology with Powder Bed Fusion (PBF) methods in designing and manufacturing forearm orthoses as a low- to medium-volume product. The applied solution addresses the problem of medical device manufacturers with regard to the analysis of production costs and mechanical properties when using 3D printing for certified medical devices.

Effects of physical interventions on pain and disability in chronic low back pain with pronated feet: a systematic review and meta-analysis.

BACKGROUND: A link between pronated feet (PF) and chronic low back pain (CLBP) has been reported in the literature. However, physical interventions (PI) like physiotherapy and orthotics mainly target the lower back, neglecting the broader biomechanical impacts of PF that affect the feet, ankles, and overall posture. Currently, there is a lack of comprehensive meta-analyses or systematic reviews on this subject. OBJECTIVES: This systematic review with a meta-analysis aimed to evaluate the effects of PI on pain and disability in patients having CLBP with PF. METHODS: From inception until October 15, 2023, Medline/PubMed, Web of Science, and Scopus databases were searched using the desired keywords for randomized control trials (RCTs). The quality of the RCTs was evaluated using the PEDro scale and risk of bias tool. RESULTS: Four studies involving 268 patients were identified, two compared custom-made foot orthoses to non-biomechanical foot insoles, while the other two used exercises. The meta-analysis included four studies for pain and three for disability. The results showed a significant change in pain [-2.43 (95% CI -2.73 to -2.13, p < .001)] and disability of -6.69 (95% CI -8.04 to -5.33, p < .001)]. CONCLUSIONS: This systematic review and meta-analysis of four RCTs elucidates that PI, specifically targeting PF, significantly alleviate pain and reduce disability in patients having CLBP with PF. These findings advocate for integrating foot-based PI within the treatment protocols for patients suffering from CLBP accompanied by PF.

Optimizing 3D printed ankle-foot orthoses for patients with stroke: Importance of effective elastic modulus and finite element simulation.

Patients with stroke often use ankle-foot orthoses (AFOs) for gait improvement. 3D printing technology has become a popular tool in recent years for the production of AFOs due to its strengths on customization and rapid manufacturing. However, the porosity of the 3D printed materials affects the kinetic features of these orthoses, leading to its lower-strength than solid ones. The effective elastic modulus of 3D printed material was measured following standard test method to obtain the kinetic features precisely in a finite element simulation. This study demonstrated that the porosity of 3D printed samples using 100% fill density was 11% for PLA and 16% for Nylon. As a result, their effective elastic modulus was reduced to 1/3 and 1/12 of fully solid objects, respectively, leading to a lower stiffness of 3D printed orthoses. A fatigue testing platform was built to verify our finite element model, and the findings of the fatigue test were consistent with the analysis of the finite element model. Further, our AFO has been proven to have a lifespan exceeding 200 thousand steps. Our study highlights the significance of determining the actual porosity of 3D printed samples by calculating the effective elastic modulus, which leads to a more precise finite element simulation and enables reliable prediction of the kinetic features of the AFO. Overall, this study provides valuable insights into the production and optimization of 3D printed AFOs for patients with stroke.

Effects of Metatarsal Foot Orthosis on Biomechanical 3D Ground Reaction Force in Individuals with Morton Foot Syndrome during Gait: A Cross-Sectional Study.

Morton's foot syndrome (MFS) is characterized by a distally longer head of the second metatarsal bone compared to the head of the first metatarsal bone. Few studies have investigated the effects of a foot orthosis on kinetic characteristics, such as ground reaction force (GRF), during walking in individuals with MFS. This study aimed to verify dynamic GRF using a 3D motion analysis system, including two platforms with and without a foot orthosis condition. Kinetic GRF data of 26 participants with MFS were collected using a motion analysis system and a force platform. Participants were asked to walk wearing standard shoes or shoes with a pad-type foot orthosis. Repeated-measures analysis of variance (ANOVA) was used to compare the kinetic GRF data in the stance phase during gait according to the side of the leg and orthotic conditions for MFS. The late sagittal and frontal peak forces showed that the presence of a foot orthosis condition significantly increased the GRF when compared with the absence of a foot orthosis condition for both sides of the feet (p < 0.05). In addition, the second vertical peak force of the GRF showed that the presence of a foot orthosis condition significantly increased the GFR when compared with the absence of a foot orthosis condition on the side of the right foot (p = 0.023). Significant effects were observed in the late sagittal and frontal peak GRFs when wearing the pad-type foot orthosis in individuals with MFS during gait. Thus, even if there are no signs and symptoms of MFS in patients diagnosed with the disease condition, clinical interventions, such as a foot orthosis, that can be simply applied to shoe insoles are needed to manage and prevent various musculoskeletal disorders that may develop in the future. It was hypothesized that when wearing a foot orthosis, the participants would walk with increased GRF during gait compared to those without an orthosis.

Geriatric Vertebral Compression Fracture: A Database Study Characterizing Use and Trends for Prescribed Thoracic/Lumbar Orthoses.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Geriatric vertebral compression fractures are the most common fracture associated with osteoporosis. Using a large national database, the current study aimed to examine and characterize bracing trends for geriatric thoracic/lumbar compression fracture management. METHODS: The current study utilized the PearlDiver database from 2015-2021. Patients who suffered thoracic/lumbar compression fractures (fifth thoracic to the fifth lumbar vertebra [T5-L5]) were identified. Exclusion criteria included patients less than 65 years old or an indication of infection or neoplasm. Patients who received a brace within 90-days after the initial diagnosis of thoracic/lumbar compression fracture were abstracted and characterized overall and by fracture level. Multivariable logistic regression was performed to assess for correlation with bracing trends. RESULTS: In total 290 388 patients met inclusion criteria and suffered a thoracic/lumbar compression fracture (greatest incidence at the thoracolumbar junction). Of these, bracing was only prescribed for 4263 (1.5%), with the greatest variance of 1.5% by level. Independent predictors of bracing were geographic region (relative to northeast, west WE odds ratio [OR] 1.31, Midwest OR 1.20), younger age (OR 1.27 per decade), female sex (OR 1.17), and ECI (OR 1.02 per 2-point increase) (P < .05 for each). CONCLUSION: Overall, the current study examined over a quarter of a million patients who suffered a T5-L5 compression fractures and found that only 1.5% of patients were braced. This low percentage, and that greatest predictor for bracing was non-clinical (geographic region), highlight the inconsistency of this practice and may be useful for developing treatment algorithms.

The Effect of a New Generation of Ankle Foot Orthoses on Sloped Walking in Children with Hemiplegia Using the Gait Real Time Analysis Interactive Lab (GRAIL).

Cerebral palsy poses challenges in walking, necessitating ankle foot orthoses (AFOs) for stability. Gait analysis, particularly on slopes, is crucial for effective AFO assessment. The study aimed to compare the performance of commercially available AFOs with a new sports-specific AFO in children with hemiplegic cerebral palsy and to assess the effects of varying slopes on gait. Eighteen participants, aged 6-11, with hemiplegia, underwent gait analysis using GRAIL technology. Two AFO types were tested on slopes (uphill +10 deg, downhill -5 deg, level-ground). Kinematic, kinetic, and spatiotemporal parameters were analyzed. The new AFO contributed to significant changes in ankle dorsi-plantar-flexion, foot progression, and trunk and hip rotation during downhill walking. Additionally, the new AFO had varied effects on spatiotemporal gait parameters, with an increased stride length during downhill walking. Slope variations significantly influenced the kinematics and kinetics. This study provides valuable insights into AFO effectiveness and the impact of slopes on gait in hemiplegic cerebral palsy. The findings underscore the need for personalized interventions, considering environmental factors, and enhancing clinical and research approaches for improving mobility in cerebral palsy.

In-silico simulations to study the effects of ankle-joint misalignments in Ankle-Foot-Orthoses during level walking.

Exoskeletons and orthotic devices are commonly used in physical rehabilitation. However, these devices, fitting intimately with the human body, often lead to skin-related issues amongst users. Misalignments between orthotic and anatomical joints cause relative sliding motion between the limb and orthosis and also cause pressure points on the limb, which may contribute to these skin problems. This research quantifies the effects of sagittal plane ankle-joint misalignments for an ankle-foot orthosis (AFO) user during walking. A 2D mathematical model that simulates the effects of sagittal plane ankle-joint misalignments in terms of relative motion between the limb and the orthosis was developed using MATLAB software. The orthotic ankle-joint was systematically misaligned against the anatomical ankle-joint to generate various misalignment conditions. Published gait data of 5 healthy subjects was used to generate walking kinematics which was then superimposed with an articulated AFO. The simulations showed that Anterior-Posterior misalignments resulted in greater pistoning motion than Proximal-Distal misalignments. Combined misalignments (Posterior-Distal, Anterior-Proximal, Posterior-Proximal, and Anterior-Distal) resulted in higher overall relative motions between the limb and AFO. The model also predicted pressure points on the shank and foot caused by misalignments. This study demonstrates that misaligned ankle-joints in AFOs lead to relative sliding motion and pressure points during walking.

Flatfoot arch correction with generic 3D-printed orthoses at different body weight percentages.

BACKGROUND: Flatfoot can be associated with foot pathologies and treated conservatively with foot orthoses to correct arch collapse and alleviate painful symptoms. Recently, 3D printing has become more popular and is widely used for medical device manufacturing, such as orthoses. This study aims at quantifying the effect of generic 3D-printed foot orthoses on flatfoot arch correction under different static loading conditions. METHODS: Participants with normal and flatfeet were recruited for this cross-sectional study. Clinical evaluation included arch height, foot posture index, and Beighton flexibility score. Surface imaging was performed in different loading conditions: 1) 0% when sitting, 2) 50% when standing on both feet, and 3) 125% when standing on one foot with a weighted vest. For flatfoot participants, three configurations were tested: without an orthosis, with a soft generic 3D printed orthosis, and with a rigid 3D printed orthosis. Arch heights and medial arch angles were calculated and compared for the different loading conditions and with or without orthoses. The differences between groups, with and without orthoses, were analyzed with Kruskal-Wallis tests, and a p < 0.05 was considered significant. RESULTS: A total of 10 normal feet and 10 flatfeet were analyzed. The 3D printed orthosis significantly increased arch height in all loading conditions, compared to flatfeet without orthosis. Wearing an orthosis reduced the medial arch angle, although not significantly. Our technique was found to have good to excellent intra and interclass correlation coefficients. CONCLUSIONS: Generic 3D printed orthoses corrected arch collapse in static loading conditions, including 125% body weight to simulate functional tasks like walking. Our protocol was found to be reliable and easier to implement in a clinical setting compared to previously reported methods. LEVEL OF EVIDENCE: II.

Comparison between prefabricated ankle-foot orthoses, Dyna Ankle and UD Flex, in patients with hemiplegia.

OBJECTIVE: To compare the kinematic effects of two widely-used prefabricated ankle-foot orthoses (AFOs), the Dyna Ankle (DA) and UD Flex (UD), on the gait cycle of patients with hemiplegia due to cerebral palsy or acquired brain injury. METHODS: This was a retrospective cohort study involving 29 patients. Gait analysis results were assessed under three conditions: barefoot, with the DA, and with the UD. Friedman tests and post hoc analysis with Bonferroni correction were performed to assess differences between the three conditions. RESULTS: The DA significantly improved ankle dorsiflexion during the mid-swing phase, making it more effective in correcting foot drop compared with the UD (DA: 2.28°, UD: 0.44°). Conversely, the UD was more effective in preventing knee flexion during the loading response (DA: 28.11°, UD: 26.72°). CONCLUSIONS: The DA improved ankle dorsiflexion during the swing phase significantly more than that with the UD in patients with hemiplegia. Compared with the DA, the UD more effectively prevented increased knee flexion during the loading response. The choice to prescribe these orthoses should consider individual patient characteristics.

Outcomes of glenohumeral dysplasia after brachial plexus birth injury using the Sup-ER orthosis.

We investigated the efficacy of the supination-external rotation ('Sup-ER') orthosis, designed as a non-operative treatment to maintain normal anatomical growth of the shoulder, on the progression of glenohumeral dysplasia in patients with brachial plexus birth injuries. The Sup-ER orthosis was fabricated for 20 infants diagnosed with glenohumeral dysplasia after brachial plexus birth injuries and its success in correcting glenohumeral dysplasia was confirmed by objective calculations of the alpha angle on serial ultrasound findings and improvement in Active Movement Scale scores. Of the 20 patients, 14 had successful resolution of glenohumeral dysplasia, confirmed by shoulder abduction, shoulder flexion, external rotation and supination, Active Movement Scale scores and improving alpha angle measurements. Failure to rectify glenohumeral dysplasia, evidenced by worsening ultrasound findings and Active Movement Scale scores, necessitated a change to operative management in six patients.Level of evidence: IV.

Custom orthotic design by integrating 3D scanning and subject-specific FE modelling workflow.

The finite element (FE) foot model can help estimate pathomechanics and improve the customized foot orthoses design. However, the procedure of developing FE models can be time-consuming and costly. This study aimed to develop a subject-specific scaled foot modelling workflow for the foot orthoses design based on the scanned foot surface data. Six participants (twelve feet) were collected for the foot finite element modelling. The subject-specific surface-based finite element model (SFEM) was established by incorporating the scanned foot surface and scaled foot bone geometries. The geometric deviations between the scaled and the scanned foot surfaces were calculated. The SFEM model was adopted to predict barefoot and foot-orthosis interface pressures. The averaged distances between the scaled and scanned foot surfaces were 0.23 ± 0.09 mm. There was no significant difference for the hallux, medial forefoot, middle forefoot, midfoot, medial hindfoot, and lateral hindfoot, except for the lateral forefoot region (p = 0.045). The SFEM model evaluated slightly higher foot-orthoses interface pressure values than measured, with a maximum deviation of 7.1%. These results indicated that the SFEM technique could predict the barefoot and foot-orthoses interface pressure, which has the potential to expedite the process of orthotic design and optimization.

The application of the strip-shaped cymba conchae orthosis in the nonsurgical correction of complex auricular deformity.

Objective: This study aims to evaluate the efficacy and safety of using a strip-shaped cymba conchae orthosis for the nonsurgical correction of complex auricular deformities. Methods: Clinical data were collected from 2020 to 2021 for 6 patients who underwent correction using a strip-shaped cymba conchae orthosis. The indications, corrective effects, and complications associated with use of the orthosis were analyzed. Results: There were four indications for treatment: cryptotia with helix adhesion; cryptotia with grade I microtia; cryptotia with excessive helix thickness; and auricular deformity beyond the treatment time window (≥6 months). Excellent corrective effects were observed in all 6 patients. Complications occurred in one patient, who recovered after symptomatic treatment. Conclusion: The use of a strip-shaped cymba conchae orthosis alone or combined with a U-shaped helix orthosis presents a feasible approach for correcting complex auricular deformities or deformities beyond the treatment time window in pediatric patients.

Therapeutic effect of the new multilevel brace orthosis on cerebral palsy gait: a case report.

Background: Infantile spastic bilateral cerebral palsy (CP) is the most common form of CP. Diplegia (with ambulatory ability) is mostly a chronic condition that impairs the ability to walk. Standard orthotic management includes hip-knee-ankle-foot orthosis (HKAFO) as a pri-mary conservative treatment option to contrast spasticity and stabilise gait through partial immobilisation of the body structure. Multilevel brace orthosis (MLB) (Registered Trademark) is a specific type of light HKAFO designed to improve functional alignment and dynamic gait stability without limb immobilisation. Aim of the case report is to verify the effects of the MLB on the diplegic gait cycle. Case: A child with a bilateral spastic gait due to CP diplegia is described. Gait analyses were performed to investigate the therapeutic effects of the MLB on walking. Discussion: The MLB improved the gross motor function measure of walking and gait temporal parameters (velocity), compared with barefoot condition. During the swing phase, we observed a reduction in plantar and knee flexion, and the orthosis increased the width and length of the step. Conclusion: Use of this specific type of HKAFO in children with diplegia improved gait symmetry and stability.