Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Abstract

Objective. To date there is only limited knowledge about the wearing time of orthoses. Ankle-foot orthoses (AFOs) have not been studied with this research question. Additional influences of the orthotic design as well as weekdays and the weekend are also unknown. Design. Monocentric, clinically prospective intervention study. Patients. Inclusion of 10 patients with bilateral spastic cerebral palsy. Methods. Equipment of all subjects with a dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS, dynamic elastic shank adaptation or ground reaction AFO). Integration of temperature sensors for recording the wearing time for a period of 3 months. Results. The actual wearing time was below the recommendations on actually worn days as well as the average of the entire study period. In addition, the actual usage in terms of days and hours was well below the recommendations. The wearing time showed differences between weekdays and weekend. Differences between DAFO and MSS were not detectable. Conclusion. The actual usage behavior of ankle-foot orthoses differs from the recommendations of the prescriber. This applies to both DAFOs and modular use with shank supplies. Environmental factors may have a significant impact on wearing times on weekdays and the weekend.

Comparison of body structure, function, activity, and participation levels according to ankle foot orthosis wearing time in children with spastic cerebral palsy

“…A study of AFO-wearing time in children with CP has shown that wearing time is varying depending on the prescriber and environmental factors. 15 Therefore, the purpose of this study was to compare the body functions and structures, activity and participation levels, and environmental factors according to the AFO-wearing time in children with spastic CP at Gross Motor Function Classification System (GMFCS) levels I-III.…”

Ankle-foot orthosis adherence in children and adolescents with cerebral palsy: A scoping review

“…Adherence was notably varied across the studies with papers reporting considerable heterogeneity within the data. One of the papers that objectively measured usage using temperature sensors reported lower usage levels than had been recommended, 15 although with so few papers in this review, this is not a firm finding and would benefit from being investigated in greater detail in the future. One paper in the review compared methods to measure AFO usage and identified variation in recorded wear times according to the monitoring method used.…”

“…16 One paper reported lower wearing times than had been recommended by clinicians. 15 Variation in usage times was seen across the participants in both studies, 15,16 with some indication toward patterns of use. 15 A third paper in this review did discuss usage; however, Maas et al 17 describes patient adherence to a knee-ankle-foot orthoses (KAFO) style device.…”

‘What if it were like this?’ Perception of mothers of children with cerebral palsy about the ankle‐foot orthosis of their children: A qualitative study

“…This indicates that mothers seemed to not perceive the need for their children to use the orthosis at home and also that their attitude might be influenced by insufficient information. This fact also seems to signal a failure in communication between therapists and mothers, as there is a lack of knowledge about the need for continuously using the AFO for at least 6 h when the goal is to prevent muscle shortening (Schwarze et al, 2019). Additionally, there is a lack of knowledge about the value of the AFO as a facilitating resource due to its ability to expand the activities and participation of its user, regardless of the environment frequented (McMonagle, Rasmussen, Elliott, & Dixon, 2016).…”