CP patients wear AFOs less than prescribed

An open-access study, published in Rehabilitation Research and Practice, investigated the wear time of commonly used AFOs in children with cerebral palsy (CP).

Shoes for Orthotics, AFOs, DAFOs. CHASA support groups

The O&P EDGE August 09, 2019

The researchers also studied if the design of the orthosis influenced adherence and whether wear time differed between weekdays and the weekends. They found that actual usage of any of the AFOs was “well below” the prescribers’ recommendations.

Ten patients, ages four to ten years old at baseline, with bilateral spastic cerebral palsy and Gross Motor Function Classification System (GMFCS) levels 1-3 were equipped with a dynamic ankle-foot orthosis (DAFO). [Editor’s note: Study authors used the term DAFO as a generic term. It is not in reference to the U.S. made DAFO brand registered as a trademark in the United States and Europe].

Patients with structural knee flexion contracture were excluded. Depending on individual needs (gait disorder, foot deformity, height, and body mass), a modular shank supply (MSS) was also used in a modular orthotic design. Integrated temperature sensors recorded wear time for three months.

The results indicated that the actual wear time was below the recommendations on actually worn days as well as the average of the entire study period. Only one out of six DAFO and one out of eight MSS participants wore the orthosis according to the recommended daily wearing time, but not a single patient wore the orthosis on every single day during the measurement period.

The wearing time also showed differences between weekdays and weekends, but differences between DAFO and MSS were not were not detected.

Source The O&P EDGE


Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach, Schwarze M, Horoba L, Block J, Putz C, Alimusaj M, Wolf SI, Dreher T. Rehabil Res Pract. 2019 Jul 15;2019:2978265. doi: 10.1155/2019/2978265. eCollection 2019. Full text

  Further reading

Measuring wearing time of knee-ankle-foot orthoses in children with cerebral palsy: comparison of parent-report and objective measurement, Maas JC, Dallmeijer AJ, Oudshoorn BY, Bolster EAM, Huijing PA, Jaspers RT, Becher JG. Disabil Rehabil. 2018 Feb;40(4):398-403. doi: 10.1080/09638288.2016.1258434. Epub 2016 Dec 7.

Acclimatization of the gait pattern to wearing an ankle-foot orthosis in children with spastic cerebral palsy, Kerkum YL, Brehm MA, van Hutten K, van den Noort JC, Harlaar J, Becher JG, Buizer AI. Clin Biomech (Bristol, Avon). 2015 Jul;30(6):617-22. doi: 10.1016/j.clinbiomech.2015.03.023. Epub 2015 Mar 28.

Day vs. day-night use of ankle-foot orthoses in young children with spastic diplegia: a randomized controlled study, Zhao X, Xiao N, Li H, Du S. Am J Phys Med Rehabil. 2013 Oct;92(10):905-11. doi: 10.1097/PHM.0b013e318296e3e8.

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