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

Prosthet Orthot Int. 2021 Dec 1;45(6):506-512. doi: 10.1097/PXR.0000000000000048.


Background: Ankle foot orthoses (AFOs) are usually recommended to prevent deformities and to increase the standing and walking performance in children with spastic cerebral palsy (CP).

Objective: To compare the body functions and structures, activity and participation levels, and environmental factors according to AFO-wearing time in children with spastic CP.

Study design: Prospective, cross-sectional-observational-clinical study.

Methods: Eighty children with spastic CP (Gross Motor Function Classification System I-III; mean age 7.3 ± 3.9 years) were divided into two groups with equal ages and duration of AFO usage, which is provided as a part of routine clinical care: 6-12 hours per day group (n = 40) and 12-24 hours per day group (n = 40). The outcomes measured were calf muscle's spasticity with the modified Ashworth Scale (MAS), passive ankle dorsiflexion angle (DA), 66-item Gross Motor Function Measurement, Pediatric Berg Balance Scale, and Pediatric Quality of Life Inventory (PedsQL). Parental satisfaction was measured with a Visual Analog Scale. Multifactorial ANOVA was used to compare the groups, corrected for 66-item Gross Motor Function Measurement.

Results: No significant differences for the Pediatric Berg Balance Scale, MAS, and DA were found between the groups. Significant differences for the PedsQL (76.99 vs. 57.63; mean difference [MD], 15.60; 95% confidence interval [CI], 10.99∼20.22), daily living activities (65.30 vs. 35.92; MD, 25.72; 95% CI, 17.58∼33.86), fatigue (76.9 vs. 56.85; MD, 23.11; 95% CI, 16.87∼29.35), and satisfaction (8.08 vs. 5.21; MD, 2.46; 95% CI, 1.64∼3.27) were found between the groups; 6-12 hour group had superiority for each outcome (P < 0.001). Wearing time was significantly correlated with PedsQL (r = -0.524, P < 0.001) and satisfaction (r = -0.521, P < 0.001) but not with MAS or DA.

Conclusions: AFO-wearing time seems to depend on the child's activity and participation levels rather than body functions and structures in children with spastic CP. Prolonged AFO-wearing time was negatively correlated with both the activity-participation level and parental satisfaction.

Publication types

  • Observational Study

MeSH terms

  • Ankle
  • Cerebral Palsy*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Foot Orthoses*
  • Humans
  • Prospective Studies
  • Quality of Life