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

Abstract

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). To compare the body functions and structures, activity and participation levels, and environmental factors according to AFO-wearing time in children with spastic CP. Prospective, cross-sectional-observational-clinical study. 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. 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. 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.