Ankle-foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children

Maria Wingstrand, Gunnar Hägglund, Elisabet Rodby-Bousquet, Maria Wingstrand, Gunnar Hägglund, Elisabet Rodby-Bousquet

Abstract

Background: Ankle-foot orthosis (AFO) is the most frequently used type of orthosis in children with cerebral palsy (CP). AFOs are designed either to improve function or to prevent or treat muscle contractures. The purpose of the present study was to analyse the use of, the indications for, and the outcome of using AFO, relative to age and gross motor function in a total population of children with cerebral palsy.

Methods: A cross-sectional study was performed of 2200 children (58% boys, 42% girls), 0-19 years old (median age 7 years), based on data from the national Swedish follow-up programme and registry for CP. To analyse the outcome of passive ankle dorsiflexion, data was compared between 2011 and 2012. The Gross motor classification system (GMFCS) levels of included children was as follows: I (n = 879), II (n = 357), III (n = 230), IV (n = 374) and V (n = 355).

Results: AFOs were used by 1127 (51%) of the children. In 215 children (10%), the indication was to improve function, in 251 (11%) to maintain or increase range of motion, and 661 of the children (30%) used AFOs for both purposes. The use of AFOs was highest in 5-year-olds (67%) and was more frequent at lower levels of motor function with 70% at GMFCS IV-V. Physiotherapists reported achievement of functional goals in 73% of the children using AFOs and maintenance or improvement in range of ankle dorsiflexion in 70%.

Conclusions: AFOs were used by half of the children with CP in Sweden. The treatment goals were attained in almost three quarters of the children, equally at all GMFCS levels. AFOs to improve range of motion were more effective in children with a more significant decrease in dorsiflexion at baseline.

Figures

Figure 1
Figure 1
Use of ankle-foot orthosis(AFO)related to age in 2200 children with CP. The proportion of children (%) in each age group indicated for the total material and for children treated to improve function and joint range of motion (ROM) respectively.
Figure 2
Figure 2
Boxplot presenting the range of ankle dorsiflexion at baseline in 2011,for 617 children using ankle-foot orthoses(AFOs)in 2011 and 2012,to maintain or improve range of motion (ROM).Decreased = children with >5 degrees decrease in dorsiflexion 2012 compared to 2011, Maintained = children with no change +/-5 degrees in dorsiflexion 2012, Increased = children with >5 degrees increase in dorsiflexion 2012. Children are divided into age-groups 0–6 years (n = 338) and 7–19 years old (n = 279).

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