Ankle-Foot Orthoses for Young Children with Cerebral Palsy

• Author / Creator

  Firouzeh, Pegah

• Cerebral palsy occurs due to brain injury during the fetal period or after birth resulting in movement and posture impairments that affect the individual’s functional ability in daily life. Ankle Foot Orthoses are often prescribed, in combination with other interventions, for children with cerebral palsy before the age of six years to prevent gastrocnemius-soleus muscle shortening, tendo-achilles contracture, and improve walking performance. Despite routine use in clinical practice, there is a low level of evidence about how AFOs affect children’s functional abilities and limited information about parents’ experiences with early AFO use. Prescription practices would be informed by a more in-depth understanding of how parents experience their young children’s AFO use so that clinicians can be more knowledgeable about the barriers and challenges faced by families.
  This thesis aimed to provide evidence-based, family-centered clinical practice recommendations for prescribing and monitoring AFOs for young children with cerebral palsy. This objective was addressed in three separate studies: 1) a scoping review to describe research on outcomes associated with early AFO use, AFO use patterns, and parent and clinician perspectives on AFO use among young children with cerebral palsy, 2) a qualitative study to understand parent experience with AFO use by their young children, and 3) a Delphi study to develop core clinical considerations for AFO prescription and monitoring. Although improving participation outcomes is a primary goal of rehabilitation, the scoping review revealed that activity and participation outcomes are often ignored in pediatric orthotics research. In the second study, I interviewed parents of young children with cerebral palsy who used AFOs to explore their experiences with their children’s early AFO use. Parents reflected on their challenges with the adjustment period to AFOs, the perceived stigma of using AFOs in public,
  the perceived benefits of wearing AFOs, and the need to work collaboratively with clinicians to determine optimal AFO dosage and wear recommendations. The final study combined the data from the scoping review and qualitative study with an expanded search of the literature to integrate research, clinicians’ views, and family perspectives into a consensus-based list of core considerations for AFO prescription and monitoring for young children with cerebral palsy. The core considerations for AFO (timing of initial prescription, selection of type and construction, communication with families, frequency and duration of use, outcomes associated with AFO use, and clinical team functioning) are intended to support clinicians in aligning their practices with the priorities of families to optimize AFO use.

• Subjects / Keywords

  • cerebral palsy
  • ankle-foot orthoses
  • pediatric rehabilitation

• Graduation date

  Fall 2023

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-r4b4-xa18

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.