Ankle-foot orthosis adherence in children and adolescents with cerebral palsy: A scoping review

Abstract

Background: 

Ankle-foot orthoses (AFOs) are commonly supplied to children with cerebral palsy (CP) to support their gait. However, usage is reported to decrease through adolescence. Because AFOs can allow users to engage in daily activities and develop their independence, a wider understanding of nonadherence is essential to determining the most appropriate ways to support orthotic prescription for children with CP in the future. This scoping review will present the literature that investigates AFO adherence of children or adolescents with CP and identify potential avenues for future research and practice.

A literature search was carried out using the EBSCO and Web of Science databases to identify literature that investigates AFO adherence by children with CP through measurement of AFO usage and exploration of factors that may influence that usage. Papers that investigated AFO adherence in children/adolescents with CP, either through usage or factors that could affect usage, were included in this review. Data were synthesized using a charting form developed for this review. In total, three papers were included in this review. Two included assessments of AFO usage and all three included at least anecdotal references to factors that could influence that usage.

Variation in usage time was seen across participants in all studies, although the method used to record usage may influence reported usage values. Key factors that could affect usage were observed in four key categories: physical/AFO-related factors, personal factors, social factors, and situational appropriateness. Adherence is a complex subject, and both measurement of usage and factors that influence usage are key components needed to understand how children engage with their AFO. By better understanding the motivators and barriers to adherence, it is possible to better support the provision of AFOs in the future.