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Firouzeh P, Morris C, Sonnenberg LK, Manns P, Pritchard L. Parent experience with ankle-foot orthoses for their young children with cerebral palsy: a qualitative study. Disabil Rehabil 2024; 46:2166-2173. [PMID: 37269309 DOI: 10.1080/09638288.2023.2218651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE This study explored the experiences of parents of young children with cerebral palsy who used Ankle-Foot Orthoses (AFOs). MATERIALS AND METHODS Parents of children with cerebral palsy (n = 11; age range 2-6 years) who used solid or hinged AFOs participated. Interpretive Description, a qualitative methodological approach focused on the application of findings to clinical practice, was used. Semi-structured interviews were conducted, and themes were developed using thematic analysis. RESULTS Four themes described parent experience with their children's AFOs: 1) "Hear what I am saying": Collaborative decision-making with families, 2) "Is my child going to be excluded because of AFOs?": Parent and child adjustment was a journey, 3) AFOs created financial and practical challenges, 4) The perceived benefits of AFO use. CONCLUSIONS Adjusting to AFOs was a challenging and time-consuming process for parents and children, which may have resulted in lower frequency and duration of use than anticipated by clinicians. Clinicians must be aware of the physical and psychosocial adjustment process as children and families adapt over time and work with families to ensure AFO use is optimized and individualized.
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Affiliation(s)
- Pegah Firouzeh
- Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, Canada
| | - Christopher Morris
- PenCRU, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Lyn K Sonnenberg
- Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Canada
- Glenrose Rehabilitation Hospital, Edmonton, Canada
- Member, Women and Children's Health Research Institute, Edmonton, Canada
| | - Patricia Manns
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, Canada
| | - Lesley Pritchard
- Member, Women and Children's Health Research Institute, Edmonton, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, College of Health Sciences, University of Alberta, Edmonton, Canada
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Smith MC, Scrivener BJ, Stinear CM. Do lower limb motor-evoked potentials predict walking outcomes post-stroke? J Neurol Neurosurg Psychiatry 2024; 95:348-355. [PMID: 37798093 DOI: 10.1136/jnnp-2023-332018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND This observational study examined whether lower limb (LL) motor-evoked potentials (MEPs) 1 week post-stroke predict recovery of independent walking, use of ankle-foot orthosis (AFO) or walking aid, at 3 and 6 months post-stroke. METHODS Non-ambulatory participants were recruited 5 days post-stroke. Transcranial magnetic stimulation was used to determine tibialis anterior MEP status and clinical assessments (age, National Institutes of Health Stroke Scale (NIHSS), ankle dorsiflexion strength, LL motricity index, Berg Balance Test) were completed 1 week post-stroke. Functional Ambulation Category (FAC), use of AFO and walking aid were assessed 3 months and 6 months post-stroke. MEP status, alone and combined with clinical measures, and walking outcomes at 3 and 6 months were analysed with Pearson χ2 and multivariate binary logistic regression. RESULTS Ninety participants were included (median age 72 years (38-97 years)). Most participants (81%) walked independently (FAC ≥ 4), 17% used an AFO, and 49% used a walking aid 3 months post-stroke with similar findings at 6 months. Independent walking was better predicted by age, LL strength and Berg Balance Test (accuracy 92%, 95% CI 85% to 97%) than MEP status (accuracy 73%, 95% CI 63% to 83%). AFO use was better predicted by NIHSS and MEP status (accuracy 88%, 95% CI 79% to 94%) than MEP status alone (accuracy 76%, 95% CI 65% to 84%). No variables predicted use of walking aids. CONCLUSIONS The presence of LL MEPs 1-week post-stroke predicts independent walking at 3 and 6 months post-stroke. However, the absence of MEPs does not preclude independent walking. Clinical factors, particularly age, balance and stroke severity, more strongly predict independent walking than MEP status. LL MEP status adds little value as a biomarker for walking outcomes.
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Affiliation(s)
- Marie-Claire Smith
- Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Benjamin J Scrivener
- Department of Medicine, The University of Auckland, Auckland, New Zealand
- Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Cathy M Stinear
- Department of Medicine, The University of Auckland, Auckland, New Zealand
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Marcotte D, Ferri E, Xue X, Katsolis A, Rajotte E, Cardiff K, Preuss R. Barriers and facilitators to lower extremity orthotic compliance in the pediatric population: A scoping review of the literature. Prosthet Orthot Int 2023; 47:155-167. [PMID: 37040169 DOI: 10.1097/pxr.0000000000000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/16/2022] [Indexed: 04/12/2023]
Abstract
Despite the purported benefits of lower extremity orthotics in the literature, pediatric compliance rates remain low. This scoping review synthesized the available literature regarding barriers and facilitators to lower extremity orthotic compliance in the pediatric population using the framework of the International Classification of Functioning, Disability and Health: Children and Youth (ICF). A comprehensive search of MEDLINE, EMBASE, and CINAHL was conducted on May 11, 2021, and of PsycInfo on May 12, 2021. Article reference lists and gray literature were also searched. A total of 81 articles were included. Factors described in at least four articles were labeled as universal barriers or facilitators. In the International Classification of Functioning, Disability and Health: Children and Youth domain of Body Functions/Body Structures, universal barriers were present in the global mental functions, experience of self and time, sensory functions, function of joints and bones, and structures related to the skin subcategories, with no universal facilitators identified. For the Activity Limitations/Participation Restrictions domain, one universal facilitator was identified in the mobility subcategory. In the Environmental Contextual Factors domain, universal barriers were found in the attitudes of immediate and extended family and societal attitude subcategories, with both universal barriers and facilitators found in support & relationships: immediate and extended family, support and relationships: health professionals, services, systems, and policies, and products and technology. The reviewed literature strongly emphasizes the importance of proper orthotic fit and comfort, and the child's experience of self, for lower extremity orthotic compliance, along with multiple environmental factors.
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Affiliation(s)
- David Marcotte
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Erica Ferri
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Xiaotong Xue
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Anastasia Katsolis
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Elise Rajotte
- Lethbridge-Layton-Mackay Rehabilitation Centre Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Katrina Cardiff
- Lethbridge-Layton-Mackay Rehabilitation Centre Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Richard Preuss
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
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Civil DA, Orlando JM, Cunha AB, Li B, Lobo MA. Development and Initial Evaluation of a Soft Ankle Support for Children With Ankle Impairments. Pediatr Phys Ther 2023; 35:268-276. [PMID: 36989055 DOI: 10.1097/pep.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE Develop and initially evaluate a soft ankle support (SAS) garment for children with ankle impairments. DESCRIPTION OF CASES Two participants were evaluated at baseline and interviews with their parent(s) to identify wants and needs for the SAS. The SAS was developed and evaluated via participant report and functional measures in barefoot, ankle-foot orthosis (AFO), and SAS conditions. OUTCOMES Children and parents expressed dissatisfaction with AFOs' dimensions, weight, adjustability, comfort, and ease of use. Gait and gross motor function were similar for SAS and AFOs' conditions; however, participants rated the SAS better for weight and bulk, integration with shoes, adjustability, comfort, cost, and washability. DISCUSSION The SAS and AFOs performed similarly in this initial testing, yet the SAS also met participants' needs across key metrics not well addressed by AFOs. Ankle support devices that meet users' broad needs may support improved adherence and user satisfaction.
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Affiliation(s)
- Danielle A Civil
- Fashion and Apparel Studies Department (Ms Civil and Dr Lobo), Biomechanics & Movement Science Program (Drs Orlando, Li, and Lobo), and Physical Therapy Department (Drs Cunha and Lobo), University of Delaware, Newark, Delaware
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Orlando JM, Li B, Bodt B, Lobo MA. Users' Perceptions About Lower Extremity Orthotic Devices: A Systematic Review. Arch Phys Med Rehabil 2022; 104:645-655. [PMID: 36395874 DOI: 10.1016/j.apmr.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/13/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review perceptions from adults, children, and caregivers in scientific and open sources to determine how well lower extremity orthotic devices (LEODs) meet users' functional, expressive, aesthetic, and accessibility (FEA2) needs. DATA SOURCES Scientific source searches were conducted in the National Library of Medicine (PubMed/MEDLINE) and Web of Science; open source searches were conducted in Google Search Engine in April 2020. STUDY SELECTION Inclusion criteria were reporting of users' perceptions about a LEOD, experimental or observational study design, including qualitative studies, and full text in English. Studies were excluded if the device only provided compression or perception data could not be extracted. One hundred seventy three scientific sources of 3440 screened were included (total of 1108 perceptions); 36 open sources of 150 screened were included (total of 508 perceptions). DATA EXTRACTION Users' perceptions were independently coded by 2 trained, reliable coders. DATA SYNTHESIS Across both source types, there were more perceptions about functional needs, and perceptions were more likely to be positive related to functional than expressive, aesthetic, or accessibility needs. Perceptions about expression, aesthetics, and accessibility were more frequently reported and more negative in open vs scientific sources. Users' perceptions varied depending on users' diagnosis and device type. CONCLUSIONS There is significant room for improvement in how LEODs meet users' FEA2 needs, even in the area of function, which is often the primary focus when designing rehabilitation devices. Satisfaction with LEODs may be improved by addressing users' unmet needs. Individuals often choose not to use prescribed LEODs even when LEODs improve their function. This systematic review identifies needs for LEODs that are most important to users and highlights how well existing LEODs address those needs. Attention to these needs in the design, prescription, and implementation of LEODs may increase device utilization.
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Affiliation(s)
- Julie M Orlando
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE
| | - Bai Li
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE
| | - Barry Bodt
- Biostatistics Core Facility, College of Health Sciences, University of Delaware, Newark, DE
| | - Michele A Lobo
- Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, Newark, DE.
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Kirker S. Orthoses for neurological ankles. Pract Neurol 2022; 22:311-316. [PMID: 35332078 DOI: 10.1136/practneurol-2022-003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Abstract
Patients with weakness or abnormal posture of their lower leg may benefit greatly from appropriate orthoses. This paper describes the sorts of problems that can be helped in neurological practice and the range of devices commonly used, and also highlights some of the factors influencing selection. With greater understanding of their use, clinicians will feel more confident about referring patients for early orthotic assessment.
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Affiliation(s)
- Stephen Kirker
- Rehab Medicine Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Ankle-foot orthosis adherence in children and adolescents with cerebral palsy: A scoping review. Prosthet Orthot Int 2022; 46:351-356. [PMID: 35315831 DOI: 10.1097/pxr.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
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.
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Ribeiro Volpini Lana M, Pimenta Maia J, Horta AA, Teixeira da Fonseca S, Guimarães Assis M. 'What if it were like this?' Perception of mothers of children with cerebral palsy about the ankle-foot orthosis of their children: A qualitative study. Child Care Health Dev 2021; 47:252-260. [PMID: 33326118 DOI: 10.1111/cch.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/05/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The family-centred approach is fundamental in the therapeutic process of children with cerebral palsy (CP), and the increased competence of parents about therapeutic devices, especially orthoses, can facilitate its implementation, thus intensifying the benefits that this device provides. The aim of this study was to understand the perception of mothers of children with CP in relation to their children's ankle-foot orthosis. METHODS This is a qualitative study using thematic content analysis technique. Data were collected using semi-structured interviews from 24 mothers of children with Levels IV and V of CP according to the Gross Motor Function Classification System (GMFCS), who were attended at a philanthropic rehabilitation centre. RESULTS Three categories were identified from analyzing the interviews: benefits of the orthosis, the orthosis in the child's daily life and 'What if it were like this?' CONCLUSIONS According to the mothers' perceptions, the ankle-foot orthosis improved their child's mobility. The orthoses are used in different contexts in the child's daily life, and the mothers pointed out suggestions regarding personalizing the orthosis with different colors and patterns, increasing comfort and facilitating the way in which the device is placed.
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Affiliation(s)
- Mariana Ribeiro Volpini Lana
- School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Associação Mineira de Reabilitação, Orthotics for Humans Laboratory (OhLab), Belo Horizonte, Brazil
| | - Joana Pimenta Maia
- Associação Mineira de Reabilitação, Orthotics for Humans Laboratory (OhLab), Belo Horizonte, Brazil
| | - Anderson Antônio Horta
- Associação Mineira de Reabilitação, Orthotics for Humans Laboratory (OhLab), Belo Horizonte, Brazil.,Escola de Design, Universidade Estadual de Minas Gerais, Belo Horizonte, Brazil
| | | | - Marcella Guimarães Assis
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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