Background: Ankle-foot orthoses (AFOs) are extensively used as a primary management method to assist walking and ambulation of children with Cerebral Palsy (CP). However, there are certain barriers that hinder their prescription and as well as their use as a mobility device in all kinds of daily-life activities. This research attempts to further understand the existing limitations of current AFOs to promote a better personalization of new design solutions.
Methods: Stakeholder (professionals in CP and end-users with CP) perspectives on AFO technology were collected by two online surveys. Respondents evaluated the limitations of current assistive solutions and assessment methods, provided their expectations towards a new AFO design, and analyzed importance of different design features and metrics to enrich the gait performance of these patients in daily-life. Quantitative responses were rated and compared with respect to their perceived importance. Qualitative responses were classified into themes by using content analysis.
Results: 130 survey responses from ten countries were analyzed, 94 from professionals and 36 from end-users with CP. The most highly rated design features by both stakeholder groups were the comfort and the ease of putting on and taking off the assistive device. In general, professionals preferred new features to enrich the independence of the patient by improving gait at functional levels. Responses from end-users also considered their social acceptance and participation. Health-care professionals reported a lack of confidence concerning decision-making about AFO prescription. The relation between the type of assistance required to each pathological gait was not straightforward, and they agreed that more information about patients’ day-today walking performance would be beneficial.
Conclusion: This research emphasizes the importance of developing new approaches to assess and treat CP gait in daily-life situations. The stakeholders’ needs and criteria reported here may serve as insights for the design of future assistive devices and for the follow-up care of these patients.