Objective. To date there is only limited knowledge about the wearing time of orthoses. Ankle-foot orthoses (AFOs) have not been studied with this research question. Additional influences of the orthotic design as well as weekdays and the weekend are also unknown. Design. Monocentric, clinically prospective intervention study. Patients. Inclusion of 10 patients with bilateral spastic cerebral palsy. Methods. Equipment of all subjects with a dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS, dynamic elastic shank adaptation or ground reaction AFO). Integration of temperature sensors for recording the wearing time for a period of 3 months. Results. The actual wearing time was below the recommendations on actually worn days as well as the average of the entire study period. In addition, the actual usage in terms of days and hours was well below the recommendations. The wearing time showed differences between weekdays and weekend. Differences between DAFO and MSS were not detectable. Conclusion. The actual usage behavior of ankle-foot orthoses differs from the recommendations of the prescriber. This applies to both DAFOs and modular use with shank supplies. Environmental factors may have a significant impact on wearing times on weekdays and the weekend.

Introduction Conservative therapy for bilateral spastic cerebral palsy (BSCP) regularly includes a modular orthosis setup with dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS). Additional effects by this modular supply have not been studied so far. The goal was thus an exploratory investigation of what effects can be expected by supplementing a DAFO with an additional MSS. Materials and Methods Ten children with BSCP were fitted with DAFO and MSS. Dynamic elastic shank adaptations (DESAs) and ground reaction force AFOs (GRAFOs) were used, depending on the participants' individual needs. Participants underwent a gait analysis after supply and 3 months later. Data analysis included a descriptive analysis and further statistical testing using a Friedman test and post hoc Wilcoxon rank test. Results The Gillette Gait Index (GGI) improved significantly with MSS compared with barefoot and DAFO, the Gait Deviation Index (GDI) only comparing DAFO to MSS. However, no further changes had occurred at follow-up, and for the Gait Profile Score (GPS), not at all. Step length, velocity, cadence, stance duration, and step width changed significantly after supply. Kinematic changes developed at ankle, knee, hip, and trunk. However, only minor changes had occurred at follow-up. Conclusions DAFOs and MSS show positive effects, as observed in spatiotemporal parameters, gait indices, and kinematic data. Most kinematic effects occur at the ankle and knee joint. MSS produces additional effects, with a particular emphasis on the extending effect on the knee in terminal stance. Only minor beneficial effects on kinematic parameters of knee and trunk during swing phase occur after a familiarization phase. The changes in the spatiotemporal parameters imply a slight deterioration.