Understanding the impact of physical, social, and attitudinal environments on the participation of children with cerebral palsy in the North East of England

Objective: The aim of this small, mainly qualitative, study was to discover what a group of children with cerebral palsy (CP) think of their orthoses and the effect they have on their walking. The study complemented a biomechanical assessment of the children walking with, and without, their orthoses. Method: Fourteen children were recruited from physiotherapy departments located in a residential school and two child development centres. The children were aged between 5 and 16 years, and had a diagnosis of CP. Between them, the children wore a variety of orthoses and used a variety of walking aids, although the Kaye walker was the most frequently used. The children’s views and experiences were gathered by semi-structured interview. During the biomechanical assessment the children were also asked to rate four aspects of their walking – speed, ease, steadiness, and level of tiredness – by means of pictorial scales. The audiotaped interview data were transcribed and subjected to content analysis. The ratings from the scales were compared using the Wilcoxon signed ranks test. Results: Most children wore their orthoses for the majority of the time, found them comfortable, and some reported definite benefits to wearing them. Even when children did not identify specific benefits they seemed to accept wearing the orthoses. Children’s ratings of their walking with and without orthoses identified no clear preference. The difference in ratings was not statistically significant apart from level of tiredness which was significantly in favour of walking without orthoses (z=–1.983, p=0.047). There was a lack of consistency between the children’s ratings and the results from the biomechanical assessments, which were also inconclusive. However, one child, for whom definite improvements were seen in velocity and energy costs when wearing orthoses, consistently rated her own performance as better with orthoses. Conclusions: The children’s experiences of wearing orthoses were mainly positive or neutral. The children did not consistently identify a preference for walking with or without orthoses. This may have been due to their age, their expectations, or the fact that the findings of the biomechanical assessments were not consistent either. The experience of carrying out this study indicates that children are able to express their views about, and experiences of, a therapeutic intervention. Acknowledgements: The children who took part in the study and their families; the physiotherapists who helped with recruitment, and the charity HOPE, for funding .