Ensuring High Quality Oyster Care for People Experiencing Severe and Persistent Mental Illness - A Three-Phase Development of A Quality Monitoring Tool.

Conservative interventions including physical therapy and bracing with orthotic devices such as ankle foot orthoses (AFOs) are typically the first treatments of choice for children with spastic cerebral palsy (CP). The goal of ankle foot orthosis (AFO) use is to improve ankle/foot alignment and stability, as distal control during gait is thought to influence proximal stability. Favorable changes in function of children with CP have been reported with AFO use; however, supporting research consists of mostly low to moderate quality studies and often lacks specificity related to AFO details. Investigations that have included the design of solid (fixed) AFOs noted the AFO's ankle angle to be either 0 degrees (standard/plantigrade) or a few degrees of dorsiflexion. A standard, or plantigrade, ankle joint alignment in an AFO can be problematic if a child lacks available range of motion in the ankle from short muscle length of the gastrocnemius, as is common with spastic CP. An improperly aligned AFO may compromise function by causing excessive hip and knee joint flexion or extension, poor foot posture, undue stress to soft tissues and joints, pain, and noncompliance with wearing the AFOs. There is a lack of consensus and standardization for the type of AFO design required to meet the specific needs of children with CP. Additionally, researchers have found that healthcare professionals lack confidence in prescribing orthoses and making decisions related to orthotic intervention. Clinicians and consumers agree that “ideal orthotic management” should be tailored to individual patient needs and goals.