Orthotic devices pave the road towards strength, balance, comfort and independence

Finding the right set of orthotics occurs only after a child has undergone a physical assessment. And like so many other facets of having a child with a disability, improvement and adjustment comes over time, in stages.

Sometimes, orthotic devices are temporary; other times, a child will need the orthotics for a lifetime. But in all scenarios, orthotic devices have the potential to bring the stability and alignment to young people that is required to grow, move, and be active participants in their own lives.

What is the goal of orthotic treatment?

According to estimates, about two-thirds of children with Cerebral Palsy have the ability to walk and ambulate. But because of the nature of Cerebral Palsy – and its effect on the muscles, joints, and patterns of motion – establishing a gait that is meaningful can be a challenge. When an orthotic device is a successful part of treatment, it should help children establish normal patterns of joint and muscle motion.

Orthotics can help remedy this situation by:

  • Providing a stable base for movement
  • Establishing an efficient gait
  • Minimizing the effects of spasticity in limbs
  • Creating an environment in which a child can take repeatable steps
  • Reducing excessive energy used to move
  • Aiding the transition between sitting and standing
  • Reducing, or eliminating, hip and knee hyperextension, missteps
  • Reducing the potential for accidents
  • Increasing a child’s ability to function physically, and mentally
  • Strengthening weak muscles
  • Controling muscular imbalances
  • Correcting poor skeletal alignment
  • Preventing deformity
  • Providing stable base of support

Babies who are born early or who have health problems that put them at risk for cerebral palsy are watched for signs of the condition. Doctors look for:

  • developmental delays, like not reaching for toys by 4 months or sitting up by 7 months
  • problems with motor skills, like being unable to crawl, walk, or move arms and legs in the usual way
  • uncoordinated movements
  • muscle tone that is too tight or too lose
  • infant reflexes (like the palmar grasp, or “hands in fists” reflex) that stay beyond the age at which they’re usually gone

How Is Cerebral Palsy Treated?

There’s no cure for cerebral palsy. But resources and therapies can help kids grow and develop to their greatest potential. Surgery can help fix dislocated hips and scoliosis (curved spine), which are common in kids with CP. Leg braces help with walking.

Even if many medical specialists are needed, it’s still important to have a primary care doctor or a CP specialist. This doctor will take care of your child’s routine health care and also help you coordinate care with other doctors.

Foot / hand splinting and braces

A complication often seen in C.P. is drop-foot. (A difficulty in lifting the front part of the foot) This may affect one or both feet. Various types of splints are made to either correct the deformity or stabilise the foot and ankle in order to facilitate walking/standing, or to hold the feet in a corrected position at night.

Ankle-foot splinting for C.P. kiddies is complex and requires specific expertise to create the best solutions and outcomes. Many systems and methods are available, but few are scientifically set up for the specific child’s needs.

For patients who are able to stand or walk, AFO’s(Ankle Foot Orthosis) are helpful for stabilising the foot and ankle by maintaining correct ankle – foot alignment. Various splint types are used such as night splints which keep the foot in the correct position during the night so that the tendons don’t tighten up while the patient is asleep.

Other splints are more dynamic and may have hinges which help to lift the foot clear of the ground so that the toes don’t hook the ground or on a step while the patient is walking. The most important principle is to calculate the angle of the Tibia in relation to the ankle and foot. The incorrect alignment calculation will result in the splint being ineffective and will cause the patient to compensate somewhere else and create biomechanical problems further up the chain. Scanner technology helps the Orthotist accurately calculate the correct angles and apply the correct forces to achieve the optimum result. It is therefore critical that the correction is done when taking the scan or the cast.

Upper limb splinting is a type of intervention where the movement of an arm, shoulder, elbow, wrist or hand is supported or restricted by a piece of material.

There are a number of different types of splints (also called orthoses), and which type you are prescribed will depend on your specific treatment plan. For example, gloves can be used to facilitate straightening at the wrists, rotating of the forearm and help provide stability to the fingers.

C.P. children have many special needs particularly with regard to mobility and daily functions.

Physiotherapists and occupational therapists focus on encouraging a person’s day-to-day movement skills such as sitting, walking, playing, dressing and toileting. There are many assistive devices which may be used to assist C.P. patients with their day to day requirements, e.g. walking frames, wheelchairs and supportive seating.

Specialised seating systems are available to help position the child so that breathing and spine balance are improved. Because many C.P. children have limited or no cognitive abilities, they are unaware of their seated position or cannot correct a poor postural sitting position by themselves.

Correct sitting position is very important for the development of the spine as well as functioning of the lungs. There is often a rotational deformity associated with the spinal deformity (Scoliosis) and it is important that the seating system accommodates not only the scoliosis deformity but the rotation component as well.

Walking and standing frames/mobility devices

DMO / SDO compression suits / gloves / garments

Dynamic Movement Orthoses (DMOs) and Sensory Dynamic Orthosis (SDOs) are Lycra-based devices that are an effective bracing alternative for some patients who have not responded favourably to traditional bracing. DMOs are tight fitting custom-fabricated garment-like orthoses that provide the correct level of deep pressure which helps to (1) regulate tone, which means high tone can be calmed & low tone can be raised, and (2) improve proprioception or body awareness of the limbs and/or trunk.

The benefits of this include reduced spasticity, increased limb and trunk control and more fluid movement patterns. Finally, DMOs include tension panels (think sewn in “rubber bands”) that help improve posture or facilitate desired movement patterns. These devices can cover any part of the body, like traditional bracing. They are more movement-oriented than traditional bracing, allowing increased freedom of movement, while still reducing undesired joint instability and postural collapse.

Advancements in technology have provided us with an array of options for patients who have complex seating and positioning needs. This can be overwhelming and intimidating to families without an adequate understanding of the technology or the advantages and disadvantages of each type of system. 

The goals for custom seating usually include:

  • Improving functional postures for participation in self-care, educational, and social activities
  • Increasing comfort
  • Minimizing the progression of current deformities
  • Correction of scoliosis and other spine deformities
  • Controlling abnormal reflexes and muscle tone
  • Evenly distributing pressure for skin protection and reducing pressure points
  • Improving trunk and head control
  • Increasing upper extremity function and manipulation
  • Improving eye gaze and visual tracking

 

We place the patient into the assessment seat (blue bean bags). Once we have the patient in a good position, we then vacuum the air out of the blue bags – which then becomes rigid and fixes the position. The patient is then removed from the assessment seat and we do a 3D scan of the “mould”. This mould then forms the basis of the seat design (similar to if one would have taken a cast of the patient).

Further adjustment is then done to the scan image –if further correction is required.

An STL file(3D image) is then created and the foam insert is then carved on a 7-axis carver.

We then re-seat the patient in the foam carving and set the trim lines. If all is well, we then send the seat in for upholstery and the rigid outer frame. The rigid frame then interfaces with a mobility base (buggy or wheelchair).

McLean seat (custom moulded spinal seating method)

FAQ

Most frequent questions and answers

Cerebral palsy is not a terminal condition. Today, between 65 and 90 percent of children with cerebral palsy reach adulthood. CP is stressful for the entire body and can cause premature aging, particularly of the heart, blood vessels, muscles, joints, and bones.

The complications stemming from CP can be life-threatening. Cerebral palsy can lead to respiratory and swallowing difficulties. Difficulty swallowing can lead to malnutrition and/or aspiration pneumonia—in which food is inhaled into the lungs causing an infection. Malnutrition causes weakness and muscle deterioration; it weakens the immune system making the patient more vulnerable to infections and less able to fully recover if an infection occurs.

CP patients whose mobility is extremely restricted may have to sit or lay down for extended periods of time, running the risk of pressure sores. Untreated pressure sores can develop life-threatening infections.

The bowel and bladder problems frequently associated with CP can lead to more serious complications when not properly managed.

Spinal deformity is a common occurrence in all types of C.P.  If untreated or not managed correctly, permanent vertebral deformity will occur. When the angle of the spine reaches certain limits the lung on the concave side becomes compressed leading to breathing difficulty and recurrent lung infections. The last (12th) rib also over-rides the top of the pelvis which is very painful.

Hip dysplasia and dislocation (subluxation) is also a common finding and usually requires surgical management.

Another complication often seen in C.P. is drop-foot. This may affect one or both feet. Various types of splints are made to either correct the deformity or stabilise the foot and ankle in order to facilitate walking/standing, or to hold the feet in a corrected position at night.

Cerebral palsy cannot be cured. The brain damage or brain abnormalities from which it stems are irreversible. Fortunately, today much can be done to improve the quality of life for CP patients.

Cerebral palsy is not degenerative. When a child is diagnosed with cerebral palsy, doctors know that the disability will not get worse with the passage of time. Instead, a child’s case of cerebral palsy can improve with consistent exercise and regular sessions with a variety of healthcare specialists, including speech and language therapists, psychologists, occupational therapists, and orthopaedic surgeons.

Cerebral palsy is not genetic; it is a disorder that can sometimes result from a brain injury experienced at birth, but in most instances, physicians are unsure of its cause. It is not, however, a disease that is passed along through DNA. In fact, cerebral palsy can no more be passed along through the DNA than any other injury such as a broken bone or a laceration.