Cerebral PalsyDeformities And Orthotic

Treatment

Prepred By: Amina JamilBsc (Hons) Orthotics And Prosthetics

2nd year

Contents…

Deformities in CP Upper extremity Spine Hip Gait disorders Foot deformities

Contents…

Orthotic treatment: Wrist Hand Orthosis Hensinger Collar ThoracoLumber Spinal Orthosis (TLSO) SupraMalleolar Orthosis (SMO) Floor reaction Ankle Foot Orthosis (AFO) Hinged AFO Solid AFO Others

Cerebral palsy

Is a group of non progressive but often changing motor impairment syndrome secondary to the lesion of immature brain.

It can occur before birth, during birth or after birth.

Deformities in CP… Upper extremity

Characteristic deformities include:Shoulder internal rotational contractureFore arm-pronation/elbow flexion deformityWrist flexion deformityThumb-in-palm deformityFinger flexion deformity

Deformities in CP… Upper extremity

Shoulder contracture:Glenohumeral internal rotational contractureForearm-Pronation / Elbow-Flexion DeformityElbow flexion contracturePronation deformityWrist-Flexion DeformityWrist is typically flexed and in ulnar deviation

Wrist-Flexion Deformity

Deformities in CP… Upper extremity

Thumb-in-Palm Deformity Flexed thumb into palm prevents grasping

and pinching activities Finger-Flexion DeformitySwan-neck deformities can sometimes be

helped with correction of the wrist flexion deformity

Deformities in CP… spine

Scoliosis common in children with cerebral palsy Overall incidence is 20% The more involved and severe the cerebral palsy,

the higher the likelihood of scoliosisCurves are typically less than 40° but can

range from 10° to 146°

Deformities in CP… Hip

• Hip subluxation and dislocation are the second most common deformities in patients with spastic cerebral palsy, with a reported prevalence of up to 28%.

Cerebral Palsy Gait Disorders

Three main gait disorders seen with cerebral palsy include

• Toe-walking gait– common in hemiplegics

• Crouched gait– common in diplegic CP

• Stiff-knee gait– common in spastic diplegic CP

Foot Deformities

Equinus deformity (plantar-flexed calcaneus)EquinovalgusEquinovarusCavus foot and hallux clawingHallux Valgus

Orthotic Treatment

Main Goals:Ambulatory: improve and maintain efficient

gait/deformity preventionNon-Ambulatory:prevention of spinal and hip

deformity/improve sitting posture

Wrist Hand Orthosis

Hand positioningThumb in palm deformityPrevent wrist finger flexion contractureCan assist in motor control functions

Hensinger collar

Head supportFoam collar around jaw and occiputImproves breathing,eating,swallowing,social

interaction

ThoracoLumber spinal orthosis (TLSO)

For positional purposes Improved sitting Head and upper extremity postural controlHave not been found to stop scoliosis

progression in CP but may slow the progression

Miller et-al no impact on scoliosis curve shape or rate of progression

ThoracoLumber Spinal Orthosis (TLSO)

• Morris et-al no evidence brace effect pulmonary function

Floor reaction AFO

Anterior trimline to proximal tibiaLocks ankle and RESISTS ankle dorsiflexionHelps correct CROUCH from weak planter

flexionRogozinski et-al improved knee extension in

stance Best when knee and hip contractures,< 10

Hinged AFO

Posterior trimline captures malleoli and posterior half of calf

Controls excess ankle planter flexion in swing and midstance

Solid AFO

Workhorse of CP orthoticsPosterior trimline extends to or above

proximal tibiaFoot plate can be extended and used to

control footUsed to LOCK ankle in plantigrade positionControls planter flexion in swing

Solid AFO

Increase stride length and thus gait velocityCan aid in sit to stand maneuvrs in diplegicBrehm et-al found AFO use in quardiplegics

decreased energy expenditure (not in hemi and diplegics)

Posterior leaf spring orthosis

Posterior trimline to proximal third of calfDistal third more flexible allowin

accomodative dorsiflexionBenefits: Control excess ankle planter flexion in swing Allow ankle dorsiflexion in midstance Dynamic spring-like effect in terminal stance

Nighttime stretching AFO

For moderate gastroc or soleus contractureContinous stretch when limb in static position

SupraMalleolar Orthosis (SMO)

Captures and controls hind footTrimline over malleoliNo ANKLE controlMild and passively correctable foot

deformitiesControl excess forefoot supination and

pronation

Other assistive devices