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