Young children with

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Young children with Cerebral Palsy (CP)
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Cerebral Palsy

• Cerebral Palsy means Brain Paralysis
• CP is caused by abnormal brain development or
  brain damage
• CP causes physical and cognitive problems
• Muscle control (spasticity, gait, coordination,
  speech, swallowing)
• Head stability (cannot keep head up, which
  affects cognitive development)
• Cognitive (learning disabilities, missed/delayed
  milestones, retardation)

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Cerebral Palsy

• Spasticity chronic contraction of muscle
• Muscle tone passive partial contraction, for
  maintaining equilibrium, for example.

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Cerebral Palsy

• Several cases of CP go unnoticed at birth
• CP becomes obvious as the child falls behind in
  his/her cognitive and physical development

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Cerebral Palsy Statistics Latin America /
Colombia
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Spastic Cerebral Palsy

• Affects 70 to 80 percent of patients
• The muscles are stiffly and in some cases
  permanently contracted.
• Surgery can be performed to loosen tight muscles
  and release fixed joints.
• Only about 5 of people with stiffness of their
  elbows, wrists, hands, and fingers benefit from
  surgery.

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Plantar Flexion of Ankles

• Due to problems with muscle control some patients
  experience constant, uncontrollable plantar
  flexion
• A rigid AFO with a stiffened knee brace.
• Due to spasticity an AFO with dorsiflexion assist
  is inappropriate for this application

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AFO With Knee Brace

• The AFO is rigid to prevent movement of the ankle
  and knee
• The knee brace serves to further stretch the
  gastrocnemius which reduces spasticity and
  prevents other foot deformities from developing

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AFO With Knee Brace

• This AFO is manufactured like a traditional AFO
• The strap it attached to the AFO using rivets
• The strap should be wide enough to properly
  support the knee and provide a strong extension
  force on the calf

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Crouch Gait or Scissor Gait

• Crouch gait is caused by the constant flexion of
  the knee and hip, as well as internal rotation
  and adduction of the hip

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Orthotic Treatment of Crouch Gait

• The preferred method of treatment is a floor
  reaction ankle foot orthosis (FRAFO)
• The FRAFO serves to properly align the ankle and
  knee as well as provide knee extension

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Manufacture of FRAFO

• A cast of the limb in desired position is taken
• Polypropylene is vacuum formed around the cast

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Manufacture of FRAFO

• At the top near the knee the anterior of the AFO
  is higher than the posterior. The anterior should
  be cut to fit just below the knee cap as high as
  possible without discomfort.
• The lower anterior portion of the AFO is removed
  as well as the top of the foot

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Manufacture of FRAFO

• The upper anterior portion of the AFO is padded
  with foam for patient comfort
• A Velcro strap is attached to the AFO just above
  the ankle joint using rivets
• The rivets should be padded to avoid rubbing

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Problems with AFOs

• If redness or bruising occurs, the AFO needs to
  be adjusted
• The most common problems are rubbing on the calf
  and shin
• The patient should wear the AFO for at least
  thirty minutes before adjustments are made if
  redness continues after thirty minutes then
  adjustments can be made
• The AFO can be spot heated and adjusted to
  relieve pressure on the upper shin, knee, calf or
  foot

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Contractures

• Muscle contractures can become fixed if left
  untreated
• The most common contractures are of the foot and
  the hands
• Serial casting can help relieve fixed contractures

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Serial Casting

• The foot is positioned in the optimal position
  and a cast is made
• The cast is left on for a short time (1-2 weeks)
• The cast is removed this should improve the
  range of motion
• With the increased range of motion the foot is
  moved to the new optimal position

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Serial Casting

• This process is repeated until the foot is in the
  desired position
• After the last cast is removed orthotics may be
  prescribed to keep the foot in the desired
  position to maintain the new range of motion

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Wrist Hand OrthoticThe WHO

• Utilized for the treatment of disorders of the
  wrist, hand and/or fingers below the elbow joint
• Orthotic Types
• Forearm-Wrist
• Forearm-Wrist-Thumb
• Forearm-Wrist-Hand
• Hand

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Forearm-Wrist-Thumb Orthotic

• Utilized to stabilize the thumb in opposition for
  3-point chuck in peripheral nerve damage in
  patients with cerebrovascular diseases
• The splint covers two thirds of the distal radial
  forearm up to the interphalangeal (IP) joint of
  the thumb
• The wrist should be placed in 15-30 of
  dorsiflexion while maintaining motion of digits
  2-5
• The thumb should be maintained in an abducted
  position to achieve a 3-point chuck

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Hand Orthotic

• Used to maintain support and provide dynamic
  corrective force in positioning the fingers,
  assisting weak motor finger extensor function
• Utilized for patients that can extend their
  wrists but cannot flex their fingers.
• Finger extension at the metacarpophalangeal
  joints of the second and third digits is attained
• Use of this device allows for a 3-point pinch.

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Manufacturing of The WHO

• Thermo-vacuumed formed
• Formed over a mold
• Utilizes polypropylene
• Velcro
• Rivets

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Scoliosis in CP Patients

• Abnormal curvature of the spine in coronal
  sagittal planes and rotation in transverse plane
• Symptoms may or may not exist
• Mild back pain
• Fatigue
• Round back
• Breathing difficulties
• Gait imparement
• Orthotic treatment Thoraco-Lumbo-Sacral-Orthosis
  (TLSO)

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TLSO
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TLSO

• Custom molded plastic and straps (velcro)
• Internal foam pads may be added for comfort
• 3-point pressure on curved spine to prevent
  progression
• Mostly prescribed for lumbar or thoraco-lumbar
  deformities

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TLSO

• Unnoticeable under clothes
• Removable (e.g. for sports)
• Typically worn for walking and sleeping

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TLSO Misconceptions

• It cures scoliosis
• It cures CP
• Suitable for upper spine deformities
• Temporary treatment
• It relieves pain forever
• Worn for very specific activities/short time
• Effective even if plastic is molded incorrectly

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CP Prevention (pre-birth)

• Rh factor tests in pregnant women
• Rh immunization if mother's Rh is negative
• Blood transfusions to baby after birth
• Exposure to virus/infection prevention
• Prevention of unnecessary X-rays, drugs, meds
• Control of diabetes
• Control of anemia and other nutritional
  deficiencies