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Cerebral Palsy Deformities And Orthotic Treatment


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Orthotic Treatment For CP Deformities

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Cerebral Palsy Deformities And Orthotic Treatment

  1. 1. Cerebral Palsy Deformities And Orthotic Treatment Prepred By: Amina Jamil Bsc (Hons) Orthotics And Prosthetics 2nd year
  2. 2. Contents… Deformities in CP  Upper extremity  Spine  Hip  Gait disorders  Foot deformities
  3. 3. 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
  4. 4. 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.
  5. 5. Deformities in CP… Upper extremity Characteristic deformities include: Shoulder internal rotational contracture Fore arm-pronation/elbow flexion deformity Wrist flexion deformity Thumb-in-palm deformity Finger flexion deformity
  6. 6. Deformities in CP… Upper extremity Shoulder contracture: Glenohumeral internal rotational contracture Forearm-Pronation / Elbow-Flexion Deformity Elbow flexion contracture Pronation deformity Wrist-Flexion Deformity Wrist is typically flexed and in ulnar deviation
  7. 7. Wrist-Flexion Deformity
  8. 8. Deformities in CP… Upper extremity Thumb-in-Palm Deformity  Flexed thumb into palm prevents grasping and pinching activities Finger-Flexion Deformity Swan-neck deformities can sometimes be helped with correction of the wrist flexion deformity
  9. 9. 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 scoliosis Curves are typically less than 40° but can range from 10° to 146°
  10. 10. 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%.
  11. 11. 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
  12. 12. Foot Deformities Equinus deformity (plantar-flexed calcaneus) Equinovalgus Equinovarus Cavus foot and hallux clawing Hallux Valgus
  13. 13. Orthotic Treatment Main Goals: Ambulatory: improve and maintain efficient gait/deformity prevention Non-Ambulatory:prevention of spinal and hip deformity/improve sitting posture
  14. 14. Wrist Hand Orthosis Hand positioning Thumb in palm deformity Prevent wrist finger flexion contracture Can assist in motor control functions
  15. 15. Hensinger collar Head support Foam collar around jaw and occiput Improves breathing,eating,swallowing,social interaction
  16. 16. ThoracoLumber spinal orthosis (TLSO) For positional purposes  Improved sitting  Head and upper extremity postural control Have 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
  17. 17. ThoracoLumber Spinal Orthosis (TLSO) • Morris et-al no evidence brace effect pulmonary function
  18. 18. Floor reaction AFO Anterior trimline to proximal tibia Locks ankle and RESISTS ankle dorsiflexion Helps correct CROUCH from weak planter flexion Rogozinski et-al improved knee extension in stance  Best when knee and hip contractures,< 10
  19. 19. Hinged AFO Posterior trimline captures malleoli and posterior half of calf Controls excess ankle planter flexion in swing and midstance
  20. 20. Solid AFO Workhorse of CP orthotics Posterior trimline extends to or above proximal tibia Foot plate can be extended and used to control foot Used to LOCK ankle in plantigrade position Controls planter flexion in swing
  21. 21. Solid AFO Increase stride length and thus gait velocity Can aid in sit to stand maneuvrs in diplegic Brehm et-al found AFO use in quardiplegics decreased energy expenditure (not in hemi and diplegics)
  22. 22. Posterior leaf springorthosis Posterior trimline to proximal third of calf Distal third more flexible allowin accomodative dorsiflexion Benefits:  Control excess ankle planter flexion in swing  Allow ankle dorsiflexion in midstance  Dynamic spring-like effect in terminal stance
  23. 23. Nighttime stretching AFO For moderate gastroc or soleus contracture Continous stretch when limb in static position
  24. 24. SupraMalleolar Orthosis (SMO) Captures and controls hind foot Trimline over malleoli No ANKLE control Mild and passively correctable foot deformities Control excess forefoot supination and pronation
  25. 25. Other assistive devices