Orthotic Treatment For CP Deformities

2. Cerebral Palsy
Deformities And Orthotic
Treatment
Prepred By: Amina Jamil
Bsc (Hons) Orthotics And Prosthetics
2nd year

3. Contents…
Deformities in CP
 Upper extremity
 Spine
 Hip
 Gait disorders
 Foot deformities

4. 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

5. 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.

6. 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

7. 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

8. Wrist-Flexion Deformity

9. 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

10. 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°

11. 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%.

12. 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

13. Foot Deformities
Equinus deformity (plantar-flexed calcaneus)
Equinovalgus
Equinovarus
Cavus foot and hallux clawing
Hallux Valgus

14. Orthotic Treatment
Main Goals:
Ambulatory: improve and maintain efficient
gait/deformity prevention
Non-Ambulatory:prevention of spinal and hip
deformity/improve sitting posture

15. Wrist Hand Orthosis
Hand positioning
Thumb in palm deformity
Prevent wrist finger flexion contracture
Can assist in motor control functions

17. Hensinger collar
Head support
Foam collar around jaw and occiput
Improves breathing,eating,swallowing,social
interaction

19. 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

20. ThoracoLumber Spinal Orthosis (TLSO)
• Morris et-al no evidence brace effect
pulmonary function

22. 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

24. Hinged AFO
Posterior trimline captures malleoli and
posterior half of calf
Controls excess ankle planter flexion in swing
and midstance

26. 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

27. 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)

29. 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

31. Nighttime stretching AFO
For moderate gastroc or soleus contracture
Continous stretch when limb in static position

33. 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

35. Other assistive devices