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.
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
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
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
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
23.
24. Hinged AFO
Posterior trimline captures malleoli and
posterior half of calf
Controls excess ankle planter flexion in swing
and midstance
25.
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)
28.
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
30.
31. Nighttime stretching AFO
For moderate gastroc or soleus contracture
Continous stretch when limb in static position
32.
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