Orthotic Management of Cerebral Palsy

Cerebral palsy refers to a group of permanent disorders occurring in the early stages of development which affect, in part, movement and posture.

The result is a host of impairments in the normal functioning of the body causing limited mobility, weak coordination of movements, loss of sensorimotor control, poor balance and decreased muscle strength.

Secondary musculoskeletal problems such as muscle contractures and bony deformities that develop gradually as a response to these impairments lead to further diminishing of motor control in the patient.

As mentioned by Richards et al. in their study on the disorder, the following cerebral palsy classification with four major components has been proposed in the past – motor abnormalities, accompanying impairments, anatomical/neuro-imaging findings and causation/timing.

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The specific motor control deficits observed in children with cerebral palsy, as listed in the study, include excessive spread of reflex excitation at rest, exaggerated stretch reflexes during passive movements, diminished or lack of antagonist muscle inhibition during voluntary movements and deficits in postural reaction to perturbations.

The authors suggest the use of two early detection tools namely, General Movements Assessment and Test of Infant Motor Performance, which could lead to an early intervention and help in the rehabilitation of children with cerebral palsy.

For those past the period of infancy and in whom the movement disorder has been established, Antigone S. Papavasiliou suggests that management and treatment strategies must focus on – 1) minimising the development of secondary problems by reducing or normalising the tone, facilitating adequate stretch to muscles and increasing active range of motion, 2) strengthening weak muscles, 3) improving mobility and acquiring functional motor skills, 4) promoting functional independence.

Although multiple orthosis may be required throughout the child’s development, an orthotic intervention in the form of customised foot orthotics such as MASS4D® may help in controlling ankle plantar flexion and treat secondary effects, having a favourable impact on the equinus foot.

With an improvement in ankle range of motion, there is a reduction in the load placed on the soft tissue supportive structures around the ankle, helping diminish compensatory movements of the lower limbs and providing a stable base of support for resistance of body sway.

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References:

1. Richards, C. L., Malouin, F. (2013) Cerebral palsy: definition, assessment and rehabilitation. Handbook of Clinical Neurology: April 2013, Vol. 111, pp. 183-195. DOI: 10.1016/B978-0-444-52891-9.00018-X
2. Papavasiliou, A. S. (2009) Management of motor problems in cerebral palsy: A critical update for the clinician. European Journal of Paediatric Neurology: September 2009, Vol. 13, No. 5, pp. 387-396. DOI: 10.1016/j.ejpn.2008.07.009.

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