Chapter 38: Orthoses for cerebral palsy

Question 1

What is cerebral palsy?

Answer 1

A static encephalopathy with onset before maturation of the central nervous system.
Anoxic events lead to quadriplegia.
Prematurity resulting in periventricular leukomalacia results in diplegic CP.
Intrauterine strokes cause hemiplegia.
No matter the type it is the central control system that is damaged.

Question 2

Patient who present with pure spasticity, what was damaged?

Answer 2

The pyramidal system

Question 3

In patients with athetoid CP, what was damaged?

Answer 3

The extrapyramidal system

Question 4

What are the primary abnormalities seen in CP?

Answer 4

Loss of selective motor control
Dependence on primitive reflex patterns for movement.
Abnormal muscle tone
Relative imbalance between muscle agonists and antagonists across joints
Deficient equilibrium reactions
Weakness.

Question 5

What is an example of tertiary gait pattern in patients with CP who have cospasticity of the rectus femoris and hamstrings?

Answer 5

Circumduction

Question 6

Why might vaulting be seen in patients with CP?

Answer 6

It is usually seen in patients with hemiplegia CP to compensate for a lack of clearance on the hemiplegic side caused b y either a drop foot in swing (Tibialis anterior dysfunction) or rectus femoris spasticity.

Question 7

Neurological conditions in CP create greater _________dysfunction?

Answer 7

Distal dysfunction. There are usually more problems at the foot and ankle rather than the foot.

Question 8

Which muscles are often affected by excessive tone caused by CP?

Answer 8

Two-joint muscles

psoas, rectus femoris, hamstrings, gastrocnemius

Question 9

Which muscles are usually elongated due to crouch gait?

Answer 9

Gluteus maximus
Vasti
Soleus

Question 10

What is primarily responsible for crouch gait?

Answer 10

Weakness and excessive elongation of the one joint muscles in conjunction with spasticity of the two joint muscles.

Question 11

Many patients with CP have weak what?

Answer 11

Plantarflexors (gastrocnemius and soleus)

Question 12

What happens when the plantarflexors fail to function adequately in midstnace?

Answer 12

Excessive dorsiflexion reults and is accompanied by excessive knee flexion (crouch gait).

Question 13

What are the foot deformity types seen in patients with CP?

Answer 13

In patients with hemiplegia: Equinovarus foot deformity is most common and pes planus.
In patients with diplegic and quadriplegic CP: Equinovalgus

Question 14

What orthoses are almost never used in patients with ambulatory problems and have CP?

Answer 14

HKAFOs
KAFOs
They are only used during rest to prevent contractures.

Question 15

What tibial deformities might be present in patients with CP?

Answer 15

Tibial malrotation (external tibial torsion)
Distal tibial valgus deformity.

Question 16

What are common lower extremity orthoses used for CP?

Answer 16

SMOs
UCBLS
To control varus or valgus deformities of the hindfoot.

Question 17

What AFOs are common prescribed for patients with CP?

Answer 17

Hinged AFOs
However as children become older and larger, the hinged AFO might not work.
They are safer to use for patients with hemiplegia because they are less likely to crouch.

Question 18

When is a solid AFO used in CP?

Answer 18

Increasily severe spasticity and weaknes typically acompanied by worsening motor control.

Question 19

When is a FRAFO indicated?

Answer 19

For completely incompetent plantaflexion function, such as previous overlengthening of the heel cord.
When knee extensor function is deficient

Question 20

What are the contraindications of using a FRAFO for CP?

Answer 20

Fixed hip an dknee contractures that prevent upright walking and the presence of either tibial torsion or uncorrected foot deformity that adversely affects the alignment of the foot relative to the knee.