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Paediatric Interventions > CP - Gait & Orthotics > Flashcards

CP - Gait & Orthotics Flashcards

1
Q

What is drop foot?

A
  • Foot falls into equinus during swing

- DF seen during stance

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2
Q

What is true equinus?

A

Ankle remains in PF throughout stance & swing

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3
Q

What is apparent equinus?

A

Child may remain on their toes, however ankle is in plantargrade

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4
Q

What is jump knee?

A
  • Increased knee flexion in early stance
  • Normal knee extension later in stance
  • Hip has normal movement
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5
Q

What is recurvatum knee?

A

Knee in hyperextension during stance

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6
Q

What is stiff knee?

A

Decreased knee flexion during swing

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7
Q

What is crouch gait?

A

Increased hip & knee flexion with ankle DF in stance

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8
Q

What are the characteristics of hemiplegia?

A
  • More distal
  • True equinus forms the basis of most patterns
  • Classification based on sagittal plane features (except type IV)
  • Focus on postural patterns caused by spasticity & contracture
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9
Q

What are the common gait patterns in spastic hemiplegia?

A
  • Type 1: Drop foot
  • Type 2A: True equinus
  • Type 2B: True equinus/recurvatum knee
  • Type 3: True equinus/jump knee
  • Type 4: Equinus/jump knee OR pelvic rotation, hip fl/add/IR
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10
Q

What types of spastic hemiplegia would a hinged AFO be used for?

A

1, 2A, 2B, 3

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11
Q

What is the treatment for type 4 spastic hemiplegia?

A
  • Solid AFO
  • GRAFO
  • NB femoral osteotomy
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12
Q

What are the characteristics of diplegia?

A
  • More proximal
  • More apparent with age
  • Apparent equinus & crouch gait frequently seen
  • 5th classification added to allow for asymmetry with each leg separately classified
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13
Q

What are the sagittal gait patterns in spastic diplegia?

A
  • Group I: True equinus
  • Group II: Jump gait
  • Group III: Apparent equinus
  • Group IV: Crouch gait
  • Group V: Asymmetric gait
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14
Q

What are the treatments for each type of spastic diplegia?

A
  • Group I, II: Hinged AFO
  • Group III: Solid AFO
  • Group IV: GRAFO
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15
Q

How can toe walking pattern progress to crouch gait with age?

A
  • Due to dominant gastroc
  • Can become a pattern of increasing hip/knee flexion
  • Due to proximal involvement becoming more apparent
  • Normal progression in many children with severe spastic diplegia or quadriplegia
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16
Q

What will an effective orthotic do?

A

Balance the need for external stability with the potential negative effects on mobility & strength

17
Q

What are the key features of orthotics?

A
  • Help prevent deformity and contractures
  • Decrease impact of spasticity
  • Reduce pain
  • Correct gait pattern
  • Improve balance
18
Q

What requirements must the design of orthotics meet?

A
  • Triplanar control of bony structures of ankle/foot complex
  • Musculoskeletal objectives
  • Motor control objectives
  • Functional objectives
19
Q

What is foot rockers in gait?

A
  • A description of foot and ankle progression in stance
  • Describes the transitions between phases of stance
  • Useful to describe the impact of an orthotic during stance
20
Q

What are the types of orthotics used to improve gait?

A
  • Foot stabilising splint (FSS) or UCBL
  • Ankle foot orthotic (AFO - static or dynamic)
  • Ground reactive AFO (GRAFO)
21
Q

What may be required to support early standing?

A
  • Boots or commercial shoes with arch support
  • If foot rolls into valgus may require FSS
  • If child goes onto toes (or not controlled by above suggestions) generally will require fixed AFO
22
Q

What are the key features of an FSS?

A
  • Control foot posture
  • Excessive valgoid posture (calcaneal eversion & forefoot pronation)
  • Prevention of mid foot break
  • Start early, fit needs to be checked every 6/12 due to growth
  • Worn in shoes 6-8 hours/day
23
Q

What does an FSS improve?

A

Biomechanical alignment - may impact on GM skills & fatigue

24
Q

What are the key features of a static AFO?

A
  • Controls triplanar aspects of foot position
  • Maintains ankle at 90°
  • Impacts on joints above the orthotic with improved knee/hip extension
  • Gait - eliminates all ‘rockers’
25
Q

What are the key features of a dynamic AFO?

A
  • Requires good hip/knee extension
  • Must have adequate range in gastroc to make use of hinge
  • Allows for more movement at ankle joint and therefore more normal gait (2nd rocker present, partial 3rd rocker)
  • More expensive
  • More bulky for fitting into shoe
26
Q

What are the key features of a GRAFO?

A
  • Fixed ankle position at 90° with knee extension piece
  • Mainly used post surgery for short time
  • Crouch gait in spastic diplegia
27
Q

When are night splints for prolonged stretch used?

A
  • Calf length

- Knee flexion contracture - 3 point knee extension splints

28
Q

What are the precautions for orthotics?

A
  • Need to address negative impact of orthotics which are limited muscle length excursion and weakness
  • Monitor for pressure areas
  • Compliance with wearing orthotics
  • Monitor effectiveness of orthotic

Paediatric Interventions (27 decks)

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