CP - Gait & Orthotics Flashcards
What is drop foot?
- Foot falls into equinus during swing
- DF seen during stance
What is true equinus?
Ankle remains in PF throughout stance & swing
What is apparent equinus?
Child may remain on their toes, however ankle is in plantargrade
What is jump knee?
- Increased knee flexion in early stance
- Normal knee extension later in stance
- Hip has normal movement
What is recurvatum knee?
Knee in hyperextension during stance
What is stiff knee?
Decreased knee flexion during swing
What is crouch gait?
Increased hip & knee flexion with ankle DF in stance
What are the characteristics of hemiplegia?
- 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
What are the common gait patterns in spastic hemiplegia?
- 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
What types of spastic hemiplegia would a hinged AFO be used for?
1, 2A, 2B, 3
What is the treatment for type 4 spastic hemiplegia?
- Solid AFO
- GRAFO
- NB femoral osteotomy
What are the characteristics of diplegia?
- More proximal
- More apparent with age
- Apparent equinus & crouch gait frequently seen
- 5th classification added to allow for asymmetry with each leg separately classified
What are the sagittal gait patterns in spastic diplegia?
- Group I: True equinus
- Group II: Jump gait
- Group III: Apparent equinus
- Group IV: Crouch gait
- Group V: Asymmetric gait
What are the treatments for each type of spastic diplegia?
- Group I, II: Hinged AFO
- Group III: Solid AFO
- Group IV: GRAFO
How can toe walking pattern progress to crouch gait with age?
- 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
What will an effective orthotic do?
Balance the need for external stability with the potential negative effects on mobility & strength
What are the key features of orthotics?
- Help prevent deformity and contractures
- Decrease impact of spasticity
- Reduce pain
- Correct gait pattern
- Improve balance
What requirements must the design of orthotics meet?
- Triplanar control of bony structures of ankle/foot complex
- Musculoskeletal objectives
- Motor control objectives
- Functional objectives
What is foot rockers in gait?
- 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
What are the types of orthotics used to improve gait?
- Foot stabilising splint (FSS) or UCBL
- Ankle foot orthotic (AFO - static or dynamic)
- Ground reactive AFO (GRAFO)
What may be required to support early standing?
- 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
What are the key features of an FSS?
- 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
What does an FSS improve?
Biomechanical alignment - may impact on GM skills & fatigue
What are the key features of a static AFO?
- 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’
What are the key features of a dynamic AFO?
- 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
What are the key features of a GRAFO?
- Fixed ankle position at 90° with knee extension piece
- Mainly used post surgery for short time
- Crouch gait in spastic diplegia
When are night splints for prolonged stretch used?
- Calf length
- Knee flexion contracture - 3 point knee extension splints
What are the precautions for orthotics?
- 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
