Pediatric Orthoses Flashcards
how often can you justify needing a new brace for pediatric patients. how many months?
6 months
what are the two big considerations for the growth of pediatric patients
night-splinting: to prevent contracture in growing children
life of the orthotic: 6 months rather than 3 years
True or false: Ease of use and independence of donning is more important for pediatric patients than adult patients?
False! they generally have a parent around to help
what kind of brace materials can be used in pediatric patients rather than adult patients for temporary braces?
plastic because they are more malleable, against an adult they likely wouldn’t hold against forces
are off the shelf or custom orthoses more common in peds?
off the shelf because they have more flexible deformitiese
what don’t you expect with low tone feet?
don’t expect arches
what are two potential indicators for foot orthoses in pediatric patients
low tone feet
pronation with or without eversion
what are two precautions of using foot orthoses in pediatric patients?
sensory defensiveness
Level of evidence: not a lot of evidence longitudinally over time!
What is the defining characteristic of UCBL?
What kind of person is it mostly used in?
totally cups the heel, trim line goes up to malleoli
For someone who has unwanted flexibility in their foot or hindfoot is everted
what is one step up from the UCLB?
Characteristics of it?
cricket: flexible sillicone and then a hard plastic liner
what size orthotic do you order for a child?
next size up from what you measure due to growth
What is the difference in orthotic between when you are trying to deal with a flexible vs. fixed deformity
flexible deformity you may be able to go off the shelf.
A fixed deformity you need to ACCOMMODATE therefore you would do a custom orthoses
Where do SMO look like
what do they control
supramalleolar so above the ankle
control ML instability NOT DF
Who are SMO’s good for
people with ML instability with no need for DF assist in swing
what are three indications for SMO use?
pronation
ligamentous laxity
mild gastroc spasticity
Who would you definitely not use an SMO for?
persistent toe walking or PF contracture: doesn’t assist with DF
what kind of orthoses is the “surestep”
what is special about it
SMO
first ray is free for extension and push off vs. the other brand of the cascade
what kind of orthoses is the kiddie gait?
toe off
what are the two indications for toe-off/kiddigait orthoses?
foot drop (DF assist)
mild crouch
What are three precautions for Toeoff/kiddigait?
insufficient DF PROM (need 5 degrees)
quad spasticity
knee hyperextension
insufficient ML control
three indications for PSL?
foot drop (DF assist)
poor pushoff? potentiall
hemiplegic CP and insufficient power
PLS vs. solid AFO?
narrow trim lines, doesn’t come all the way to malleolo. So if the person needs ML control or has greater muscle tone the AFO is a better choice
2 precautions for use of PLS
low trimline: insufficient ML control
gastroc spasticity: its a little maliable
4 indications for articulating AFO
insufficient DF in swing
GASTROC SPASTICITY
active DF present
idiopathic toe walking: have DF and PF actively allowing tibial translation
2 precautions for articulating AFO
PF contracture: must address this first or they’ll just hang out in PF
severe proximal weakness: alignment may be compromised
solid vs. articulating AFO things to think about
if you have no active DF no need for articulating
Tamarack and ultraflex are what kind of orthoses
articulating AFO
an ankle brace controlling knee hyperextension would stop what motion at the ankle?
PF: blocking posterior translation of tibia
articulating knee braces still allow what
strengthening of the quads through squats
4 indications for articulating AFO with free DF and PF block
toe-heel gait: not just toe walking, toe heel gait means they’re getting active DF at some point just not getting good heel strike
early heel rise
gastroc tone
knee hyperextension
2 precautions for articulating AFO with free DF and PF blocked
gastroc contracture
persistent toe walking pattern
for both they need more help with getting DF than free bracing allows
what is the purpose of check strap
can be tightened down to ankle orthoses a solid AFO
4 indications for solid AFO
poor foot alignment in standing
PF spasticity
risk of PF contracture
PF paralysis: no DF or PF
what orthoses would you use for an individual who is non ambulatory in a standing program
Solid AFO
what activity is super difficult with solid AFO
stairs
3 precautions of solid AFO
if they are able to independently ambulate without AD
potential for recovery of DF or ambulation
blocking of transfers, functional mobility such as stairs and floor mobility in kids!
what kind of orthoses is a turbo/
solid AFO
DRAFO is used for what?
accomodate contractures (she doesn’t like them)
what does a floor reaction AFO look like?
part that opens and closes is anterior
what are the 3 indications for floor reaction AFO?
crouched gait
PF weakness
hamstring spasticity
2 precautions of floor reaction AFO
toe walking: brace still allows for PF
set the angle to accomodate knee contracture/functional standing position.
if a child has crouched gait what kind of orthoses are you thinking abuot using witht hem
floor reaction AFO
solid AFO
your pt is unable to maintain knee extension in standing what kind of orthoses do you want to use?
KAFO
2 indications of KAFO, HKAFO’s, RGO use
inability to maintain knee extension in standing
weakness/paralysis
2 precautions to KAFO’s and HKAFO’s/RGO’s
spasticity
align for A/P weight line
what is the major consideration for HKAFO or RGO?
they’re super heavy!! decreases energy efficiency
high level spina bifida would use what kind of orthses?
parapodium
what is the major precaution of parapodium?
lots of points of contact, want to make sure skin integrity is good
when would you consider a parapodium
independence with transfers not possible
define
plagiocephaly
brachycephaly
scaphocephaly
plagiocephaly: flattness on one side more than the other
brachycephaly: flattened on posterior side
scaphocephay: long narrow head
what age is the precaution for cranial molding helmets?
> 1 year
when do you think about intervening for asymmetry of a babies head?
moderate or severe asymmetry: positioning education, refer to an orthotist to get a scan done, neurology
what is the wear schedule goal for a hemet?
23 hrs/7days a week
What are some things to keep in mind for cranial molding helmets?
skin checks! (red should go away in 30 minutes)
perspiration
Remove for an hour a day for PROM/ROM
work up to wear schedule
red marks due to helmets should go away in what time frame?
30 minutes within taking it off
true or false: it is okay to leave helmets on for bathing and swimming
false, take them off
where do you typically start for a helmet wear schedule?
end?
1 hour on, 1 hr off, not during naps or night
23 hrs/day during all sleeping
every time the helmet is removed you do what?
skin check!
what is the goal of wear time for night splinting?
4-6 hours
what are the three most commonly night splinted LE muscles
PF, knee flexors, ADD
can you get over the shelf night splints?
yes! can also get custom
what is the point of dynamic night splints?
the joint has a resistance function: it allows you to relax into the position that you can get to and applies resistance.
what is the con of dynamic splints
they’re very expensive! only order it if you think your pt is going to use it
where do you begin the wear time for nightsplinting?
1-2 hours increase by half an hour every day or every other day.
working up to 6 hours
if they cannot sleep with nighsplint on what is a good alternative
4 hours after school
