Pediatric Orthosis Flashcards
What are some pediatric-specific considerations for orthoses?
Growth (Life of the orthotic and night splinting)
Development or recovery of function
Ease of use and independence of donning
Brace materials
When would foot orthoses be indicated and what are some precautions?
Potential indications: Low tone feet, Pronation with/without excessive eversion
Precautions: Sensory defensiveness, Level of evidence*
When would supramalleolar orthoses be indicated and what are some precautions?
Indications: Pronation, Ligamentous laxity, even in the setting of mild gastrocnemius overactivity
Precautions: Persistent toe walking, Plantarflexor contracture
What does a supramalleolar orthoses help control and how high does it go?
Above the ankle
Controls medial lateral instability, but does not assist with dorsiflexion in swing
What are some examples of minimal AFOs?
Toe Off
Posterior Leaf Spring
Alternate materials or trimline compared to AFOs
When would toe off orthoses be indicated and what are some precautions?
Indications: Foot drop (dorsiflexion assist), Mild crouch (potentially)
Precautions: Plantarflexor contracture (need at least 5 DF), Quadriceps spasticity, Knee hyperextension, Insufficient medial lateral control
When would posterior leaf spring orthoses be indicated and what are some precautions?
Indications: Foot drop (DF assist), Poor power (may assist with push off or improving power, esp. in hemiplegia)
Precautions: Insufficient medial lateral control, Significant gastrocnemius overactivity
When would an articulating AFO orthoses be indicated and what are some precautions?
Indications: Insufficient DF in swing, but active DF ROM, Gastrocnemius overactivity, Idiopathic toe walking
Precautions: Plantarflexor contracture, Severe proximal weakness due to potential impact on alignment (e.g. Duchenne muscular dystrophy)
What can be added to an articulating AFO?
Tamarack joint to provide DF assist
Ultraflex: adjustable dynamic response joint
When would an articulating AFO (free DF w/ PF block) orthoses be indicated and what are some precautions?
Indications: Toe heel gait, Early heel rise, Gastrocnemius overactivity, Knee hyperextension
Precautions: Persistent toe walking gait pattern, Gastrocnemius contracture
When would a solid AFO orthoses be indicated and what are some precautions?
Indications: Plantarflexor (PF) overactivity, Ankle weakness or paralysis, Risk of further PF contracture, Poor foot and ankle alignment in pts standing program
Precautions: May initially lose some independence with ambulation as they adjust to alignment, Consider potential for recovery of active dorsiflexion, May make transfers from floor and descending stairs more difficult
When would a floor reaction or ground reaction AFO orthoses be indicated and what are some precautions?
Indications: Crouched gait, Significant PF weakness, Hamstring overactivity
Precautions: Toe walking
When would a KAFO orthoses be indicated and what are some precautions?
Indications: Inability to maintain knee extension in standing, Weakness or paralysis of quadriceps and ankle musculature
Precautions: Patients with muscle overactivity, Consider alignment and the A/P line, May lock or unlock the knee joint
When would a HKAFO or RGOs orthoses be indicated and what are some precautions?
Indications: Inability to maintain knee extension in standing, Weakness and paralysis at the hip, knee, ankle
Precautions: Patients with muscle overactivity
Considerations:
Energy efficiency, Cost and adjustments needed at onset and over time
When would a Parapodium be indicated and what are some precautions?
Indications: Thoracic spina bifida, Paralysis or significant weakness
Precautions: Skin checks will be needed
Considerations: Gross motor function (opting for WB instead of floor mobility), Robotics in the future: size limitations at present
