Pediatric Orthotics Flashcards
Requirements for successful locomotion
- progression
- stability
- adaptability
- long term viability
- long distance navigation
Goals for LE orthotics in children
- enhance skeletal system development
- improve efficiency of locomotion
Enhancing Skeletal System development
- promote weight bearing in good alignment
- promote normal bone growth
- prevent deformity
Improve efficiency of locomotion
- support normal joint alignment and mechanics
- improve mechanical efficiency of muscles
- allow for variable range of motion to promote active muscle use during ambulation
psychological considerations
- parents can be affected a lot
- kids may be more affected when they go to school
- use different vocabulary to make it kid friendly (magic shoes)
Developmental and Growth considerations of orthotic prescription
- Has to do with financial resources
- they grow out of them - have to replace about every 6 months
functional limitations that may indicate the need for an orthosis
- inability to stand and/or walk
- frequent falling
- excessive fatigue
- decreased activity participation due to pain/discomfort
Impairments that contribute to the need for orthotic intervention in a child who has CP:
- abnormal muscle tone
- range of motion limitations
- muscle weakness
- decreased balance
- poor endurance
- joint and/or bony deformity
Types of orthosis typically used with children who have CP
- heel cups
- sure steps
- cascade hotdog, pattibob, pollywog
- Neurotec/Gaitway
- aquaplast splints and fiberglass casts
- custom orthoses
Heel cups
made to stabilize the calcaneus
*only used for GMFCS I
Sure Steps
Similar to SMO
*highly functioning children
Cascade hotdog, Pattibob, Pollywog
- Shoe inserts
- Purpose to control rear foot/trying to get subtalar neutral
- Minimal flexibility issues
Serial Casting
- Plaster or Fiberglass
- Used in the presence of contracture or minor deformity we are trying to correct
- Kids with increased tone in ankle and are stuck in PF may benefit
- Be careful with skin integrity –> must prevent wounds, skin breakdown, discomfort, or cutting off circulation
SMO (Super malleolus orthosis)
- Controls subtler joint positing in a more aggressive way
- severe rear foot valgus (navicular almost in WBing)
- DOES NOT CONTROL SAGITTAL PLANE
- Controls medial and lateral excessive motion
In order use an articulating AFO, how much passive ankle DF do kids need?
5 degrees
(measure correctly by locking midfoot)
What occurs if a child does not have 5 degrees of passive DF?
- foot hits the ground and tibia progresses over –> leads to skin breakdown because heel pops out of the brace
Toes Component
- Toe Lift
- Kids with high tone have toe curling that is strong, so toe lifts can help address it
- Toe 1 isn’t usually elevated by toes 2-5 are to help with dissociation between the toes and help with toe curling
Straps
- Pre tip strap
- Straps at ankle bc that’s where you need more control (especially with D ring)
- can add a forefoot strap
External Build Ups
- Prevent the brace from rocking in the shoes
When can floor reaction AFOs be used with children
- Only if the child does not have a contracture deformity at the hip and knee
- Only if they have enough hip extension moment/strength to control the moment (tibia is locked so there is an extension moment up the chain)
SWASH
- Standing Walking and Sitting Hip Orthosis
- Helps work on kids that have a lot of spasticity that adduct and IR –> puts hips more neutral so they can sit
- has to fit perfectly
- can be used as night splint
Research stuff
- Hinged AFOs increase efficiency bc it increases stride length, step length, and speed
- Only orthoses that extension to the knee (AFO) decrease an equinous deformity bc of the sagittal plane control
Impairments that contribute to the need to orthotic intervention in a child who has MM
- muscle weakness
- ROM limitations
- Deformities
orthoses for MM
- Standing Frame
- Parapodium
- HKAFO
- Reciprocating gait orthosis
- Hip Guidance Orthosis
- KAFO, AFO, Ground reaction AFO, Foot orthotic
Standing Frame
- Typical for those that have upper thoracic or lumbar lesion
- Weight bearing activities: purpose is to increase physiologic functioning and bone growth
- Not much mobility to it
Parapodium
- Does allow some functioning and mobility for a child that has a high level of innervation
- All about the swivel of the arm that does the mobility
- Gets kids up at eye level
HKAFO
- Low thoracic and lumbar lesions
- the ones we see mostly with his are reciprocating gait orthoses –> spring loaded mechanisms that progress the legs with some weight shift from the trunk
Hip Guidance orthosis
- same type of thing as a reciprocating gait orthotist but no spring mechanism
- purely gravity that helps swing the legs
KAFO for MM
L3-L4 lesions
AFO for MM
L3-S1 lesions
Ground reaction AFO for MM
L3-S1 lesions
Foot orthotic for MM
L4-S1 lesions
What does research say about MM?
- RGOs or HGOs improve efficiency over the typical HKAFO
- Swing through gait with HKAFO is faster than RGO
Impairments that contribute to the need for orthotics in a child who has DS
- hypotonia
- ligamentous laxity
- Gait deviations: out toeing, flat foot, wide base of support
*** should not have orthotic device above the knee unless something else is going on
Low tone pronation
- SMOs are great to increase stability but no bracing has been found to increase gross motor development or skill with kids with DS
- Shoe inserts alone will not be great
Congenital Hip Dislocation - Pavlik Harness
- Put on an infant at the time they are born in the presence of dislocated or subluxed hip
- Problem for kids bc acetabulum is flat and they need WBing to round it out
Legg- Calves Perthes Disease: Scottish-Rite Orthosis
- When there is avascular necrosis of the femoral head, the bone dies but the bone can be remodeled so this holds the hip in good position or the child must have surgery
- Similar to Pavlik Harness but for older kids
Severs Heel: Heel cup
- Can develop in all population of children due to apophysitis of the calcaneus
- Growth plate is still developing –> typically happens when they start playing sports
- Inflammation of the growth plate causes pain and heel cup stabilized the calcaneus to make pain go away
Idiopathic toe walking
- use AFO
- No pre-tib strap
JRA
splints to decrease inflammation by limiting movement
plagiocephaly
cranio-orthosis
Sensory integrative dysfunction:
- soft orthosis (SPIO and Theratogs)
- Weighted vests to provide proprioception
Shoes for children:
- need a fastener
- no backless or slip ons
- breathable materials
- no heels
- pattern or textured sole for traction
- soles should be sturdy and thick to protect feet from pain and injury BUT sole needs to be flexible so it can bend with the foot
- Shoes over orthoses
