Pediatric Orthotics

Question 1

Requirements for successful locomotion

Answer 1

1. progression
2. stability
3. adaptability
4. long term viability
5. long distance navigation

Question 2

Goals for LE orthotics in children

Answer 2

1. enhance skeletal system development
2. improve efficiency of locomotion

Question 3

Enhancing Skeletal System development

Answer 3

1. promote weight bearing in good alignment
2. promote normal bone growth
3. prevent deformity

Question 4

Improve efficiency of locomotion

Answer 4

1. support normal joint alignment and mechanics
2. improve mechanical efficiency of muscles
3. allow for variable range of motion to promote active muscle use during ambulation

Question 5

psychological considerations

Answer 5

• 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)

Question 6

Developmental and Growth considerations of orthotic prescription

Answer 6

1. Has to do with financial resources
2. they grow out of them - have to replace about every 6 months

Question 7

functional limitations that may indicate the need for an orthosis

Answer 7

1. inability to stand and/or walk
2. frequent falling
3. excessive fatigue
4. decreased activity participation due to pain/discomfort

Question 8

Impairments that contribute to the need for orthotic intervention in a child who has CP:

Answer 8

1. abnormal muscle tone
2. range of motion limitations
3. muscle weakness
4. decreased balance
5. poor endurance
6. joint and/or bony deformity

Question 9

Types of orthosis typically used with children who have CP

Answer 9

1. heel cups
2. sure steps
3. cascade hotdog, pattibob, pollywog
4. Neurotec/Gaitway
5. aquaplast splints and fiberglass casts
6. custom orthoses

Question 10

Heel cups

Answer 10

made to stabilize the calcaneus
*only used for GMFCS I

Question 11

Sure Steps

Answer 11

Similar to SMO
*highly functioning children

Question 12

Cascade hotdog, Pattibob, Pollywog

Answer 12

• Shoe inserts
• Purpose to control rear foot/trying to get subtalar neutral
• Minimal flexibility issues

Question 13

Serial Casting

Answer 13

• 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

Question 14

SMO (Super malleolus orthosis)

Answer 14

• 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

Question 15

In order use an articulating AFO, how much passive ankle DF do kids need?

Answer 15

5 degrees
(measure correctly by locking midfoot)

Question 16

What occurs if a child does not have 5 degrees of passive DF?

Answer 16

• foot hits the ground and tibia progresses over –> leads to skin breakdown because heel pops out of the brace

Question 17

Toes Component

Answer 17

• 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

Question 18

Straps

Answer 18

• Pre tip strap
• Straps at ankle bc that’s where you need more control (especially with D ring)
• can add a forefoot strap

Question 19

External Build Ups

Answer 19

• Prevent the brace from rocking in the shoes

Question 20

When can floor reaction AFOs be used with children

Answer 20

• 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)

Question 21

SWASH

Answer 21

• 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

Question 22

Research stuff

Answer 22

• 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

Question 23

Impairments that contribute to the need to orthotic intervention in a child who has MM

Answer 23

• muscle weakness
• ROM limitations
• Deformities

Question 24

orthoses for MM

Answer 24

• Standing Frame
• Parapodium
• HKAFO
• Reciprocating gait orthosis
• Hip Guidance Orthosis
• KAFO, AFO, Ground reaction AFO, Foot orthotic

Question 25

Standing Frame

Answer 25

- 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

Question 26

Parapodium

Answer 26

- 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

Question 27

HKAFO

Answer 27

- 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

Question 28

Hip Guidance orthosis

Answer 28

- same type of thing as a reciprocating gait orthotist but no spring mechanism - purely gravity that helps swing the legs

Question 29

KAFO for MM

Answer 29

L3-L4 lesions

Question 30

AFO for MM

Answer 30

L3-S1 lesions

Question 31

Ground reaction AFO for MM

Answer 31

L3-S1 lesions

Question 32

Foot orthotic for MM

Answer 32

L4-S1 lesions

Question 33

What does research say about MM?

Answer 33

- RGOs or HGOs improve efficiency over the typical HKAFO - Swing through gait with HKAFO is faster than RGO

Question 34

Impairments that contribute to the need for orthotics in a child who has DS

Answer 34

- 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

Question 35

Low tone pronation

Answer 35

- 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

Question 36

Congenital Hip Dislocation - Pavlik Harness

Answer 36

- 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

Question 37

Legg- Calves Perthes Disease: Scottish-Rite Orthosis

Answer 37

- 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

Question 38

Severs Heel: Heel cup

Answer 38

- 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

Question 39

Idiopathic toe walking

Answer 39

- use AFO - No pre-tib strap

Question 40

JRA

Answer 40

splints to decrease inflammation by limiting movement

Question 41

plagiocephaly

Answer 41

cranio-orthosis

Question 42

Sensory integrative dysfunction:

Answer 42

- soft orthosis (SPIO and Theratogs) - Weighted vests to provide proprioception

Question 43

Shoes for children:

Answer 43

- 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