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.Donning the KAFOs on andoff takes a lot of time and they are difficult to wear.For thesereasons, KAFOs for functional ambulation have disappeared fromuse in children with CP.Use anti recurvatum AFOs or GRAFOsFFfor knee problems in ambulatory children.GGUse the plastic KAFO at night and in the early postoperative period after Consider the knee immobilizer after hamstring surgery.multilevel surgery to protect the extremity while allowing early mobilization.Bracing50Foot orthoses (FO)BBAAFoot orthotics do not prevent deformity.They provide a bettercontact of the sole of the foot with the ground.Supramalleoler orthosis (SMO) Extends to just above themalleoli and to the toes [A,B].Consider in mild dynamicequinus, varus and valgus instability.University of California Biomechanics Laboratory Orthosis(UCBL) Medial side is higher than the lateral, holds theSupramalleoler orthosis (SMO) calcaneus more firmly, supports the longitudinal arch [C].Prescribe in hind and midfoot instability.Heel cup Holds the calcaneus and the surrounding soft tissue,ends laterally underneath (trim lines are below) the malleoliand proximally ends at the metatarsals.Use in cases of mildSMOs can be used inside hingedAFOs to provide better valgus -subtalar instability causing varus or valgus deformity.varus control while allowing ankleHip abduction orthosesdorsiflexion.Consider using hip abduction orthoses in children with hipadductor tightness to protect hip range of motion and preventCCthe development of subluxation.It is easier and cheaper touse a simple abduction pillow.Use mainly at night or duringperiods of rest.There is no scientific evidence to support thebelief that they prevent subluxation.One clear indicationfor hip abduction orthoses is the early period after adductorlengthtening.Spinal orthosesUCBLThere are various types of braces used for spinal deformity [D].None of them alter the natural history of scoliosis in childrenDDwith CP.Do not aim to stop the progression of scoliosis byprescribing a brace.Contrary to idiopathic scoliosis, thedeformity continues to progress even after skeletal maturityin CP.Therefore, most children with scoliosis need spinalsurgery to establish and maintain sitting balance in the longrun.Prescribe a brace for the time period until surgery toenable the child to grow as much as possible.An importantindication for using a brace in a spinal deformity is to providebetter sitting balance [E].A thoracolumbosacral brace helpsthe child sit better during the growth spurt period when spinaldeformity becomes apparent, progresses fast and the childoutgrows custom molded seating devices quickly.Childrenwho are not candidates for surgery for different reasons mayuse spinal braces instead of seating devices for better sitting.Patients with mild and early scoliosis tolerate brace withoutdifficulty.The brace should not be too difficult for the child toThe spinal brace becomes part of the total body involved child.put on and take off should not compress the chest too tight andCourtesy of J.Batzdorffshould be properly ventilated for comfortable use.EEThe indication for spinal bracesTo slow the progression of deformity to delay surgery and allowskeletal growthTo assist sitting balanceTo protect the surgical site from excessive loading after surgeryBracing51Upper extremity bracingAAThe indications of bracing in the shoulder and elbow are verylimited.An example of a resting splint [A] is a thermoplasticresting elbow, wrist and hand splint which keeps the wrist in10o extension, the metacarpophalangeal joints in 60o flexionand the interphalangeal joints in extension.This type of splintis used at night and during periods of inactivity with the hope ofpreventing deformity.An example of a functional splint is an opponens splint [B] to Resting hand splint Copyright Smith & Nephewbring the thumb out of the palm of the hand, allowing for bettergrasp.This type of splint is used in every day activities.Hand orthoses may inhibit the active use of the extremity.They also effect sensation of the hand in a negative way.Usethem only in the therapy setting or at school and take off duringother times in the day.References2004 Buckon CE, Thomas SS, Jakobson-Huston S, et al  Comparison of threeankle-foot orthosis confi gurations for children with spastic diplegia Dev Med ChildBBNeurol.46(9):590-82002 Sienko Thomas S, Buckon CE, Jakobson-Huston S, et al  Stair locomotionin children with spastic hemiplegia: the impact of three different ankle foot orthosis(AFOs) confi gurations Gait Posture16(2):180-7.2002 Sussman M  Adaptive Equipment For Children With Spastic Diplegia Turk JPhys Med Rehabil 48 (2):12-132001 Buckon CE, Thomas SS, Jakobson-Huston S, et al  Comparison of threeankle-foot orthosis confi gurations for children with spastic hemiplegia. Dev MedChild Neurol.43(6):371-8 [ Pobierz całość w formacie PDF ]