Did you know that 17 million people globally live with cerebral palsy? According to MY CEREBRAL PALSY CHILD, there are more boys than girls born with cerebral palsy. Statistics show that for every 100 girls, there are 135 boys with CP. Out of 100 babies, 61-77.4% suffer from spastic CP which is the most common. 58.2% can walk independently, 11.2% can walk with assistive devices and 30.6% cannot walk
Cerebral palsy (CP) is a group of abnormal movement disorders that appear in early childhood, caused by non-progressive disturbances in the developing brain. Individuals with CP often experience a range of motor impairments, including muscle stiffness, spasticity, and difficulties with balance and coordination.
Patients with CP also experience disruptions in sensation, cognition, perception, secondary muscle-skeletal problems and epilepsy.
Orthotic management is crucial in improving mobility, functionality, and overall quality of life. However, it only addresses the physical deformities as the disease is known to have no cure.
This article delves into the crucial part played by orthotics in bringing corrective and sustainable solutions to facilitate better movement, posture alignment, strength, comfort and independence.
Understanding Cerebral Palsy
CP develops when the brain cells are damaged before, during, or soon after birth. The causes of brain damage are diverse but let’s look at the most common.
1. Pre-natal period:
Brain damage can occur due to insufficient oxygen supply to the brain. Contributors to this problem are sickle cell disease, heart defects, blood clots ( due to probable incompatibility between mother and child), abnormal blood vessels, or stroke. Infections like rubella, cytomegalovirus, and toxoplasmosis during pregnancy may also contribute to CP.
2. During childbirth:
Prolonged labor and difficult childbirth can result in CP. During this time, a mother may constantly lose breath or run out of energy. This may cause the baby to suffer from fatigue, and low oxygen in the blood causing brain damage. The situation could call for a vacuum extraction Which is also a risk factor.
3. Post-natal period:
After birth, a baby is very delicate and vulnerable to the new environment. Trauma from various sources like falls, blunt objects, or even abuse could cause brain damage leading to the development of cerebral palsy. Severe infections like meningitis and encephalitis cause inflammation of the brain cells also causing CP.
4. Jaundice
Jaundice is the yellowing of the body and eyes of a baby. Babies usually produce a lot of red blood cells while at the same time breaking down older ones. In the process, a chemical substance called BILIRUBIN is produced which causes the yellowing. The liver helps to eliminate this chemical through excretion. If the liver fails to flush out this chemical causing an accumulation in the blood, this chemical can cause brain damage which if not treated leads to irreversible damage.
It is also noted that CP on the onset does not develop further but symptoms may become severe with age if proper management is not undertaken.
Another point to note is that the severity of the symptoms will largely depend on the part of brain and its level of damage.
Types of CP
There are different types of CP classified according to their presentation though symptoms may overlap. Here are the major types:
- Spastic Cerebral Palsy: This is the most common form. People with spastic CP have stiff muscles, leading to jerky or repeated movements. There are different forms within spastic CP:
- Spastic hemiplegia: Affects one arm, hand, and sometimes one leg. Intelligence is usually normal.
- Spastic diplegia: Mainly affects leg muscles, with less severe impact on arms and face. Intelligence and language skills are typically normal.
- Spastic quadriplegia: The most severe form, involving severe stiffness in both arms and legs. Walking may be impossible, and speech difficulties are common. Intellectual and developmental disabilities (IDD) can also be present.
- Dyskinetic Cerebral Palsy: Characterized by slow, uncontrollable jerky movements of hands, feet, arms, or legs. Face muscles and tongue may be overactive, leading to drooling or facial expressions. Intellectual problems are less common.
- Ataxic Cerebral Palsy: Affects balance and depth perception. People with ataxic CP hobble and struggle with precise movements (e.g., writing). Intellectual abilities are usually normal.
- Mixed Types: Some individuals exhibit symptoms that combine features from different CP types12.
Remember that treatment and management strategies vary based on the specific type of cerebral palsy. To learn more about cerebral palsy, kindly visit : https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
Role of Orthotics in Cerebral Palsy Management
An orthotic is an externally applied device that influences the structural and functional characteristics of the neuromuscular and skeletal systems.
Benefits of using orthotics to manage CP.
Orthotics can be incredibly beneficial for individuals with cerebral palsy (CP). Here are some of the key advantages:
- Improves Mobility and Independence: Orthotics help enhance mobility by providing the necessary support and stability, allowing individuals with CP to move more freely and independently.
- Manages Spasticity: Spasticity, or high muscle tone caused by involuntary muscle contractions, is common in CP. Orthotics can help manage this by providing consistent support and reducing muscle tightness.
- Corrects Posture: Orthotics can assist in maintaining proper posture by supporting the muscles and joints, which is crucial for individuals with CP who may have high or low muscle tone.
- Reduces Pain: By providing structural support and improving alignment, orthotics can help decrease pain associated with muscle imbalances and joint stress.
- Minimizes Deformity: Early use of orthotics can help prevent or minimize deformities by ensuring proper alignment and support as the individual grows.
- Enhances Functional Abilities: Orthotics can improve overall functional abilities, making daily tasks more manageable.
- Prevents Injuries: By stabilizing the body and improving balance, orthotics can reduce the risk of falls and related injuries.
Orthotics are often custom-made to fit the specific needs of the individual, ensuring the best possible outcomes.
Types of orthotic devices used in CP.
Orthotics are crucial in managing the symptoms of CP. As already stated, these devices enhance stability, correct physical deformities, and foster independence.
It is advisable to see a pediatric orthotist to have a customized device that fits a child’s specific needs.
- Foot Orthotics- These are removable inserts worn inside the shoe. They play a major role in weight distribution in the feet, reducing pain caused by flat feet or high arches.
- Ankle Foot Orthotics (AFOs): used for aligning the knees and ankles.
- Hip Knee Ankle Foot Orthotics (HKAFOs): are in the form of belts or girdles to maintain an upright position.
- Knee Ankle Foot Orthotics (KAFOs): designed with hinges to aid in walking.
- Spinal Orthotics (Jackets): are devices worn around the torso to keep a straight posture and support the spinal cord. It also helps to support a weak trunk.
Assessment and prescription
A multidisciplinary team is needed to make a sound evaluation and establish a structured intervention schedule. These would involve:
- Pediatrician
- Nutritionist
- Occupational therapist
- Physiotherapist
- Mental health doctor
- Audiologist.
An exhaustive examination is done, the findings are discussed by the participants, and then an informed decision is made. This decision will consequently inform the course of action to be taken.
Diagnostic Tests:
- Brain Imaging Studies: these include X-rays, computed tomography (CT scan), or magnetic resonance imaging (MRI) to examine brain structures.
- Laboratory tests: these may be done to determine things like bone profile,
- Electroencephalogram (EEG): measures brain activity.
- Genetic testing: detects genetic abnormalities.
- Metabolic testing: assesses metabolic function.
There are many options for customizing orthotics. This will largely depend on the goal to be achieved. In another previous article on the introduction to orthotics, we have stated the various customizable options like material, size, and shape.
Following a professional’s instructions is the best way to go due to follow-up and constant evaluation of results. The orthotic also needs adjustments occasionally to relieve pressure points and redirect weight distribution accordingly.
Limitations/challenges of using orthotic devices
Despite the many benefits of using orthotics, there are several drawbacks.
- May cause discomfort and skin problems. Due to a tight fit and long duration of wear, the devices may cause pain and skin rashes.
- Take time to produce the intended results as they have to undergo adjustments and replacements over a long time.
- Are expensive since they have to be customized for specific purposes. A patient may be required to use several devices at the same time to produce the intended goal.
- Children grow fast and there is a need for constant replacement which is another reason why they are not affordable to some people.
- They are not cure-all solutions. Devices are intended for physical deformities leaving out underlying issues that will require other interventions for optimal results.
- Do not address severe structural deformities and abnormalities. Some patients may need more aggressive treatments like surgeries.
- Not covered by insurance companies.
Case study: 1
This thesis was done by SALT Journal of Scientific Research in Healthcare (Vol 4, No.1).
VERMA, V., KUMAR, A., & KASHYAP, D. (2024). THE EFFECTIVENESS OF KNEE BRACES IN CEREBRAL PALSY PATIENTS: A CASE STUDY. SALT Journal of Scientific Research in Healthcare, 4(1), 62–66. https://doi.org/10.56735/saltjsrh.ms2404016266
Case Study: 2
Aboutorabi, A., Arazpour, M., Bani, A. M., Saeedi, H., & Head, J. S. (2017). Efficacy of ankle foot orthoses types on walking in children with cerebral palsy: A systematic review. Annals Physical and Rehabilitation Medicine, 60(6), 393-402. https://doi.org/10.1016/j.rehab.2017.05.004
Conclusion
These 2 case studies done by medical professionals clearly show that orthopedic devices really work by improving mobility and other important structural functions. It is always advisable to work with multidisciplinary professionals to get optimal results. Note also that these orthotic interventions work over long periods extending to years. Follow-up and replacements of worn-out devices are critical.
Research and advances in technology are also taking center stage in the management of biomechanical imbalances in feet and ankles.
References
Child at Cerebral Palsy.com My
https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
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