FW: [OANDP-L] orthotic care for Cerebral Palsy
Randy McFarland
Description
Collection
Title:
FW: [OANDP-L] orthotic care for Cerebral Palsy
Creator:
Randy McFarland
Date:
4/4/2012
Text:
ORIGINAL POST
I evaluated a 50+ lady with CP who has internal hip rotation, knee valgus
(visually exaggerated by the internal rotation), knee flexion contractures
and flaccid ankles which are in varus (to get the foot flat on the floor
with the medial leaning tibia). She can ambulate with great effort using a
cane or walker. Forefoot drag is the first thing I notice that seems to be
holding her back with her highly-compensated method of ambulating. I suspect
I'll need to hold her in her maximum dorsiflexion to get clearance
To avoid interfering with the compensations/adaptations that allow
ambulation in persons with CP, I understand we try to avoid the temptation
to straighten out deformed joints. I know this would not work with this
patient. But to make an AFO with dorsi assist that would fit her alignment
when standing would result in a very deformed-looking device.
Please let me know what you've had success with for this type of case.
Thanks, Randy McFarland, CPO
RESPONSES
Try incorporating higher heels. With the knee contractures it uses up the
ability to dorsiflex the ankles. The heels will leave you a little ROM.
Sometimes I put the heels on the AFO's with polypro.
If the patient has knee flexion fontractures already, I would avoid putting
her in any sort of Articulated AFO. A solid AFO is the only way to go.
Un-restricted pssive Dorsiflexion under her own body weight will only serve
to further he knee deformity, and if there is associated Gartrocs shortening
you will only to create mid-foot deformity. I would make a solid AFO at the
Gatrocs appropriate angle, and then do footwear modifications to get the SVA
and foot-roll-over shape correct
Have you considered placing her ankle in a neutral position and then adding
heel lifts to tune the position to a point where she's comfortable
standing and has a smooth gait?
If the patient is contracted or tight you are correct in not necessarily
changing the walking pattern and just work at assisting dorsi flexion. If
the joints are flexible you may want to attempt to either control the
position or even go to the joint above by reducing the valgus while
assisting dorsifelxion. Has this person had orthoses previously? Are you
able to have her stand and straighten her knees for her? Does she walk in a
crouch type gait? Has she ever been in a floor reaction orthosis? If she had
an orthosis previously did she tolerate it well? These are all things you
would need to know before making her an orthosis. The simpler the orthosis
the more likely she will use it and it is important to know these things
before deciding on an AFO with dorsi assist. What it might look like and how
it functions are 2 different things.
Might want to try ToeOff design braces or BlueRocker. Often this gives
dynamic control without taking away function. I used it before successfully
on a CP case (43 y.o.f)
I evaluated a 50+ lady with CP who has internal hip rotation, knee valgus
(visually exaggerated by the internal rotation), knee flexion contractures
and flaccid ankles which are in varus (to get the foot flat on the floor
with the medial leaning tibia). She can ambulate with great effort using a
cane or walker. Forefoot drag is the first thing I notice that seems to be
holding her back with her highly-compensated method of ambulating. I suspect
I'll need to hold her in her maximum dorsiflexion to get clearance
To avoid interfering with the compensations/adaptations that allow
ambulation in persons with CP, I understand we try to avoid the temptation
to straighten out deformed joints. I know this would not work with this
patient. But to make an AFO with dorsi assist that would fit her alignment
when standing would result in a very deformed-looking device.
Please let me know what you've had success with for this type of case.
Thanks, Randy McFarland, CPO
RESPONSES
Try incorporating higher heels. With the knee contractures it uses up the
ability to dorsiflex the ankles. The heels will leave you a little ROM.
Sometimes I put the heels on the AFO's with polypro.
If the patient has knee flexion fontractures already, I would avoid putting
her in any sort of Articulated AFO. A solid AFO is the only way to go.
Un-restricted pssive Dorsiflexion under her own body weight will only serve
to further he knee deformity, and if there is associated Gartrocs shortening
you will only to create mid-foot deformity. I would make a solid AFO at the
Gatrocs appropriate angle, and then do footwear modifications to get the SVA
and foot-roll-over shape correct
Have you considered placing her ankle in a neutral position and then adding
heel lifts to tune the position to a point where she's comfortable
standing and has a smooth gait?
If the patient is contracted or tight you are correct in not necessarily
changing the walking pattern and just work at assisting dorsi flexion. If
the joints are flexible you may want to attempt to either control the
position or even go to the joint above by reducing the valgus while
assisting dorsifelxion. Has this person had orthoses previously? Are you
able to have her stand and straighten her knees for her? Does she walk in a
crouch type gait? Has she ever been in a floor reaction orthosis? If she had
an orthosis previously did she tolerate it well? These are all things you
would need to know before making her an orthosis. The simpler the orthosis
the more likely she will use it and it is important to know these things
before deciding on an AFO with dorsi assist. What it might look like and how
it functions are 2 different things.
Might want to try ToeOff design braces or BlueRocker. Often this gives
dynamic control without taking away function. I used it before successfully
on a CP case (43 y.o.f)
Citation
Randy McFarland, “FW: [OANDP-L] orthotic care for Cerebral Palsy,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/233453.
