Orthoses

Many children with cerebral palsy utilize orthotic devices for maintaining or increasing range of motion, protection or stabilization of a joint, or promotion of functional activity.

Upper Extremity (UE) Orthoses

Static wrist hand orthosis (WHO) are commonly used in CP to improve hand position for functional activities and to maintain range of motion. Dynamic WHO are much less commonly used because children are often reluctant to use them for functional activities, in part due to the decreased sensory feedback caused by the orthosis. The use of either type is not well studied in CP, but a small controlled study of 10 children revealed increased grip and dexterity with the use of dynamic splint (190).

Lower Extremity (LE) Orthoses

Many different types of LE orthoses are utilized in the management of CP, including supramalleolar orthot­ics (SMOs), solid ankle foot orthotics (AFOs), hinged AFOs, posterior spring-leaf AFOs, and ground-reactive AFOs. Knee ankle foot orthoses and hip knee ankle foot orthoses are rarely used in CP. In spite of many published studies on the effectiveness of LE orthotics in CP, precise indications have yet to be established. A systematic review of 27 studies (191) resulted in the following recommendations: a) Only orthoses that extend to the knee and have a rigid ankle, leaf spring, or hinged design with a plantarflexion stop can prevent equinus deformities; b) SMO designs with tone-reduc­ing features (or dynamic ankle foot orthotics) do not prevent equinus; c) preventing plantarflexion or equi­nus has been shown to improve the temporal param­eters of gait, such as walking speed and stride length for the majority of children, and thereby improved gait efficiency; d) children with less severe impairments often performed better on stairs and moving from sit­ting to standing in less restrictive hinged, leaf spring, or SMO designs.

Rotational-control orthoses, both twister cables and rotation straps, are also used occasionally in chil­dren with cerebral palsy.

Spinal Orthoses

The role of spinal orthoses in children with CP and scoliosis has not been well studied. There are no RCTs, and there is no agreement as to whether spinal ortho­ses can prevent the progression of scoliosis. There is general agreement that if bracing controls the progres­sion of scoliosis, it will not work in every patient (192) and it at best is only likely to slow progression, delay­ing surgery until a more ideal time (193). Regardless of its effect on curve progression, a positive effect on sitting stability and function has been reported by par­ents and caregivers (194), but this also has not been well studied.