Lower Extremity Orthoses for Children and Youth with Cerebral Palsy

Abstract

Lower extremity orthotic treatment is ubiquitous for children with cerebral palsy. Orthoses are prescribed with the goal of improving the function of the child usually to allow them to stand better or to have a better ability to move. In growing children, the intimate contact fitting of the orthosis requires more frequent changes or modifications. The mechanical requirements of the orthosis require the device to be strong enough; however, it should also be lightweight and comfortable to wear. Lower extremity orthoses only provide a useful benefit if worn; therefore if the child refuses to wear the orthoses, they are of no functional use. Orthoses should be prescribed for a very specific problem such as equinus in which the goal would be to control plantar flexion or for a combination of problems such as equinovarus in which the goal would be to control plantar flexion along with the varus or supination instability. It is most useful to consider prescriptions for lower extremity orthoses to mimic the process that the physician uses to write a drug prescription. In this analogy, a specific pathology has to be defined, a specific device has to be ordered, and the specific dose of wearing time is recommended. Also in this conceptual model, it must be recognized that orthoses (just like drugs) have risks and complications which should be considered. The goal of this chapter is to define specific biomechanical problems of the lower extremities which can be addressed appropriately with orthotic intervention. We will then explore the specific orthoses that can be used, the recommended wear time, and the potential risks and complications associated with each treatment.