Orthotic Devices and Braces

Children with cerebral palsy commonly suffer with muscle spasticity and this abnormal muscle tightness usually makes it harder to move and walk and rest in comfortable positions.  Spasticity may cause joints to be held relatively fixed in certain positions. This can also weaken other muscles around the joint. Orthotic devices and braces can help hold joints and parts of the child’s body in positions which then allow them to move more easily, sit with more stability, and encourage a child with cerebral palsy to develop more strength and mobility.

Children with cerebral palsy which affects their legs commonly experience mobility-related problems. They may walk more slowly than those not affected by cerebral palsy and may use much more energy to walk at that pace. This may be because their movement is affected by instability and abnormal positioning of the hip and/or knee joint.  Ankle-foot orthotics provide stability to the ankle and foot and this indirectly stabilizes the hip and the knee joint. This makes it easier for the child to walk more quickly and to use less energy doing so. This can then help with development and independence and improve a child’s quality of life.

A SWASH brace is designed specifically for children with cerebral palsy who are affected by leg scissoring. This is where the upper part of the legs and knees hit and sometimes cross, and the hips and knees can stay in a flexed position which gives the impression that the child is crouching. The brace encourages the legs not to cross and may hold the hip in a more correct alignment. This can be used in conjunction with AFOs and provides some degree of trunk control.

Also known as spinal orthoses, body jackets allow children with cerebral palsy to sit and stand with more stability. Cerebral palsy can cause spinal scoliosis as the muscles supporting the spine may also be affected by spasticity and so contract in a way which causes imbalance. Those affected by scoliosis, or curvature of the spine, have more difficulty sitting or standing straight and this can affect their balance, ability to walk and their ability to use their arms and hands.

A body jacket is a fully rigid or semi-rigid case which goes around the chest, lower back and abdomen. It can be fitted to a child specifically and adjusted or remade as the child grows. It provides support to the child when sitting and standing and encourages them to use their arms and hands more. It can be uncomfortable to wear for long periods and so may only be used for times when additional support is most beneficial, like when sitting to do tasks at a table or when walking.

Theratogs are orthotic undergarment and strapping products which are designed to improve posture, stability and joint stability and encourage more precise movement and movement skill. The studies looking at the effect of these garments are small and they have not been compared to other orthotic devices, but they may improve the gait and functional skills of children with diplegic cerebral palsy who are classified as Gross Motor Function Classification System level 1.

All devices should be fitted by those trained to do so. Incorrectly fitting devices and braces can cause skin breakdown, pain and put additional strain on joints which may already be vulnerable. As a child grows, devices will also need to be adjusted and re-fitted to ensure they fit correctly.

Some devices, such as AFOs, may be covered by government health care plans where a family’s income is below a certain level and potentially only until the child reaches 18 years of age. Other devices may not be covered at all by government health care plans or private insurance plans. Some devices are very costly and may adversely affect a child if not correctly fitted. Therefore, advice from a health care professional such as a physiotherapist, pediatrician or occupational therapist should be taken prior to trying any device.