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Cerebral Palsy (CP)

Cerebral Palsy has been described as a group of permanent disorders of the development of movement and posture, causing activity limitation, attributed to progressive disturbances that occurred in developing foetal or infant brains. The motor disorders of CP are often accompanied by disruptions of sensation, cognition, perception, secondary musculoskeletal problems and epilepsy.

Children’s Orthotics provide a range of orthotic solutions to help reduce the symptoms of CP by aiding function, decreasing muscle tightness and increasing mobility.

What causes Cerebral Palsy?

Whilst research is ongoing into the causes of cerebral palsy, there are known causes for cerebral palsy.

  • Malformations can develop on the outer layer of a cerebrum during antenatal pregnancy. Vascular events that may cause occlusion to arteries in the brain and infections during the first and second trimesters of pregnancy. Less common causes of cerebral palsy include metabolic disorders and rare genetic syndromes
  • Perinatal causes such as obstructed labour, antepartum haemorrhage or cord prolapse may lead to hypoxia (oxygen shortage), linked to cerebral palsy.

What are the types of cerebral palsy?

The type of cerebral palsy is often determined by the area of the brain affected. The level of damage done usually has a strong correlation to the severity of symptoms. The different types of CP include:

Spastic CP - The most common type of CP, the muscles of people with spastic CP feel stiff and their movements may appear stiff or jerky. Spasticity is a form of increased muscle tone, which can make movement difficult or impossible..

Symptoms of spastic CP include:

  • Spiff, spastic muscles
  • Difficulties sitting up, crawling or walking
  • Speech problems, such as poorly formed or slurred words
  • Abnormal movements
  • Poor eyesight
  • Poor muscle coordination

Ataxic CP - Children with ataxic CP have trouble with balance and coordination. They may walk with their legs further apart than other kids and have a hard time with activities that require fine motor skills, e.g. hand movements like writing.

Ataxic CP can present itself it many ways, but the most common symptoms include:

  • Balance problems
  • Tremors or shakes
  • Trouble swallowing
  • Poor depth perception
  • Poor body coordination
  • Unusual speech
  • Unsteady wide walking gait

Athetoid CP - Athetoid CP (also known as dyskinetic CP) is the second most common type of CP after spastic forms. Athetoid CP is typically caused by non-progressive lesions to the basal ganglia or thalamus regions of the brain.and It is characterised by abnormal postures or movements associated with impaired tone regulation or movement coordination.

Athetoid CP can present with the following symptoms:

  • Repetitive and sustained movements
  • Awkward postures
  • Movements that are rapid and slow and often painful
  • Involuntary movements triggered by attempts at controlled movements
  • Involuntary movements occur more frequently when the person is tired, anxious, tense or emotional

Mixed CP - As the name suggests, mixed CP can be a combination of more than one type of CP and therefore can display with a wide range of symptoms commonly seen in Spastic, Ataxic and Athetoid CP

How does Cerebral Palsy cause muscle tightness and what are the treatments?

Spastic Cerebral Palsy causes mixed up signals from the damaged area of the brain (motor cortex) to the muscles. Spasticity is manifested by increased stretch reflex which intensifies with movement velocity. Fast uncontrolled movements are a common symptom of spastic CP, this excessive and inappropriate muscle activation can cause hypertonia (too much muscle tone, i.e. arms and legs stiff and difficult to move).

Treatment options available for CP are:

  • Physical therapy, as well as language, occupational, and behavioural therapies
  • Medications to control symptoms, such as muscle spasms or seizures
  • Baclofen pump to help control muscle spasticity
  • Spine or spinal cord surgery to repair scoliosis or reduce spasticity

How can Children’s Orthotics help?

Orthotic intervention can be helpful for managing cerebral palsy in children, with proven benefits. Our orthotics devices (bespoke or off the shelf) are designed to prevent compensatory movements and provide support to increase mobility. This can reduce the chance of hazards such as trips and falls.

In some cases, orthotics can be used to address muscular imbalances and even prevent or stabilise deformities.

Orthotics can be used to hold the muscle in a stretched position to counter muscle tone, a common symptom of cerebral palsy. It is also possible to correct posture using orthotics.

What types of orthotic might be helpful?

  • Ankle Foot Orthosis (AFO’s) - Can be made from fabric, plastic or carbon fibre. The AFO is often designed in a way that inhibits certain movement (e.g. drop foot) whilst providing support and alignment to help your child walk with a more natural gait.
  • Dynamic Ankle Foot Orthosis (DAFO’s) - DAFO’s provide stability at the foot and ankle yet allow for a greater range of movement than an AFO. DAFO promotes a natural gait as well as storing and releasing energy during gait to reduce energy expenditure of your child. DAFO’s are commonly made from thermoplastics or carbon fibre
  • Spinal braces - The natural history of untreated scoliosis in patients with cerebral palsy is one of deterioration. In some cases, early intervention can prevent or slow your child’s scoliosis from developing.
  • Silicone splints - Silicon is a lightweight, comfortable and life-like material that can be used to manufacture splints that provide stability and support to weak muscles.
  • Carbon fibre splints - Carbon fibre splints are very strong, lightweight, thin and have good energy return to aid with ambulation. Children’s Orthotics have access the large pool carbon fibre devices to support or stabilise any point of the body
  • Insoles - Insoles can cater for leg length discrepancies, a common symptom of cerebral palsy. Our orthotics are able to provide bespoke insoles that can provide pain relief and help to align the ankle, knee and hip joint whilst providing additional support to the dorsal side of the foot.
  • Head protection - A common issue with cerebral palsy is a heightened risk of falling due to the disorder commonly affecting balance and coordination. At Children’s Orthotics, we can design your child a unique, specifically designed helmet, using the latest technologies to ensure a bespoke fit and a helmet that disperses energy upon impact.
  • Upper limb support - The upper limb can suffer from instability, deformity and muscle tightness. Children’s Orthotics has a range of tailored devices to provide your child with stability, support and muscle assistance.
  • Knee bracing - Knee braces for children are commonly used to help keep legs straight and improve walking. A common gait displayed in children with cerebral palsy (diplegic gait) causes them to walk with a narrow base and drags both legs. It can cause extreme tightness in the hip abductors, which can make the legs cross the midline.
  • Stretching devices - Overactive muscles are a common symptom of cerebral palsy. Over time, muscle tightness begins to develop from the high volume of rapid contractions. The muscle tightness can then have a negative effect on the joints, reducing range of movement. Children’s Orthotics provide both static and spring loaded stretching devices to reduce the effects of tight muscles.

What Might the Assessment Procedure Involve

In the first instance, an appointment would be made with an orthotist in which a full initial assessment would be conducted. Areas assessed would look at:

  • Skin condition
  • Sensation in the affected area
  • Temperature
  • Ranges of motion (passive and active)
  • Normal locomotion
  • Footwear
  • Spatial and temporal measures during gait

Your orthotist will ask you questions about your child’s daily activities and medical history. The paediatric orthotist will undertake a gait examination and watch them walk, paying attention to movements at their affected joints and making observations of how their body moves. Following this, your child’s treatment options and goals will be discussed and a prescription made. Any devices that are required will be fabricated using materials chosen specifically to meet their requirements and then a fitting session arranged. All of our prescriptions and fittings are followed by a review to ensure that the treatment is effective and any adjustments can be made.

To get in touch or arrange an appointment, you can call us at 0330 088 3949 or email office@orthotics.co.uk.

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