1 - Medical Doctor - Physical and Rehabilitation Medicine at “Hospital Dona Estefânia” and “Centro de Paralisia Cerebral Calouste Gulbenkian”, Lisbon, Portugal
2 - Medical Doctor – Peadiatric Orthopaedic Surgery at “Hospital Dona Estefânia” and “Centro de Paralisia Cerebral Calouste Gulbenkian”, Lisbon, Portugal (Coordinator)
3 - Medical Doctor - Physical and Rehabilitation Medicine at Hospital Dona Estefânia, Lisbon, Portugal
4 - Medical Doctor – Peadiatric Orthopaedic Surgery at “Hôpital Necker – Enfants Malades”, Paris and “Fondation Ellen Poidatz”, Saint-Fargeau, France
Publicação integral sob a forma de capítulo de livro ORTHOPEDIC MANAGEMENT OF CHILDREN WITH CEREBRAL PALSY Chapter: 4.2 INDICATIONS FOR ORTHOSIS ISBN: 978-1-63483-349- (E- Book) – Nova – Biomedical; Federico Canavese and Jacques Deslandes Editors, New York
Cerebral palsy (CP) is the most common chronic disability of childhood today.
Motor impairment is the main manifestation of CP, and it has a consequent effect on the biomechanics of the body. Because contracture development is inevitable in growing children with spastic musculature or muscle imbalance and is a prime cause of musculoskeletal dysfunction, its control over time is essential.
The treatment strategy is based on a realistic evaluation of the child; indications differ according to the age, clinical type, selective motor control level, type of deformity, and functional prognosis. The GMFCS can also be used to inform prognosis for the development of movement ability as a child grows, and to monitor progress.
The goals of orthotic treatment for children in I-II-III GMFCS levels are mostly related to the lower limb and aim to improve and maintain an efficient gait, although prevention of deformity is also important.
Children in IV and V GMFCS levels are more at risk of associated impairments. There is greater emphasis on preventing spinal and hip deformities, and improving sitting posture for functional and social reasons. Orthoses can also be used to enable upright standing and weight-bearing, with potential physiological and psychosocial benefits. The goals of bracing are to increase function, to delay the development of contractures, to correct or prevent structural deformity, to keep the joint in the functional position, to stabilize the trunk and extremities, to facilitate selective motor control, to decrease spasticity, and to protect the extremity from injury in the postoperative phase.
Unfortunately there is little or no scientific evidence regarding the extent to which these benefits are achievable in practice.
Orthoses are rarely used isolatedly from other interventions; they must be used together with other therapeutic strategies including: therapy, botulinum A toxin, baclofen, orthopaedic, and/ or neurosurgical procedures.