Lower extremity splinting for children with cerebral palsy
The purpose of this multi-centre randomized control trial was to evaluate the effects of lower-extremity orthoses on the gross motor function and performance of children with spastic CP who are not yet walking independently. Although lower-extremity orthoses are widely used in the management of children with cerebral palsy (CP), their usefulness remains uncertain.
Thirty-four children, aged 12 to 48 months, were randomized to either an "experimental" group (N=17) to receive lower extremity orthoses and weekly physiotherapy for four months or to a "control" group (N=17) for weekly physiotherapy without orthoses for four months. All subjects were assessed before intervention (base-line), at four months and at follow-up at eight months.
We found that there was no major difference in the development of gross motor skills between the children in the physiotherapy group compared to the children in the physiotherapy and orthoses group. Both groups of children showed similar improvement in their gross motor skill level after 4 months and after 8 months. We were able to demonstrate that the alignment or position of the lower limb was significantly improved when children in the orthoses group were tested wearing their orthoses compared to the children who did not receive orthoses. This means that orthoses may have a biomechanical effect on the foot and ankle and may over time help prevent the development of undesirable structural changes.
Further study is required to determine the effect of orthoses on the mechanical and postural alignment of the foot and ankle.
Evans, C., Gowland, C., Rosenbaum, P., Willan, A., Weber, D., & Plews, N. (1994). The effectiveness of orthoses for children with cerebral palsy. Developmental Medicine and Child Neurology, 36(9), 26.
Weber, D., Russell, D., Plews, N., Gowland, C., Evans, C., & Rosenbaum, P. (1994). The development of an orthotic management protocol for a study of preambulatory spastic diplegia cerebral palsy children. Journal of Prosthetics and Orthotics, 6(3), 67-73.
Findings indicate that casting does not provide additional benefits to this group of children.
Ontario Ministry of Health - $200,860 (1991-1993)