Author: Darlene K. Sekerak, PT, PhD
Emily is four years old. She loves going to ?school? and idolizes her older sister Tammy who is seven. Emily has spastic hemiplegia, a type of cerebral palsy, affecting her left arm and leg. She uses her left arm to assist her right arm for carrying large objects but has difficulty with fine movements of her hand. She walks without assistance but tends to walk on her toes and the side of her left foot. Her heel never touches the floor. This makes her walking awkward but she is amazingly fast. She cannot run or balance on her left leg. Emily?s therapist and mom are both concerned about the long term effects of walking this way on her foot and ankle.
Emily has almost full passive range of motion of her left knee and ankle (her knee and ankle will bend and straighten almost completely when moved by someone else). Emily can bend and straighten her knee and ankle but only when moving her entire leg. She can fully bend her ankle if she also bends her knee but cannot bend her ankle up if her knee is straight. Her therapist has suggested that an ankle foot orthosis (AFO) or brace [see handout on Lower Extremity Orthoses] might help to improve her walking by helping to keep her ankle bent and her foot in good position when she walks. Fortunately, Emily?s family?s insurance will cover most of the cost of the orthosis.
The therapist has suggested that the goals for the use of the orthosis are to
1. Hold the foot and ankle in a functional position when walking.
2. Maintain range of motion of the ankle.
3. Decrease the effort required for walking.
4. Decrease the stress on Emily?s joints during walking.
Because her therapist is not specifically trained to make orthoses, she recommended that Emily?s mom take her to see a physical therapist who is an orthotic specialist at a regional children?s hospital. With mom?s permission her therapist also arranges to accompany Emily and her mom for this appointment to consult about the orthotic prescription. Together the therapists and mom reassess Emily?s needs and agree to try a fixed ankle AFO with a contoured footplate. The orthotic is custom-made to fit Emily and mom is instructed about how to put the orthosis on and take it off, how to look for evidence of skin irritation, and how to clean and care for the orthosis. Together they develop a schedule that will allow Emily to gradually begin wearing the orthosis. They also set up specific goals to determine the effectiveness of the orthosis. They set an appointment to return to see the orthotic specialist in six weeks.
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