At Lawall Prosthetic & Orthotic Services, we care for patients of all ages, including children. Properly fitting a pediatric prosthetics or orthotic on a child requires a range of skills, including interacting with the child, helping them become comfortable with their device, and choosing a device after considering how the child will grow and change.
There are typically no concerns about outgrowing orthotics for adults, leaving them with a brace that lasts for a long time. However, children are continually growing, so fitting them with a device must also force the orthotist to consider how the child will grow and how the device can remain comfortable and functional.
Children who need an orthotic most often fall into three categories:
– those with disorders affecting mobility (e.g., cerebral palsy, spina bifida, Down syndrome)
– those with scoliosis
– babies with an abnormally shaped head
Disorders Affecting Mobility
Three of the most common conditions affecting mobility in children are cerebral palsy, spina bifida, and Down syndrome, and they often require very similar sets of orthotics. This is because all of these conditions benefit from increasing strength and stability in the child, which helps them maintain mobility and corrects any physical issues preventing the child from being fully ambulatory.
With cerebral palsy, many children can walk, yet the way cerebral palsy affects someone’s muscles, joints, and patterns of motion make it challenging to establish an effective gait. Orthotic devices help children with cerebral palsy develop typical joint and muscle movement patterns.
Similar to cerebral palsy, those with spina bifida benefit from orthotics to help provide stability and aid mobility.
Children with Down syndrome are at a much higher risk of foot problems due to low tone and lax ligaments. Essentially, these characteristics lead to joint hypermobility, which results in improper stabilization of the bones of the feet when standing and walking. Orthotics help to provide ligamentous support, which encourages an efficient walking pattern.
Types of Orthoses
All of these conditions benefit from additional support in the ankle and foot. When choosing the best brace for your child, your orthotsist will consider the structure of your child’s leg, ankle, and foot and where they need the most support. The braces must allow for growth while still providing the necessary support and stability to promote good foot and ankle alignment to maximize the child’s mobility.
Molded Ankle Foot Orthosis
The molded ankle-foot orthosis offers support from your child’s calf to the foot, maintaining proper alignment for the entire lower limb. There are two main types of molded ankle-foot orthoses: articulate and solid. The orthotic allows for ankle movement with the former, while the solid version does not.
Supra malleolar Orthosis
The supra malleolar orthosis (SMO) supports the foot above the ankle bone. They are often offered for those with flat feet as it helps to maintain a neutral heel while also supporting the foot’s arches.
Compared to the molded ankle-foot orthosis, the SMO does not extend up the leg, instead of stopping at the child’s ankle.
Foot orthotics provide arch support for a child’s foot. They are placed inside a shoe and conform to the child’s foot, providing the necessary support to the bones of the foot. This helps to improve ankle alignment when walking while also improving postural stability.
Scoliosis is a condition diagnosed by an abnormal lateral curvature of the spine and is most often diagnosed in childhood or early adolescence.
The spine is naturally curved, with curves occurring at the cervical, thoracic, and lumber planes in the “sagittal” plane. These curves are essential for absorbing shock and distributing mechanical stress when moving. Additionally, it is these curves that place the head over the pelvis.
In most cases, scoliosis is a curvature in the “coronal” or frontal plane. This is the vertical plane from head to foot, parallel to the shoulders. Essentially, it divides the body into the front and back sections. In comparison, the sagittal plane (where spine curvature naturally occurs) divides the body into right and left halves.
Causes of Scoliosis
There are three categories of scoliosis causes: congenital, idiopathic, and neuromuscular.
Congenital scoliosis occurs due to an embryological malformation of one or more vertebrae, causing curvature and other spinal deformities. Neuromuscular scoliosis occurs secondary to neurological or muscular diseases, such as cerebral palsy, muscular dystrophy, spinal cord trauma, spina bifida, or spinal muscular atrophy. The last type is idiopathic scoliosis, a catch-all term for scoliosis that does not fall into the other categories.
When it comes to choosing a treatment for scoliosis, your orthotist will consider many factors, including:
– if the spine is still growing
– degree and extent of curvature
– the possibility of curve progression
– location of the curve
Braces for Scoliosis
Braces are very commonly used for scoliosis in children because they are only effective in those whose spines are still growing and changing. They work by placing pressure on the spine’s curve pattern to prevent further curvature. Braces are also typically used when the curve is between 25 and 40 degrees to help prevent the curve from progressing.
There are many types of braces:
The Boston brace is the most common brace prescribed for scoliosis and is often referred to as an underarm brace. It consists of plastic components custom-made to fit the child’s body. In the front, the Boston brace starts just below the breast and extends to the top of the pelvis area. In the back, it begins below the shoulder blades and continues to the tail bone of the spine.
Another common thoracolumbosacral orthosis (TLSO) is the Wilmington brace created based on a cast taken when the patient is lying down. During the casting process spinal correction is achieved, the cast is removed, modified and a thermoplastic material is pulled over the positive model to create the Wilmington TLSO.
Charleston Bending Brace
When it comes to braces worn only at night, the Charleston bending brace is the most common option because it is designed to be worn laying down, not standing up like the daytime braces. Since it is created for laying down, it can apply lateral forces to push the curvature closer to the back’s midline while also bending and holding the spine in an overcorrected position, which is much easier to maintain at night when laying down compared to during the day.
Similar to the Charleston bending brace, the Providence brace is meant for nighttime use and applies the same hypercorrective force to the spine. However, instead of the spine’s curve bending in the opposite direction, one shoulder is instead slightly elevated to apply rotational and lateral forces on the curve.
Rigo Cheneau Brace
The Rigo Cheneau brace consists of a lightweight plastic vest that can be worn all day. It is a newer type of brace that puts pressure on the spine where it needs to straighten and unwind the curve. Additionally, it consists of open areas that allow the child’s body to expand when breathing and exercising.
Cranial Molding Helmets
A baby’s head is full of soft plates with spaces between them that gradually knit together and harden over time. However, the soft plates may form to make an abnormal shape in some cases. Helmet therapy is a non-painful(noninvasive? )way to remedy this and correct the shape of a baby’s skull.
There are two categories of conditions that necessitate a helmet:
Positional Skull Deformity
Three conditions that fit this category include brachycephaly, deformation plagiocephaly, and NICUcephaly. All three of these conditions cause the baby’s skull shape to change due to pressure on the skull from the infant spending a lot of time in one position.
For these conditions, helmet therapy is not always needed; sometimes, changing your baby’s position or starting physical therapy can help. However, moderate or severe positional skull deformity may not respond to changing positions, and in this case, helmet therapy is the preferred treatment.
With this condition, the bony plates in the skull are abnormally fused together, and this causes the head to form an abnormal shape as the brain grows and pushes out on other parts of the skill. This condition may also affect brain growth, which is why treatment is essential. Typically, treatment consists of surgery to correct the abnormal fuses followed by helmet therapy to correct the shape of the head.
When it comes to helmet therapy, your baby’s head shape is measured, and this is used to make a custom-fitted helmet. This helmet correctly supports your baby’s skull while also allowing the head to grow and round on its own.
How long your baby needs to wear their helmet will depend on the child, but our dedicated team is happy to answer any questions you may have.
Caring for Pediatrics
The Lawall Prosthetic & Orthotic Services team is proud to provide exceptional care to all our patients, including children. Whether your child needs foot orthotics, a brace for scoliosis, or a cranial molding helmet, we will take the time to fully explain the process to you and your child and create well-fitting orthotics that serve your child and help address any areas of need. When you come to Lawall Prosthetic & Orthotic Services, you can be sure that you and your family are in good hands.