Orthotic management of cerebral palsy: Recommendations from a consensus conference

Abstract

An international multidisciplinary group of healthcare professionals and researchers participated in a consensus conference on the management of cerebral palsy, convened by the International Society for Prosthetics and Orthotics. Participants reviewed the evidence and considered contemporary thinking on a range of treatment options including physical and occupational therapy, and medical, surgical and orthotic interventions. The quality of many of the reviewed papers was compromised by inadequate reporting and lack of transparency, in particular regarding the types of patients and the design of the interventions being evaluated. Substantial evidence suggests that ankle-foot orthoses (AFOs) that control the foot and ankle in stance and swing phases can improve gait efficiency in ambulant children (GMFCS levels I-III). By contrast, little high quality evidence exists to support the use of orthoses for the hip, spine or upper limb. Where the evidence for orthosis use was not compelling consensus was reached on recommendations for orthotic intervention. Subsequent group discussions identified recommendations for future research. The evidence to support using orthoses is generally limited by the brevity of follow-up periods in research studies; hence the extent to which orthoses may prevent deformities developing over time remains unclear. The full report of the conference can be accessed free of charge at www.ispoint.org.

Efficacy of suit therapy on functioning in children and adolescents with cerebral palsy: a systematic review and meta‐analysis

“…There is often a lack of clarity about what is being evaluated in orthotic research studies. 15 The original suit was developed for Russian cosmonauts in the late 1960s. It was referred to as a 'Penguin suit' and designed to counteract the adverse effects of zero gravity including muscle atrophy and osteopenia, and maintain neuromuscular fitness during weightlessness experienced by cosmonauts.…”

“…18 Some of the available literature advocates that suit therapy has many benefits such as improving motor function and posture, 18 improving vertical stability (e.g. standing posture), 21 increasing range of motion, 22 normalizing electroencephalography signals, 23 providing proprioceptive input and improving the vestibular system, 15 improving symmetry, increasing walking speed and cadence, 24 improving trunk control, 25 motor function (in all dimensions of Gross Motor Function Measure [GMFM]), 26 and self-care 27 capacity in children with CP. However, most of these studies are case reports or descriptive studies in which the methodological quality limits the possibility of supporting or rejecting the use of the suit therapy in clinical settings.…”

The influence of standards and clinical guidelines on prosthetic and orthotic service quality: a scoping review

“…International Society of Prosthetics and Orthotics [65] Table 1 Search terms and illustrative yields. Searches 1 to 6 were on the basis of title, abstract and keyword to increase sensitivity, search 6 and 9 were on basis of title and keyword.…”

Long‐Term Effects of Orthoses Use on the Changes of Foot and Ankle Joint Motions of Children With Spastic Cerebral Palsy

“…There are few studies that have investigated the effect of orthoses on patients with CP over an extended period of time [11]. One study followed 12 children with CP over a 2-year period and discontinued their AFO use for 4 weeks in two separate 2-week increments [12].…”