Cerebral Palsy Orthotics in London
Cerebral palsy affects movement, muscle tone and posture, and it presents differently in every person. Orthotic care is usually one strand of a much wider plan involving physiotherapy, occupational therapy and in some cases orthopaedic or neurological input.
We assess both children and adults with cerebral palsy at four London clinics, and are used to working as part of an existing team rather than in isolation.
How Cerebral Palsy Affects Movement and Posture
The features most relevant to orthotic management include:
- Spasticity, where increased tone makes muscles stiff and restricts movement
- Dystonia and involuntary movement, which can make position harder to control
- Ataxia, affecting coordination and balance
- Muscle imbalance across a joint, which over time can pull a limb towards a fixed position
- Contracture and joint deformity developing as a consequence of that imbalance
- Reduced endurance, so that walking is harder to sustain over distance
What Orthotic Treatment Sets Out to Do
The aims differ from person to person, but usually fall into a few broad categories: improving the mechanics of standing and walking, holding joints in a better position through the day or the night, maintaining the range of movement that is available, and reducing the rate at which deformity progresses.
For children there is an additional consideration, which is that all of this is happening while the body is still growing. Orthotic management in childhood is as much about the trajectory over years as it is about the present moment.
Children, Growth and Review
Children outgrow devices, sometimes surprisingly quickly. A device that fits well can become uncomfortable or ineffective within months, and a poorly fitting one tends not to be worn. Regular review is therefore built into paediatric orthotic care rather than added on when something goes wrong.
We also think about the practical side. A splint has to work at school, in the playground, with the shoes the child actually owns and, quite often, with a child who would rather not be wearing it. Those conversations are part of the appointment.
What Happens at Your Assessment
For a child, assessment covers muscle tone, joint range, hip and spine position, standing and walking where applicable, skin condition and current footwear. We will ask about the school day, activity levels, sleep and what the family is finding hardest.
3D scanning is available and is a quick, clean and comfortable alternative to traditional casting and for younger children in particular tends to make the appointment considerably easier. Traditional casting is still used often where clinically appropriate but we will always try to scan where possible. Where a device is to be manufactured, 3D printing allows a level of tailoring to both anatomy and cosmetic appearance that traditional methods do not and we can create your custom orthoses with a high level of precision.
Orthoses Used in Cerebral Palsy
- Ankle foot orthoses in solid, hinged and dynamic designs, selected according to how much control is needed and how much movement should be preserved or controlled
- Ground reaction ankle foot orthoses, used where control at the knee is limited
- Knee ankle foot orthoses, are designed to support the knee, ankle and foot
- Night splints and resting orthoses, used to maintain position and range outside walking hours
- Wrist and hand orthoses, for positioning, comfort and function in the upper limb
- Spinal bracing, where posture and trunk control need support
- Custom insoles, modular footwear and custom footwear, to improve contact, comfort, stability and accommodate foot shape
Thinking Across the Whole Day
Orthotic management in cerebral palsy is not only about walking. The position a body spends time in when sitting, lying and sleeping influences joint range and the rate at which deformity develops, often more than the hours spent on the feet do.
This is why night splints and resting orthoses come up so frequently, and why the discussion at assessment covers seating, sleeping position and how long is spent in each. Devices worn at different times of day serve different purposes, and it is common for more than one to be in use at once. Tolerance matters here too, since a night splint that disturbs sleep will not be worn for long.
Adults With Cerebral Palsy
Adults with cerebral palsy often find that support drops away once they leave paediatric services, at exactly the point where new issues start to appear. Pain, increasing fatigue, joint changes and a walking pattern that is becoming harder to maintain are all common reasons for adults to seek an orthotic assessment.
Devices fitted years ago may no longer suit the body or the life around it. A fresh assessment is often worthwhile even where nothing dramatic has changed.
Common Questions
At what age can my child be assessed?
There is no fixed lower age limit. Assessment is guided by what your child is doing and what the wider team is working towards, so it is best discussed directly with us.
Does my child need to be cast?
Not always. Three dimensional scanning can replace casting in many cases and is generally quicker and easier for a young child to tolerate.
How often will devices need replacing?
This depends largely on growth, wear and any change in tone or function, so it varies. Review intervals are agreed as part of the plan rather than set to a fixed rule.
Will you work with my child's physiotherapist?
Yes. We would normally expect to, and can liaise with physiotherapists, consultants, case managers and school-based teams where that is helpful.
Do you see adults as well as children?
Yes. We assess adults and children with cerebral palsy.