The early introduction of independent mobility is important in children with cerebral palsy, because the ability to explore one’s environment has been demonstrated to improve self-esteem. Orthoses are frequently required to maintain functional joint position in the upper and lower extremities, especially in nonambulatory or hemiplegic patients. These devices may also help to control limb position during gait such as an ankle-foot orthosis (AFO) in foot drop to prevent tripping over the toes in a patient with inadequate dorsiflexion.
If a patient has impaired mobility, a wheelchair and/or mobility aids such as a cane or walker may help. Seating adaptations should be included with a manual wheelchair to keep the back straight and protect the hips from excessive adduction or abduction. A power wheelchair may be needed for children with severe spasticity or athetosis; this device can be introduced to children who have the ability to understand cause and effect for safe and appropriate use.
Serial casting and splinting can improve the range of motion (ROM) of a joint and decrease tone. This is often used at the ankles to help with plantar flexion contractures, but it also can be done on any contracted joint to provide a slow, progressive stretch. Splints should be worn as much as possible without causing skin breakdown (at least 6 hours to provide a good stretch or sometimes a schedule of 2 hours on, 1 hour off throughout the day).
Orthoses can become especially important in ambulatory cerebral palsy to improve gait, decrease contracture, and increase endurance. Patients with cerebral palsy usually have a very inefficient gait pattern, and there can be an energy expenditure gain of as much as 350%. Devices such as an AFO help to maintain foot position and prevent worsening contractures; thus, orthoses can be of great benefit, and while wearing them, patients can potentially have fewer trips and falls.
Walkers also may be prescribed to enhance mobility. Any child with the ability and/or desire to ambulate should be given every opportunity to do so. A posterior walker promotes a more upright posture than do traditional walkers.
Frequent reevaluation of orthotic devices is important because children quickly outgrow them and can undergo skin breakdown from improper use of this equipment.