Common Pathologies
Scoliosis (Adolescent Idiopathic Scoliosis AIS, Congenital Scoliosis, Neuromuscular Scoliosis)
Scoliosis* is when a person's spine curves from side to side. When this occurs the spine looks more like and 'S' or 'C', rather than a straight line. This curve can lead to changes in one's shoulders, ribcage, pelvis, waist, and the overall shape of one's back.
For moderate scoliosis, when the spine is curved between 20-50 degrees, orthopaedic bracing is commonly prescribed to patients to try to prevent the curve from progressing (which would then require surgery). Orthopaedic bracing does not cure or reverse scoliosis, but it can slow down its progress. It is also used post-surgery to ensure that the spine is kept in a stable and proper alignment.
*Cited from BC Children's Hospital pamphlet on its orthopedic spine program
Scoliosis can be defined as a three dimensional deformity of the spine and trunk; causing a lateral curvature in the frontal plane, an axial rotation in the horizontal plane and a disturbance of the sagittal plane normal curvatures of kyphosis or lordosis.
Idiopathic Scoliosis is described etiopathogenetically as a sign of a syndrome with a multifactorial etiology and is the most common of all forms of lateral curvature of the spine in an otherwise healthy child, for which a currently recognizable cause has not yet been found.
Less common but better defined etiologies of the disorder include scoliosis of neuromuscular origin, congenital scoliosis, scoliosis in neurofibromatosis, and mesenchymal disorders like Marfan’s syndrome.
*Cited from International Scientific Society on Scoliosis Orthopaedic and Rehabiitiation Treatment Guidelines and Consensus Paper, SOSORT
Cerebral palsy
Cerebral palsy* (CP) is a term used to describe a group of disorders which affect movement and posture. Different parts of the brain control the movement of every muscle of the body. In cerebral palsy, there is damage to, or lack of development in part of the brain (which occurs within the first two years of life). Symptoms of CP can be very different in every person, ranging from mild to severe problems with motor skills, muscle weakness, muscle tone, balance, awkwardness, slowness, reflexes, learning disabilities, and/or speech.
Orthopaedic devices are often prescribed to address the physical outcomes of CP, which can become particularly severe during childhood as the body grows and muscle formation is not able to keep up with bone growth. This can result in symptoms such as toe walking or bone remodeling. The purpose of orthotic devices, especially at a young age, is to prevent these deformities using devices that support posture and function.
*Cited from BC Children's Hospital
Spina bifida
Spina bifida* is a birth defect that affects the spinal cord causing partial or complete paralysis from the waist down. Because of this children's legs often do not have much (or any) strength, and the bones in the legs and muscles may not develop properly. Stiff joints, or muscle contractures occur in the feet, knees and hips affecting brace wear or good sitting positions in a wheelchair. There is no known cure for spina bifida, and treatment usually involves surgery to reduce the muscle contractures in the legs, or back surgery to correct a scoliosis deformity often seen in these children.
*Cited from BC Children's Hospital
Orthopaedic devices are used post-surgery to ensure that the progress made from surgery is retained and to improve independent function and prevent deformities. Usually the first type of orthosis a child with spina bifida is fitted with is an ankle-foot orthosis (AFO) to prevent plantarflexion contractures and other angular deformities. The AFO provides stability around the ankle and foot to enable patients to stand. AFOs also are frequently used to maintain a surgical correction. Depending on how much stability patients need as well as their cognitive ability, upper extremity strength and level of defect, patients will advance to a knee-ankle-foot orthosis (KAFO), a hip-knee-ankle-foot orthosis (HKAFO) or a reciprocating gait orthosis (RGO).*
*Cited from Healio Orthotics/Prosthetics News
Arthrogryposis
Arthrogryposis is when a child is born with joint contractures. This means some of their joints don't move as much as normal and may even be stuck in one position. Often the muscles around these joints are thin, weak, stiff or missing. Extra tissue may have formed around the joints, holding them in place. Most contractures happen in the arms and the legs. They can also happen in the jaw and the spine. Arthrogryposis does not occur on its own. It is a feature of many other conditions, most often amyoplasia. Children with arthrogryposis may have other health problems, such as problems with their nervous system, muscles, heart, kidneys or other organs, or differences in how their limbs, skull or face formed.
The main goal of treatment for arthrogryposis is to help your child's joints move as normally as possible. This means improving their flexibility, their strength and the way their bones line up. For your child's lower body, the focus is on working with their feet and legs so they may be able to stand and walk. For their upper body, the focus is on working with their hands and arms so they may be able to do things on their own.
Orthopaedic treatment for arthrogryposis is aimed at providing rigid support that goes around a joint to hold it in place. These supports can help line up your child's bones so your child can move better. Splints and casts also help keep joints stretched, and they can improve or prevent contractures. Your child may need different splints or casts at different times. Some splints are worn only at night. Often children go through a series of splints or casts that are changed as their range of motion changes.
*Cited from Seattle Children's Hospital
Muscular Dystrophy
Muscular Dystrophy (MD) is caused by a genetic mutation that primarily affects boys as it is found on the X chromosome, and which leads to a degeneration of muscle strength starting in the lower limbs and eventually travelling to the upper limbs and organs. The more severe form of MD is Duchenne, which results in progressive loss of strength and is caused by a mutation in the gene that encodes for dystrophin. Because dystrophin is absent, the muscle cells are easily damaged. The progressive muscle weakness leads to serious medical problems, particularly issues relating to the heart and lungs. Young men with Duchenne typically live into their late twenties. Becker muscular dystrophy, which is less severe than Duchenne, occurs when dystrophin is manufactured, but not in the normal form or amount.
During the middle stages of MD, night Ankle Foot Orthoses are usually prescribed by physicians to keep comfortable boys with MD as they sleep, and studies have found that regular stretching combined with night splints can reduce the development of contractures in lower limbs. Knee Ankle Foot Orthoses may also be recommended by physicians as walking becomes increasingly difficult for patients with MD, which assist with standing and stretching the hips, knees and ankles simultaneously.
*Cited from the Parent Project on Muscular Dystrophy
Clubfoot
Clubfoot is a condition in which the foot/feet of a child turn(s) inward and point(s) down. There are three types of clubfoot: positional clubfeet have been held in a curved position in utero and are easily treatable by repositioning the foot; teratologic clubfoot may be associated with other conditions such as arthrogryposis or spina bifida; and idiopathic clubfoot originates from an unknown cause.
*Cited from BC Children's Hospital Clubfoot Clinic
Ortho Dynamics works with the BC Children's Clubfoot Clinic on a weekly basis, providing boots and bars to babies with clubfeet to maintain the progress made from the prior use of botox and serial castings and manipulations. Depending on the effectiveness of this treatment, or once they have outgrown boots and bars, children with clubfeet may be prescribed orthotic devices such as AFOs to continue the progress made by treatment during the clubfoot clinic if they have a relapse or post-surgically.
Charcot-Marie-Tooth
Charcot-Marie-Tooth disease (CMT) is one of the most common inherited neurological disorders, also known as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy, and comprises a group of disorders that affect peripheral nerves. The peripheral nerves lie outside the brain and spinal cord and supply the muscles and sensory organs in the limbs. CMT affects both motor and sensory nerves, which cause muscles to contract and control voluntary muscle activity such as speaking, walking, breathing, and swallowing. A typical feature includes weakness of the foot and lower leg muscles, which may result in foot drop and a high-stepped gait with frequent tripping or falls. Foot deformities, such as high arches and hammertoes are also characteristic due to weakness of the small muscles in the feet. In addition, the lower legs may take on an "inverted champagne bottle" appearance due to the loss of muscle bulk. Later in the disease, weakness and muscle atrophy may occur in the hands, resulting in difficulty with carrying out fine motor skills (the coordination of small movements usually in the fingers, hands, wrists, feet, and tongue).
There is no cure for CMT, but physical therapy, occupational therapy, braces and other orthopedic devices, and even orthopedic surgery can help individuals cope with the disabling symptoms of the disease. Many CMT patients require ankle braces and other orthopedic devices to maintain everyday mobility and prevent injury. Ankle braces can help prevent ankle sprains by providing support and stability during activities such as walking or climbing stairs. Thumb splints can help with hand weakness and loss of fine motor skills.
*Cited from the National Institute on Neurological Disorders and Stroke