Library Type: Condition

Treatment

The use of an orthosis (brace) may reduce some of the negative effects of hypertonia. The brace can help with joint movement and muscle function for standing and walking.  

Orthoses can help by addressing one or more of the following issues:

• Providing a stable base for movement 
• Improving walking patterns
• Reducing the impact of spasticity on upper and lower limbs
• Reducing excessive energy used to move 
• Reducing the risk of falls
• Controlling muscular imbalance 
• Providing balance and control over spastic movement

The most common brace prescribed for hypertonia is an ankle-foot orthosis (AFO). AFOs have been shown to help support mobility in children with hypertonia. AFOs help make walking easier and more energy-efficient, allow children to perform certain activities more easily, and improve balance to increase safety. Other orthotic interventions may also include a wider span of lower limb bracing and potentially even hip, spinal, and hand/wrist bracing.

Internal tibial torsion in children will usually improve on its own with growth and time in the typically developing child. It is most commonly diagnosed by the pediatrician through family history and a physical exam.

Treatment

Leg braces, specialized shoes, and therapy are often prescribed to treat internal tibial torsion but have not been shown to be very effective. However, these treatments may be effective in older children to reduce pain, which may result from the condition.

Though it occurs very infrequently, there are cases where internal tibial torsion does not correct on its own and may have a negative impact on walking and running. A surgical procedure on the tibia (called an osteotomy) may be required to realign the lower leg and foot. This procedure is typically only done in older children and adults, once adult alignment has been achieved.

Treatment

The primary goal when treating a child with a genetic disorder is to improve their quality of life. This includes increasing their ability to walk and do other typical daily activities. Orthotic intervention, also known as bracing, may help stabilize a joint, support a limb, provide better joint alignment, or assist a weak muscle.

While ankle-foot orthoses (AFOs) are the most common orthosis (brace) prescribed for kids with genetic disorders, braces can be ordered for any body part, depending on the child’s needs.

Diagnosis & Treatment

When diagnosed at an early age, torticollis can often be treated with physical therapy and a home exercise program. A physical therapist will stretch the baby’s neck to improve the tightness of the neck muscles. If torticollis is untreated, significant head shape changes can develop as it can limit efforts in repositioning and normal development.

In the case of persistent torticollis or torticollis diagnosed at a later age, a neck brace (cervical orthosis) can be prescribed to keep the head in a corrected position. When torticollis causes head shape changes, a cranial remolding orthosis (or helmet) may be needed.

Early orthotic/prosthetic treatment can provide better outcomes for the patient, including improvements in standing, balance, and walking. There may be a need for a brace to protect the limb after surgery. A prosthesis will be started for a child after the limb is fully healed. Evaluations, fittings, and follow-up care for a prosthesis are continuous throughout life.

Children fit with a brace or prosthesis are usually able to walk, run, play sports, and have an independent life. All patients with fibular hemimelia will require consistent follow-up visits as they continue through adolescence. These visits are necessary to provide follow-up care and identify when it is necessary to replace the brace or prosthesis as the child progresses through adolescence and into adulthood.

Hanger Clinic has developed a set of Clinical Practice Guidelines that address the use of AFOs as an orthotic intervention for children with cerebral palsy. These Clinical Practice Guidelines give treating orthotists (clinician) evidence-based recommendations on the use of the device for a specific condition, in this case, the orthotic management of the legs of children with cerebral palsy. Below are the recommendations outlined in the Clinical Practice Guidelines:

• Recommendation #1: Among children with cerebral palsy, AFOs are indicated to increase gross motor function.
• Recommendation #2:  Among children with spastic cerebral palsy and equinus, AFOs are indicated to increase stride length and gait speed and decrease cadence, with greater impacts observed in children with hemiplegia than in diplegia.
• Recommendation #3:  Among children with spastic cerebral palsy and equinus, AFOs are indicated to increase ankle dorsiflexion during swing phase and at initial contact. 
• Recommendation #4: AFOs may have an effect on ankle power generation during ambulation.²