Management of muscle contractures is part of the overall management of cerebral palsy when there are muscle groups with high tone, or contractures of muscle from positioning.
Contractures of the legs restrict standing and walking, contractures of the hands and arms affect activities of daily living.
Orthoses can have a significant role to play in the fight against contracture and joint deformity. These can be simple positioning splints to hold a position when at rest, or complex dynamic orthoses designed to actively stretch a joint.
Lower limb (Legs):
Contractures of the knee can be managed statically with simple three-point knee extension orthoses, or more dynamically with Monodos or Ultraflex dynamic brace systems (www.ultraflexsystems.com). These devices are typically used at rest for a prescribed period. Three point orthoses are commonly used in conjunction with AFOs to stretch both the hamstrings and the calf muscles.
Foot and ankle contractures can sometimes be helped by the use of night splinting. Ankle-Foot Orthoses (AFOs), either pre-fabricated or custom made, can be used to keep a stretch on a calf muscle or reduce a foot angulation
Upper limb (Arms and hands):
Wrist and finger contractures are often managed through the use of custom-made wrist-hand orthoses, commonly known as resting splints. These can be moulded directly to the hand in most instances. At Orthokids we are also able to fit off-the-shelf devices for simple issues or take a cast to make a more complicated orthosis for more difficult situations where direct moulding will not be appropriate.
Wrist and elbow contractures can be managed and sometimes reduced by using dynamic orthoses such with Ultraflex joint systems (www.ultraflexsystems.com) or Monodos one-way wrist and elbow joint components. These are complicated orthoses that require a plaster cast to be taken for the brace to be manufactured.
Upper limb orthoses are often prescribed after botulinum toxin injections to provide a stretch post injection.