Assistive devices, splinting and AFOs

By Natan Gendelman | http://www.enabledkids.ca | http://www.healthinmotionrehab.com

As we’ve indicated before, cerebral palsy is a neurological condition which results from damage to a certain area of the brain. When this occurs, a child’s ability to control specific parts of his body is affected, leading to impaired function and mobility. Since the brain is not sending the appropriate signals to parts of his body, a child will try to function in any way that he can and fight the condition that he is in. In turn, this will cause hyper tone, as we have written about before in our previous blogs.

In the case of a child, having hyper tone may cause certain patterns to occur during development. High tone in the trunk, for example, will lead to high tone in his hands, arms and legs, as well as to improper sensorial development. Now, what happens is that it becomes difficult for him to learn to walk properly, perform grabbing motions, or even bend his hands in the first place. For kids with cerebral palsy, this can result in the emergence of certain patterns like forming crab hands without bending them, or performing robot-like movements where the whole body is moved at once. When these methods of moving are left unchecked, they can have severe consequences on a child’s condition, and what he will be able to accomplish.

The effects of splinting and other devices

With this in mind, many people try to address these problems through the use of assistive devices, splints and AFOs (ankle-foot orthoses). Splints and other assistive devices are often used to maintain an appropriate range of movement in a child’s joint. However, it’s important to note that their usage may cause a chain reaction to occur in a child’s condition. When a child has a splint applied, his brain is not taught the appropriate function to go with the movement. Therefore, while his limb may be held in the correct position, his muscles will be stretched passively--that is, without the child’s active participation. This sends a message to the brain that the device is a foreign body, causing his body to try and fight it. As a result, that is why a lot of therapists find that a child’s tone will go up the moment a splint is taken off.

Making the decision

So, the question is: should we be using splints? Like I’ve said before, each situation has to be dealt with as a separate case which depends on the child’s condition, his ability to move and function, and--very importantly--his age. One key factor which will affect his need for these devices is his weight bearing and movement. A crucial part of joint development, weight bearing plays a necessary role in several movements which are part of a child’s function including sitting, crawling, standing, and walking. If a child places weight on his feet and hands in the process, he will not need a splint because his function will be corrected by his own weight. As he progresses from his knees to standing and then walking, the child then learns how to shift his weight properly. However, if a child is not moving at all, then--again, depending on the case--the use of a splint or other device may prove to be the most beneficial option.

For these reasons, it is important to understand and consider your child’s needs and condition before choosing and implementing splints, AFOs and other devices. Remember, their use will immediately limit certain movements for your child. As a result, it’s a good idea to think twice, do your research and learn how to use them safely and wisely.

If you have any questions or comments about this article, feel free to leave me a message down below or send an email to natan@enabledkids.ca. Thanks everyone, and I hope to hear from you soon!