Cerebral Palsy (CP)
Cerebral palsy (CP) is a neurological condition which is caused by damage to the developing brain before, during or after birth. Every case is unique depending on the area of the brain that has been affected and the timing of the injury to the developing brain. Cerebral Palsy can affect movement, coordination, vision and hearing.
Liverpool Orthotics provide a range of orthotic solutions to help reduce the symptoms of CP by aiding mobility, reduce muscle tightness and increasing mobility.
What are the types of Cerebral Palsy?
The types of Cerebral Palsy depends on what area of the brain has been affected. The amount of damage to the brain often reflects the severity of symptoms. The types of CP are;
Spastic Cerebral Palsy (Hypertonic) - is the most common type of CP accounting for an estimated 75% of all cases. It causes increased limb rigidity through muscle stiffness, as muscles cannot relax particularly when moving. This is called spasticity and over time the affected muscles can become tight if they are not adequately supported.
Spastic Cerebral palsy can be catagorised into which limbs are effected;
- Hemiplegia - one side effect i.e left arm and left leg
- Diplegia - both lower limbs affected
- Quadriplegia - all 4 limbs affected.
The symptoms of Spastic CP are:
- Difficulties with controlling and coordinating muscle movements
- Speech problems, such as slurred or poorly formed words
- Stiff, spastic muscles
- Difficulties sitting up, crawling and walking (compared to peers)
- Abnormal movements
- Poor coordination of muscles of the tongue and mouth, which affect swallowing and make it difficult to eat and drink
- Poor eyesight
Athetoid Cerebral Palsy - is characterised by abnormal and involuntary movement control due to damage to the basal ganglia area of the brain. Jerky, slow writhing movements of the neck, upper and lower limbs are most commonly seen but it can affect the whole body. Muscle tone often varies from high to low tone. This is a less common form of CP affecting 15% of individuals. Intellect is often normal.
Symptoms of Athetoid CP are;
- Slow, writhing movements
- Repetitive movements (often with hand or neck)
- Unpredictable movements
- Irregular movements
- Poor posture and coordination
- Sporadic uncontrolled limb movements
Ataxic Cerebral Palsy - is the least common type affecting less than 5% and is caused by damage to the cerebellum section of the brain. It is characterised by poor balance, coordination and individuals struggle with fine motor control such as writing, speech and vision.
Symptoms of Ataxic CP are;
- Poor balance
- Poor coordination
- Tremors to limbs
- Slow and slurring speech
- Poor vision (constantly moving eye speed)
Mixed Cerebral Palsy - there are occasions where an individual may present the symptoms of one or more of the above types of CP. The symptoms can vary significantly.
How does Cerebral Palsy cause muscle tightness and what are the treatments?
Spastic Cerebral Palsy causes mixed up signals from the damaged area of the brain (motor cortex) to the muscles. As a result the muscles are constantly tense and the affected limbs appear to be stiff. Often spasticity increases or is only present when the body attempts to move.
Over time the tense muscles become tight and joint function often becomes disrupted as a result. This can often cause compensatory walking patterns or even symptoms of pain.
An effective way to relax the muscle is through injecting Botulinum toxin (Botox) into the muscle. The Botox acts as a blocker to unwanted signals from the brain to the muscle and can help the muscle to relax. The Botox eventually wears off, however if orthotic treatments are put in place while the Botox is active, the muscles can be stretched for long term functional gains.
Liverpool Orthotic provides a spasticity management service that involves serial casting and muscle stretching devices.
How can Liverpool Orthotics help in the treatment of Cerebral Palsy?
Liverpool Orthotics provide a range of leading custom made and ‘off the shelf’ orthotic solutions to aid the treatment of Cerebral Palsy for both adults and children. The primary goals of orthotic treatment is to support weak muscles, improve joint alignment, increase mobility and resist muscle tightness. Liverpool orthotics provide;
AFO’s (Ankle Foot Orthotic) - AFO’s are splints that provide support to the ankle and foot. AFO's are normally made from thermoplastic, silicon, lycra or carbon fibre to control unwanted movements and improve mobility. Liverpool Orthotics provide custom made devices to target the areas of the leg that require specific support while maintaining as much natural function as possible.
DAFO’s (Dynamic Ankle Foot Orthosis) - DAFO’s are splints that provide stability to the ankle and foot but allow for a greater range of movement at the ankle than an AFO. These devices can work really well for individuals with ataxic CP or mild spastic symptoms. DAFO's can be manufactured from thermoplastic, silicon, Lycra or carbon fibre.
KAFO’s (Knee Ankle Foot Orthotic) - KAFO’s are splints that provide stability to the knee, ankle and foot joints. They can be made from thermoplastic, carbon fibre and lightweight metal. A KAFO can help support the muscles and align joints to enable optimal function.
Spinal braces - Spinal bracing can help improve trunk posture which in turn can allow for improved upper and lower limb function. Spinal bracing can reduce painful symptoms by reducing deformity and providing stability for both high and low muscle tone issues. Liverpool Orthotics provide a range of custom and ‘off the shelf’ spinal supports.
Lycra - Lycra is a lightweight and discreet alternative to more traditional rigid splinting. Lycra fits directly against the skin to provide stability and offer targeted support to affected limbs or to the spine (trunk). The base layer of Lycra can be reinforced with strips of stronger Lycra to assist or resist muscle movements.
Silicon splints - Silicon is a lightweight, comfortable and life-like material that can be used to manufacture splints that provide stability and support to weak muscles.
Carbon Fibre splints - Carbon fibre is an extremely strong and lightweight material that can be made exceptionally thin. Liverpool Orthotics provide carbon fibre devices to support or stabilise any joint of the body.
Insoles - Having flat feet can be a common consequence of Cerebral Palsy. Insoles can be an effective solution to provide support and stability to the foot and ankle to improve mobility. An insole can also be constructed with a neurological foot bed, that can help reduce increased muscle tone.
Head protection - Liverpool Orthotics provide a range of custom made and ‘off the shelf’ head protection that can help to reduce head injuries for individuals who wish to be independently mobile but suffer with balance issues or epilepsy.
Upper limb support - The upper limbs can often suffer from muscle tightness, deformity and instability as a result of Cerebral Palsy. Liverpool Orthotics provide a range of hand support solutions for daytime and night time to provide stability, support and muscle assistance.
Knee bracing - Knee weakness is a common symptom of Cerebral Palsy. Liverpool Orthotics provide knee supports that are specifically designed for the effective treatment of Cerebral Palsy. Knee braces can aid weak quadriceps (thigh muscles) to enable improved mobility, confidence and independence.
Stretching devices - Cerebral Palsy often causes overactive (spastic) muscles. These muscles are at risk of developing muscle tightness over time. This muscle tightness can lead to reduced range of movement at a joint. Liverpool Orthotics provide both static and spring loaded stretching devices to reduce the effects of muscle tightness.
Gaiters - Leg gaiters are most commonly used by children. When children grow they are susceptible to muscle tightness. Gaiters can be fitted on the arms to stretch the bicep muscles or on the leg to stretch the hamstring muscles. Gaiters can be worn for periods during the day or some children wear them at night time.
What is the first step to arranging an assessment?
The first step is to arrange an initial consultation with one of our experienced HCPC and BAPO registered orthotists at home, work or at one of our clinics.
During the assessment the orthotist will take a full medical history, establish your goals of treatment and conduct a physical assessment. The assessment will consist of joint range of movement tests, muscle power tests and an observation of your walking (if appropriate).
The orthotist will then measure, scan or take plaster casts of the area of the body in question to have a suitable orthotic device ordered. Suitable fitting appointments can then be arranged. For more complex devices there may be more than one fitting appointment required. A complimentary review appointment will be arranged once the device has been fitted.
To arrange an appointment call Liverpool Orthotics now on 0330 088 3949, or email us at office@liverpool-orthotics.co.uk