Clinical specialties in orthotics and prosthetics Image Courtesy of Orthokids Orthoses in paediatrics: supporting development and therapeutic intervention in babies, children and young people

What is an orthosis? Cranial orthoses for babies with An orthosis (pl. orthoses) is an externally applied device that is positional plagiocephaly and designed and fitted to the body. Orthoses (historically known as splints or braces) are described by the body part they encompass. An orthosis may be used to correct body alignment, What is positional plagiocephaly and support function, minimise discomfort or pain, protect a body part after injury or surgery, re-distribute pressure, correct deformity or brachycephaly? assist in rehabilitation. Positional (or deformational) plagiocephaly (pron. play-gee-o-kef- a-lee) and brachycephaly (pron. brak-ee-kef-a-lee) are types of Orthoses in paediatrics – who needs them? cranial deformity – meaning a misshapen head. Plagiocephaly Orthoses play an important role in supporting development occurs when there is flattening on one side of the head, causing and therapeutic intervention across a range of pathologies in asymmetry. Brachycephaly occurs when there is flattening of the the paediatric population – from orthoses to encourage hip back of the head. Plagiocephaly and brachycephaly are common development in newborn babies, to spinal orthoses to reduce cranio-facial conditions that occur most often when babies spend abnormal spinal curves in adolescents with or . prolonged periods lying with their head in the same position. How do cranial orthoses help? Hip orthoses for babies with Cranial orthoses are a developmental dysplasia of the hip (DDH) treatment option for babies What is DDH? with more severe deformity, where counter positioning Developmental dysplasia (or dislocation) of the hip (DDH) is an is not possible or has not abnormal development of the hip joint. The ball at the top of the improved head shape, and thighbone (the femoral head) is not stable within the socket (the who also have good head acetabulum). The ligaments which hold the joint together may also control. A cranial orthosis be stretched and loose. DDH can occur in one or both hip joints. is a custom-made helmet fabricated with a hard plastic How do hip orthoses help? shell and foam lining. An orthotist designs the helmet to Babies with DDH can be successfully treated with hip abduction Image Courtesy of Orthokids orthoses. There are different types of hip abduction orthoses – a redirect growth by fitting Cranial Remodelling Helmet pavlik harness, a ‘Denis Browne’ brace, a ‘Rhino’ brace. Though closely to the head but leaving varied in design, these hip orthoses all hold the hip joint in the room for growth in the flattened area. Refer to the Plagiocephaly most stable position – with the thigh ‘up and out’ - so that the and Brachycephaly Clinical Specialty Fact Sheet for further ligaments tighten and the hip joint develops normally. An orthotist information. works with a multidisciplinary team and the family to determine the hip abduction orthosis design that best meets the hip position Foot abduction orthoses for children requirements of the individual baby. with Congenital Talipes Equinovarus What is Congenital Talipes Equinovarus? Congenital Talipes Equinovarus (or CTEV or congenital ) is the most common congenital deformity affecting 1 in 1000 Denis Browne Brace live births. In CTEV, the foot is twisted, pointing inward and Image Courtesy of Orthokids downward. www.aopa.org.au 1 of 2 Orthotists – supporting the Australian community

How do foot How do spinal orthoses abduction orthoses help? help? Spinal orthoses provide The foot abduction corrective forces on the spine orthosis is also known to promote symmetrical spinal as ‘boots and bar’. alignment in adolescents who It is part of the gold have moderate structural curves standard treatment for (scoliosis 25-45° or kyphosis 55- treating CTEV as part of Foot Abduction Orthosis 80°) and who are still growing. Spinal orthoses effectively the Ponseti method. This method begins with manipulation and prevent curve progression in AIS casting to stretch the foot into a corrected position, then often a Image Courtesy of Orthokids and reduce kyphotic curves in small operation is performed to lengthen the Achilles tendon (a Boston Brace people with Scheurmann’s disease. tenotomy), and finally, wearing of special boots, connected by a Orthotists combine knowledge of complex anatomy and bar (the foot abduction orthosis) to keep the feet in their corrected biomechanics to design and fabricate an orthosis (made out of position and avoid relapse. An orthotist works as part of a rigid plastic) that incorporates the necessary forces to correct multidisciplinary team in the selection and fitting of foot abduction spinal alignment. Refer to the Spinal Clinical Specialty Fact Sheet orthoses to support therapy and surgical interventions. for further detail. Ankle-foot orthoses for children with Who provides orthoses? cerebral palsy An orthotist (pron. or-tho-tist) is a tertiary qualified Allied Health What is cerebral palsy? Practitioner who is trained to assess and treat the physical and functional limitations of people, using orthoses. Orthotists are Cerebral palsy (or CP) is a neurological disorder caused by a responsible for paediatric orthotic management including DDH, non-progressive brain injury or malformation that occurs while plagiocephaly, CTEV, cerebral palsy, scoliosis and kyphosis. the child’s brain is still developing — before birth, during birth, Orthotists combine clinical and biomechanical expertise with or immediately after birth. Cerebral Palsy primarily affects body their knowledge of current evidence, materials and product movement and muscle coordination. Cerebral palsy is the most developments to support children with developmental and mobility common childhood physical disability in Australia. impairments to meet their personal goals. How do ankle-foot orthoses help? How do I access an orthotist? The most common type of orthosis If your child requires orthotic management for one of these – or used to help children with cerebral any other – condition, your GP or medical specialist will refer you palsy is the ankle-foot-orthosis (or to an orthotist. Certified Orthotist/Prosthetists ‘cOP-AOPA’ AFO). AFOs are custom-made can also be located using the ‘Find a practitioner’ search function and encompass the foot, ankle on the AOPA website (www.aopa.org.au). and lower leg. The design and purpose of the AFO is different according to each person’s unique Orthotic management in paediatrics: needs and goals, which often • Many babies, children and young people benefit from includes supporting or correcting orthotic intervention – including those with Developmental abnormal limb positioning, Dysplasia of the Hip (DDH), deformational plagiocephaly, preventing deformity, providing Congenital Talipes Equionovarus (CTEV or clubfoot), cerebral a stable base for sitting and Image Courtesy of Orthokids palsy, scoliosis and kyphosis Ankle Foot Orthoses standing, and facilitating a safer and • Orthoses help to reduce deformity, correct body alignment more efficient walking pattern. AFOs are also used by children and support functional goals such as sitting, standing and who have other conditions such as , developmental walking delay or CTEV. Orthotists work with the client, family and members • Orthotists are Allied Health Professionals who support babies, of the multidisciplinary team to determine the most appropriate children and young people by providing comprehensive and AFO to help each child meet their personal goals. evidence based orthotic care and interventions Spinal orthoses for adolescents with scoliosis and kyphosis What is spinal deformity? Spinal deformity is an abnormal curvature of the . Two common spinal deformities are Adolescent Idiopathic Scoliosis (AIS) - a sideway curvature of the spine with rotation resulting in a hump; and Scheurman’s kyphosis – an increased forward curve of the thoracic (upper) spine presenting as rounded . Disclaimer – This fact sheet does not replace clinical advice. If you require orthotic services AOPA recommend speaking to your practitioner. This fact sheet was developed based on interpretation of current evidence as of August 2016. References available on request. www.aopa.org.au 2 of 2