Treating cerebral palsy: braces
Braces, also referred to as orthoses, help children with cerebral palsy by stretching muscles that are usually over-flexed, and can be invaluable in aiding a child’s mobility and ability. They are available for ankles, legs, backs, aiding a crouched gait, elbow contractures, flat foot deformity, feet, hands, with a Harrington rod, for hemiplegic legs, hips, knees, wrist contractures and scoliosis.

A brace may be made of metal, leather, plastic or a combination of these. Braces made of different materials require different care. Your child’s orthotist and physician will give you instructions for keeping the brace in good working order. In addition to maintaining the integrity of the brace, proper care of the skin exposed to the braces is essential. Checking your child’s skin for rashes, redness, blisters and open skin is needed, as it may be an indication of the brace’s function. If a braces does not fit right, if the child outgrows it or the materials in the orthosis have broken down over time, the device may not only be useless in helping your child, it may be hurting him. If you see any skin irritation you should bring your child to his or her physician and have him investigate the problem. Sometimes, however, it is a matter of hygiene and not a matter of the brace’s dysfunction. You can help your child and any possible skin irritation by always keeping the brace clean and in good working order.

Ankle-foot orthoses, or AFOs, are very common in children with cerebral palsy. It is worn for the purpose of stretching the Achilles tendon. An AFO can be quite helpful to children with hemiplegic involvement who are walking on tiptoe. The brace is applied if the foot can be brought to a neutral position. Children who wear AFOs should wear them during the day as they would their shoes. While walking barefoot after a bath or in the evening can do no harm, you might consider having the child wear them at night, even while sleeping, for stretching particularly tight muscles. There is always an adjustment period, usually several months after they receive their brace, that a child feels very uncomfortable wearing the brace, even though their posture and walking may have improved. During this period, encourage your child to wear it as much as possible to try to let him or her become acquainted with it. After this period, the brace will stop feeling unnatural and will begin to feel quite comfortable. If the child continues to complain about it, however, the AFO should be carefully checked, and adjustments may have to be made.

Braces for elbow contractures are widely used due to the general urgency some parents feel in addressing the contracture. In some cases, the elbow becomes so flexed that it can no longer be extended enough to cleanse the elbow crease, and a foul odor can arise from the moist area. Braces can be very effective in treating this, and usually will allow the muscle to relax enough that the elbow crease can be cleaned.

Back braces are used to help straighten up a child who is having trouble sitting up and, in some cases, to straighten the spine, which may be developing a deformity or already have one.

A tone-reducing brace, also known as an inhibiting cast, is usually applied to the leg or sometimes the arm to inhibit a specific motion. “The cast is used to keep the foot in a position where the sole and heel touch the ground. By keeping the ankle from flexing, other movements are improved, and the elbows flex better, fingers move more easily, and spasticity decreases in the hips or knees.” The inhibitive ankle-foot brace is also helpful in stabilizing the ankle for standing. The benefits of inhibitive casting are lost, however, when the brace is removed.