Some aspects of orthopaedic rehabilitation for children with cerebral palsy

Authors:

Skirmont Elena Ivanovna, senior researcher, Department of orthopedic shoes and special clothing for the disabled of the Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Center of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; е-mail: 812skirmont@mail.ru; https://orcid.org/ 0000-0002-7924-2445.

Golubeva Yulia Borisovna, Head of the Department of orthopedic shoes and special clothing for the disabled of the Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Center of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; е-mail: 812skirmont@mail.ru.

Zimina Elena L’vovna, senior researcher, Department of orthopedic shoes and special clothing for the disabled of the Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Center of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; е-mail: 8120zimina@mail.ru; https://orcid.org/0000-0003-3121-6237.

Lade Aleksandra Sergeyevna, junior researcher, Department of orthopedic shoes and special clothing for the disabled of the Institute of Prosthetics and Orthotics, Albrecht Federal Scientific Center of Rehabilitation of the Disabled, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; е-mail: 812skirmont@mail.ru.

Pitkin Mark Rafailovich, Dr. Tech. Sci., Prof., Tufts University, Boston, MA 02111, USA. Phone 617-636-7000, e-mail: mpitkin@tuftsmedicalcenter.org.

Annotation:

Introduction. Cerebral palsy (CP) is the leading cause of childhood disability, representing a non-progressive encephalopathy before, during, or after childbirth. The most common consequence is spastic diplegia leading to frequent walking problems. The need for early rehabilitation treatment stems from the characteristics of the child’s brain — its plasticity and universal ability to compensate for impaired functions. A special role belongs to the early correction of the pathology of the child’s functional system of antigravity by methods of orthopedic rehabilitation. Without the correct design and prescription of orthopedic shoes and other orthopedic products, the opportunity to timely develop a more normal gait to reduce compensatory movements and spasticity, which in turn would increase the effectiveness of other types of treatment, can be missed.

Aim. To identify the design features of orthoses and orthopedic shoes in accordance with the medical and technical requirements for technical means of rehabilitation, which are prescribed for children and adolescents with spastic forms of cerebral palsy.

Materials and methods. In this paper, we consider the role of the design of orthoses and orthopedic shoes in the normalization of the basic characteristics of balance and walking in children with cerebral palsy. Particular attention is drawn to the possibility of fitting the device to such an extent and with such frequency that it would meet medical requirements as the child grows, and takes into account the results of various types of treatment. Data are given on the evaluation of the effectiveness of supplying orthopedic equipment with orthoses and shoes.

Results. The results of a comparative analysis of the biomechanical characteristics of the range of orthopedic products for cerebral palsy, as well as an expert assessment of orthoses and orthopedic shoes, confirmed the timeliness of studying the principles of prescribing and manufacturing orthoses and orthopedic shoes for this pathology.

Discussion. The study of the assortment of products prescribed for this pathology and presented on the market of orthopedic services is carried out on the basis of the classification of various forms of cerebral palsy, reflecting visible pathological abnormalities in the lower extremities. When developing and creating prosthetic and orthopedic products, it is necessary to take into account the type and severity of deformities that occur with this pathology. The algorithm for prescribing orthopedic shoes depends on the severity of anatomical and functional disorders of the lower limb. Innovative technologies make it possible to supplement the mentioned traditional methods of orthopedic support with fundamentally new approaches.

Conclusion. It is shown that technical means of rehabilitation prescribed for children with spastic forms of cerebral palsy must be manufactured in strict accordance with the medical and technical requirements and parameters specified in the regulatory and technological documentation. To do this, the design of the products must provide the possibility of their repeated adjustment following changes in the biomechanical status of the child in the course of biological growth and the therapy used.

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