Costumized external strap orthosis for

Cerebral Palsy children

Presentation order:
 Summary about CP (ayah)
 Orthosis used by CP patient (rola qoqazah)
 External strap orthosis (rola shaheen)
 Case study (Rana Olaimi)
 Conclusion (ayah)
 CEREBRAL PALSY
IN WESTERN
Cerebral palsy in Because it is a COUNTRIES,
children is cause nonprogressive THE
PREVALENCE
by brain injury in brain injury, the
OF CP
early childhood patients need a RANGES
long time to heal. FROM 1.5 TO
2.5 PER 1000
LIVE BIRTHS.
 CEREBRAL PALSY
Cerebral palsy causes nervous system injury and results
in lower limb spasticity, contracture, lack of
coordination, muscle weakness, and inability to move
independently in children the children with cerebral
palsy had less units than the healthy children . Along
with muscular spasm and joint contracture, the
problems cause abnormal gait, joint restriction, and loss
of functional activity . Ambulation is an important
functional activity, 54% of the children were unable to
walk alone.
Toe-in and crouch gaits are affected
by medial femoral torsion, which is
produced by aberrant muscle tension
and causes instability during
ambulation.
The effect of the toe in and crouch on gait phases

1 2
Increase legs crossed collision in
Decrease the base of the swinging phase which may
support in the stance increase the risk of falling
phase
IN CP PATIENTS, AN
ORTHOSIS IS USED
TO CORRECT TOE IN
AND CROUCH GAIT.
 FROM SAGITAL PLANE

The therapist used to correct toe in gait and crouch gait

a solid ground reaction ankle foot orthosis, it was more
typically used in children with cerebral palsy to increase
ankle dorsiflexion, , and hip and knee flexion during the
stance phase of gait.
TRANSVERSE PLANE CORRECTIVE
ORTHOSES

Such as theratogs, a type of dynamic

elastomeric fabric orthosis that may enhance
lateral torque in gait.

This orthosis was helpful for children with

cerebral palsy , but it needed long-term usage
and extensive adjustments.
REASON FOR INVENTING AN
EXTERNAL STRAP ORTHOSIS
The requirement for lower limb motion
correction and fall prevention during a short-
term treatment course.

The requirement for a specialized orthosis

capable of providing lateral torque for rapid
application
The Orthosis
The customized external strap orthoses were manufactured in a rehabilitation center in a hospital
and adjusted for each child by an occupational therapist . the orthoses were fabricated from an
elastic fabric strap and a metal retaining clip with a loop fixed to the ankle and foot ,the strap was
tensioned with a spiral pattern , which ran from the lateral ankle to posterior calf and inner thigh to
lateral sacral crest and was fixed to be close to anterior superior iliac spines . it was not wrapped
around the hip and knee joints . the customized external strap orthosis formed an outward strap
and provided an elastic force that can assist in correcting the child's lower extremity . in this
study , the children wore the orthosis on both lower extremities and removed the shoe and other
orthoses during the test.
 The current results support the importance of applying a customized external strap
orthosis for the child in the treadmill ambulation training. Ankle-foot orthosis (AFO) is
the most frequently used type of orthosis in children with cerebral palsy (CP). AFOs
are designed either to improve function or to prevent or treat muscle contractures.
Some studies indicated that outcomes of using
lower extremities orthoses could present the
changes of spatiotemporal gait analysis and
represent the improvement of gait function , the
current report is a preliminary study exploring
the changes in plantar pressure and
spatiotemporal gait parameters ( gait speed ,
cadence , and stride length ) while using the
proposed customized external strap orthosis . the
immediate changes in kinetics of the customized
external strap orthosis were still unclear
SOLID GROUND
REACTION ANKLE ETHERATOGS
FOOT ORTHOSIS
Case study
PARTICIPANTS
Nine children with mild cerebral palsy, who confirmed assessments of toe-in
gait, who all had a dominant right leg, all of them received physical therapy,
they had experiences of wearing ankle foot orthosis and wore customized
external strap orthosis for the first time.

Exclusion criteria
1. Who had lower extremity surgeries
2. Who had language or hearing impairment
3. difficult standing and walking without wearing shoe or
orthoses
 METHOD
Analyzing the changes in plantar pressure
while wearing or removing the customized
external strap orthosis on the dominant
right leg while standing and walking.
The figure below shows that the heel goes from valgus when removing
the orthosis to varus when wearing the orthosis

Positive values for valgus

Negative values for varus
•When wearing the strap, the foot goes into supination, so the plantar
pressures were distributed to the forefoot area and increasing the area of
toe contact, which improves standing stability and increase the base of
support.

Positive values for pronation

Negative values for supination
• pressure trajectory under removing (a)
and wearing (b) the customized
external strap orthosis shows that the
orthosis .
• OTHE PATH OF PRESSURE
TRAJECTORY WAS CLOSE TO
THE FOOT MIDLINE, AND THE
PEAK PLANTAR PRESSURE
RESPONSE CHANGED FROM
THE HEEL TO THE FOREFOOT.
Study limitation
1. Lack of participants
2. the sample size was still small. Therefore, the data did not
accurately represent the outcome.
3. length of customized external strap orthosis must be defined by
the individual leg length in the children. Which affect the elasticity
of the strap.
4. long-term effects of the orthosis on functional activity
also needed to be investigated.
Conclusion
FINDINGS
Results showed that customized external strap orthosis can:
• Improve gait speed, cadence and stride length.
• Maintain standing balance and stability.
• Reduce the risk of falling.
• Achieve immediate corrective effects of the static and dynamic aspects in
the children with mild cerebral palsy.
• The cost of customized external strap orthosis was lower than
that of ankle foot orthosis
The reason of the findings is the elasticity of the
applied external rotation force of the customized
external strap can correct the mal directed lower
extremity and increase stability in the gait cycle.
also, Immediate correction of this orthosis and it
low wight and cost make it better for children CP
patient .
THANK YOU!
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