Cerebral palsy

== Orthotics in the concept of therapy ==
[[File:Cerebralparese Orthese orthotics.jpg|thumb|Child with cerebral palsy and [[orthotics]] with adjustable functional elements to improve safety when standing and walking]]
To improve the gait pattern, [[orthotics]] can be included in the therapy concept. An orthosis can support physiotherapeutic treatment in setting the right motor impulses in order to create new cerebral connections.<ref>{{Cite book| vauthors = Horst R |title=Motorisches Strategietraining und PNF|publisher=Renata Horst|year=2005|isbn=978-3-13-151351-9}}</ref> The orthosis must meet the requirements of the medical prescription. In addition, the orthosis must be designed by the orthotist in such a way that it achieves the effectiveness of the necessary levers, matching the gait pattern, in order to support the proprioceptive approaches of physiotherapy. The characteristics of the stiffness of the orthosis shells and the adjustable dynamics in the ankle joint are important elements of the orthosis to be considered.<ref>{{Cite book|url=https://musculoskeletalkey.com/orthoses-for-cerebral-palsy/|title=Orthoses for cerebral palsy|vauthors=Novacheck TF|publisher=John D. Hsu, John W. Michael, John R. Fisk|year=2008|isbn=978-0-323-03931-4|series=AAOS Atlas of Orthoses and Assistive Devices|location=Philadelphia|pages=487–500}}</ref> 

Due to these requirements, the development of orthoses has changed significantly in recent years, especially since around 2010. At about the same time, care concepts were developed that deal intensively with the orthotic treatment of the lower extremities in cerebral palsy.<ref>{{Cite journal|vauthors=Muñoz S|date=2018|title=The new generation of AFOs|url=https://www.opedge.com/Articles/ViewArticle/2018-11-01/the-new-generation-of-afos|journal=The O&P EDGE|volume=11|access-date=16 July 2021|archive-date=6 June 2021|archive-url=https://web.archive.org/web/20210606193110/https://www.opedge.com/Articles/ViewArticle/2018-11-01/the-new-generation-of-afos|url-status=dead}}</ref> Modern materials and new functional elements enable the rigidity to be specifically adapted to the requirements that fits to the gait pattern of the CP patient.<ref>{{cite journal | vauthors = Kerkum YL, Harlaar J, Buizer AI, van den Noort JC, Becher JG, Brehm MA | title = An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion | journal = Gait & Posture | volume = 46 | pages = 104–111 | date = May 2016 | pmid = 27131186 | doi = 10.1016/j.gaitpost.2016.03.001 }}</ref> The adjustment of the stiffness has a decisive influence on the gait pattern and on the energy cost of walking.<ref>{{Cite journal|vauthors=Kerkum YL|date=2016|title=The effect of ankle foot orthosis stiffness on trunk movement and walking energy cost in cerebral palsy|url=http://dx.doi.org/10.1016/j.gaitpost.2016.07.070|journal=Gait & Posture|volume=49|pages=2|doi=10.1016/j.gaitpost.2016.07.070|issn=0966-6362}}</ref><ref>{{cite journal | vauthors = Meyns P, Kerkum YL, Brehm MA, Becher JG, Buizer AI, Harlaar J | title = Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking | journal = European Journal of Paediatric Neurology | volume = 26 | pages = 68–74 | date = May 2020 | pmid = 32147412 | doi = 10.1016/j.ejpn.2020.02.009 | s2cid = 212641072 | url = http://resolver.tudelft.nl/uuid:8042e419-4780-4ee8-9a7d-d2868ed15174 }}</ref><ref>{{cite journal | vauthors = Waterval NF, Nollet F, Harlaar J, Brehm MA | title = Modifying ankle foot orthosis stiffness in patients with calf muscle weakness: gait responses on group and individual level | journal = Journal of Neuroengineering and Rehabilitation | volume = 16 | issue = 1 | pages = 120 | date = October 2019 | pmid = 31623670 | pmc = 6798503 | doi = 10.1186/s12984-019-0600-2 | doi-access = free }}</ref> It is of great advantage if the stiffness of the orthosis can be adjusted separately from one another via resistances of the two functional elements in the two directions of movement, [[dorsiflexion]] and [[plantar flexion]].<ref name=":5">{{cite journal | vauthors = Ploeger HE, Waterval NF, Nollet F, Bus SA, Brehm MA | title = Stiffness modification of two ankle-foot orthosis types to optimize gait in individuals with non-spastic calf muscle weakness - a proof-of-concept study | language = German | journal = Journal of Foot and Ankle Research | volume = 12 | pages = 41 | year = 2019 | pmid = 31406508 | pmc = 6686412 | doi = 10.1186/s13047-019-0348-8 | doi-access = free }}</ref>