05 March 2018
March marks the start of Cerebral Palsy Awareness Month and to spread awareness we are having a look at how Ankle Foot Orthoses can help patients with Cerebral Palsy or brain injury learn to walk again.
Most people think of shoe inserts when they hear the term ‘orthotics’, but they often underestimate their potential for making a life-changing difference for people with reduced or limited ability to walk. The human foot is a complicated biomechanical structure; each one contains 26 bones.
Cerebral palsy is a neurological disorder caused by brain injury either before, during or after birth. It can mean that a person diagnosed with cerebral palsy struggles with controlling their muscle movements as they grow. In the UK, cerebral palsy affects one in every 400 children and symptoms vary from person to person. Terms like monoplegia, hemiplegia, diplegia and quadriplegia refer to the part of the body that is specifically affected; one limb, half the body, two limbs and all four respectively.
An Ankle Foot Orthosis (AFO) can either be fixed in one position, allow a slight degree of movement or allow a full range of movement in one plane while controlling movement in all other planes. AFOs should first and foremost protect bones and joints from the abnormal gait patterns and loading that CP can create. In doing so, they should also try to produce a normal gait pattern by controlling the forces and mimicking their interaction with the body in that of normal gait.
The use of correctly prescribed AFOs in Cerebral Palsy can have wide-reaching positive effects such as:
Unfortunately, the inverse is also true – incorrectly prescribed orthoses or poorly made orthoses can have a negative effect on a child’s development and future.
LOC feel it is hard to get it right. The process involved in delivering a gold standard service requires an extensive combination of time, knowledge and facilities. They have worked very hard to put all of those in place in their Kingston clinic. As a result, they now boast one of the most advanced and patient-centred clinics in the UK.
Working with LOC and Elaine has been a great experience – they really take the time to look at your child and understand their individual challenges and needs. For parents who are in the same position that we were, I would say do your research – see what clinics are available near you and what the costs are, but my feeling is it’s worth every penny.
After 10 years of daily physiotherapy and swimming, not to mention SDR, hamstring and tendon lengthening, we have finally achieved independent walking – it was a mother’s day gift that would take some beating.
LOC’s video vector technology measures exactly where Austin’s weight is being distributed, how his hips are moving and how his legs are moving. It’s those insights that have made his new AFOs so effective. Even within a few days, LOC’s splints have had more impact on his independence of movement than anything else we have done.
Since his new orthoses, his change has been remarkable. He is more mobile and can walk independently. Jason is now walking indoors and outdoors and is unrestricted. He is now properly enjoying the summer sunshine for the first time in a few years with no complaints of pain.
It has been a breath of fresh air – LOC’s ability to accommodate Sophie’s circumstances and manufacture her orthotics so quickly has taken a huge amount of potential stress away. Alan talks to Sophie as well - she looks forward to seeing him. He has even been able to fulfil her request to have her SMOs decorated with unicorns! It makes her feel special and much happier about wearing them.
I can now go a mile without having to stop, so it is a lot better and I’m walking in a regular pattern now. The orthotic fits perfectly because LOC took proper mouldings and photographs; they were very thorough.
Amelia was always looking for something to hold on to, now she runs around. Sam really puts in that extra effort to make the clients happy. I’d recommend LOC because they have all the equipment and extremely professional staff who have been trained by world-renowned physiotherapist Elaine Owen.
Lilac just flits about now. Every day she's getting stronger and our expectation now. We are absolutely with The London Orthotics Consultancy for the long haul now. We’ve found a business that can provide what we need and who we trust, and it’s the trust that's the most important thing to us.
Multidisciplinary teams in business will sit down together and discuss a project with all parties concerned, each adding their particular expertise and insight. This is what it is like at London Orthotic Consultancy (LOC) but on a more personal level: Teamwork is evident. The camaraderie and mutual respect are undeniable. The attention to the smallest achievement is uplifting.
My left knee hyperextends and Sam felt he could improve that condition with a different design of brace and also improve my gait with some other adjustments. The brace was such a success that I used it solely after receiving it. I am most thankful to Sam and his colleagues for their dedication to my case and their prompt assistance, which changed a potential disaster into a great tourist visit.
The orthotics help support my foot. Not only that, they have endured daily use, training for the Marathon des Sables, the race itself and they are still going! I am amazed that they survived the MDS and they are still being used today.
Some young children who are diagnosed with cerebral palsy will undergo Selective Dorsal Rhizotomy (SDR) surgery in order to reduce the spasticity and movement of their muscles. After this surgery, orthoses can play a crucial part in the rehabilitation process. Although their movement will have improved as a result of the operation, the AFOs will help them learn to use their new movement correctly and safely with support.
Here at LOC, we have seen numerous children through their rehab process post-SDR. We have a case study of a seven-year-old cerebral palsy patient who underwent SDR surgery at Great Ormond Street Hospital aged 5 Years. LOC has been involved in her rehabilitation from the age of 18 months. Over that time we have made a mixture of AFOs and Hinged SMOs. They have all been prescribed using our Gait Lab facility and using a careful algorithm based on the OSKAR (Optimal Segmental Kinematic Alignment approach to Rehabilitation) principles. Her walking is always carefully monitored to ensure both kinetics and kinematics are optimal. As she is still growing, LOC will continuously review her orthoses and will refit them when required.
Clinician Sam Walmsley has been overseeing her treatment since the first appointment and has seen her incredible progress. He explained: “I first saw her when she was one and I’ve made her AFO’s since that point. She has worked with Elaine Owen in the Gait Lab and we have helped align and optimise the function of the AFOs.
“After her SDR surgery at Great Ormond Street we managed to get her out of one of her fixed AFOs and into a hinged pair – allowing some movement. So, we’ve managed to reduce the prescription for part of her day, enabling her to do more of the things she wants to do at school like climbing up climbing frames.”
LOC has also recently treated a 19-year-old girl with acquired brain injury – causing mobility issues in some of her muscles. She was fitted with an AFO in LOC’s Gait Lab in December 2017 and is now walking beautifully with good hip and knee extension – showing just how bespoke orthoses can make a difference.
Sam adds “She is now having treatment on her right hand as she was not getting enough wrist extension. We’ve suggested a lycra gauntlet with a wrist extension panel to see if that makes a difference.”
The Lycra gauntlet can help improve proprioception on an affected limb. In this case, we wanted to improve her wrist extension. We didn’t want anything too bulky and used Lycra to make her more aware of her Arm and wrist and therefore able to use it better.
LOC has developed a reputation in the SDR community for its treatment and management of patients who have undergone this life-changing surgery. Our clinicians are also highly experienced in orthotic treatment to improve gait post- brain injury.
If you think you, or someone you know, could benefit from an Ankle Foot Orthosis, please get in touch via the contact form at the top of the page, or give us a call on 0208 9749 989.
We have the following facilities and amenities at our Kingston Upon Thames location:
We also have the Gait Laboratory for orthotics patients and Onsite Manufacturing for speedy turnarounds and adjustments whilst you wait.
We have the following facilities and amenities at our Cambridge location:
For more information about The Beechwood Complementary Medical Practice, please visit The Beechwood Practice.
We have the following facilities and amenities at our Bristol location:
For more information, visit Litfield House Medical Centre.
We have the following facilities and amenities at our Romford location:
For more information about The Colin Dove Practice, please visti The Colin Dove Practice
LOC’s clinic is based in the University of Salford’s Podiatry Department and provides treatments for orthotics, scoliosis, pectus deformities, positional plagiocephaly and club foot.
It is also the base for LOC’s northern OSKAR clinic which is run by Sam Walmsley, clinical director of LOC, in conjunction with Elaine Owen MBE MSc SRP MCSP.
Due to COVID-19, we have had to temporarily close the Salford clinic and are operating out of another clinic in Bolton.
508 Blackburn Rd,
For more information, please visit The Good Health Centre
Clothing worn is dependent on which clinic you are attending. You will be sent a letter detailing what clothing to wear along with all other details prior to any appointment at the clinic.