15 September 2022
Mariam was born 3 months prematurely with cerebral palsy. As a child, she was able to stand on her own but after several operations in Bolivia, her country of birth, and Mexico, where she had the SDR procedure, Mariam lost the ability to stand by herself for any length of time. She had lost confidence as she was losing her balance all the time and needed to look for support when standing alone. This year Mariam was visiting her Aunty Coral in Basingstoke for the first time and Coral had decided to see if she could find a way to help her niece regain her balance and improve her posture and walking.
Coral began researching on the internet; the breakthrough came when she also talked to the head teacher at a special needs school who highly recommended the London Orthotic Consultancy because she had referred pupils with cerebral palsy to LOC previously and had been very impressed with the physical improvements that she had seen in those children. This endorsement backed up what Coral had found in her internet research and Mariam was booked in for an assessment at LOC.
Mariam was seen by Jack Choong, one of LOC’s senior orthotists, on 4 May. At her assessment Jack found that Mariam was affected in both legs and could not stand for more than ten seconds before losing balance and feeling unsafe; she was continuously reaching out for a surface to hold onto. Mariam was assessed in LOC’s Gait Laboratory which provides our orthotists with objective data relating to each patient’s gait and is used to optimise the bespoke orthotics we prescribe, manufacture and fine-tune for treating lower limb conditions. Jack prescribed rigid AFOs but with a flexible footplate and 10-degree pitched shoes. LOC spends a lot of time working out the best footwear for CP patients as getting the footwear wrong can negate any benefit the orthosis may be providing.
An AFO is an Ankle Foot Orthosis which as the name would suggest encompasses the ankle and foot. The objective is to control the position and movement of the ankle. AFOs are used to support weak limbs; they can also be used to immobilise the ankle and lower leg to correct foot drop. When set up correctly they can also have a great influence on the knee and hip joints. They are the most commonly used Orthoses.
A patient’s comfort in their AFO is vital for compliance with the prescribed wearing regime.
So there are a number of steps the orthotist should take to ensure a comfortable fit: the patient’s heel should fit fully into the heel cup without excess space, the contours of the plantar surface of the AFO should match the patient’s foot, for children there needs to be up to half an inch growth room in the toe shelf length. At LOC we use our Gait Laboratories at our Kingston and Manchester clinics to fine-tune our bespoke orthotics.
The most flexible type of AFO is a Dynamic Ankle Foot Orthosis (DAFO). It is thin and provides flexible support to the foot and ankle.
The simple answer is: yes they can. However one has to be sensible and look for wide-fitting trousers/jeans preferably of light and thin material.
Mariam has now had her final review with Jack prior to returning home. Coral says:
“The change in Mariam is incredible, immediately her AFOs were fitted she was able to stand without assistance for 5 minutes or more and now she feels so much more confident. She looks in the mirror and smiles, she feels taller (because she is standing straighter). She says her feet are far more flexible which helps with her walking and of course, she is far more active than she has ever been. Now the only problem is she will miss Jack’s help and guidance. From being monosyllabic at her first assessment now it is questions, questions at each review!!”
Jack has provided Mariam with detailed guidance about her AFOs, and hints and tips for improving her gait herself. Reviews will be conducted remotely until Mariam returns to visit Coral next year.
If your child has cerebral palsy like Mariam or another neurological condition that affects their lower limbs, properly designed bespoke orthotics can make all the difference. Please take a look at our AFOs and our bespoke orthotics to get a broader understanding of what LOC offers, or contact LOC directly.
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.