SENSORY DYNAMIC LYCRA ORTHOSIS – AN ALTERNATIVE IN THE TREATMENT OF CEREBRAL PALSY

Following the wearing of lycra splints fot 3 months, children with cerebral palsy displayed movements that were faster, more effi cient and required lesssecondary corrections. Th is was evident by the signifi cant improvements in movement time, fl uency of movement. Notably, chidren with dystonia andataxia showed the greatest improvements in movement jerkiness with splinting.

Cerebral palsy (CP) is defined as an assembly of motor and / or postural disorders, which are permanent, but may also have clinical changes over time. These are due to a lesion or to a nonprogressive disturbance that occurred in the developing or immature brain.

The clinical forms, according to the neurological symptoms, are:

• Pyramidal spastic forms

• Dyskinetic forms: cortical and dystonic (extrapyramidal)

• Ataxic forms, often associated with hypotonia.

The rehabilitation treatment for these motor disorders includes kinesitherapy, occupational therapy, botulinum toxin infiltration, orthotic services, surgery.

For the last 13 years, randomized studies on Dynamic Lycra Orthosis lasting 3 months have been published in England, Australia and Germany, with significant changes in the period of time needed to make one movement, the precision of prehension, diminution of dystonia [1].

The studies covered cases with tetraparesis, hemiparesis, dystonia. In cases with spastic hemiparesis, the orthotics of the affected upper limb (UL) managed to diminish hypertonia due to the effects of constant heating, constant circumferential pressure, and of prolonged stretching. This soft orthosis does not affect only spasticity but also posture and the way of motion in the sense of movement fluency, without tremors or dyskinetic components at the moment of prehension and manipulation of objects [2,3].

A un it of motion is defined as an oscillating acceleration pattern followed by a deceleration. An adult with no neurological problems requires a single unit of motion to perform a task, while one with a neurological deficiency needs several units of motion for the same task [4].

In the absence of studies on children, the researchers’ aim was to collect observations on children, namely to see whether the sensory dynamic orthosis will improve the fluency of the UL movement, and secondly if there are improvements of those with dystonic elements.

The purpose of orthotics according to the clinical form:

– External rotation of UL, elbow extension, supination

– External rotation, elbow flexion, pronation

– External rotation, reduction of elbow hyperextension, supination.

Studies have confirmed the reduction of UL hypertonia and implicitly the decrease in the time necessary to execute a task, the disappearance of gesture dysmetria (hesitation) in various proportions [5, 6].

It was also noticed that patients with dystonic or ataxic hypertonia had more evident improvements after 3 months of orthosting compared to spastic patients.

The conclusion of this research was that the dynamic orthosis altered hypertonia, which influenced the efficiency and fluency of the movement and thus increased the functional performance of the little patients. The or thoses are strictly individualized, made of lycra pieces assembled under tension, with a particular direction of the fibers. The properties of the material allow it to resist muscle hypertonia, facilitating the action of the antagonists. In the UL the orthosis produces extension from the radiocarpal joint to the axilla and closes by means of a zipper [5, 6].

The orthosis allows an elbow extension, flexionpronation or extension-supination.

Flexionpronation is indicated for cases with limited functioning due to hypertonia in extension and supination, and the orthosis in extension-supination for those with elbow in flexion and pronation [7,8].

Dynamic orthoses for UL have been worn by children at school for about 6 hours a day, 5 days a week for 3 months during the research. They are much better tolerated, unlike fixed correction orthoses that do not allow movement. Ten years ago, when the therapist from England first introduced us to the dynamic orthoses, they were made for 3 cases of spastic hemiparesis, with obvious results since the first use, with elongation of the elbow and a correction of the forearm pronation, as well as a significant reduction in dorsal kyphosis.

Unfort unately, the high costs prevented the method from being expanded, since the orthosis is not discounted by the National Health Insurance House.

When the therapists from England returned in 2016, they showed us the improvements in the material and orthoses for a child with spastic hemiparesis and for another with axial hypotonia were tailored. For the hemiparesis, a whole thoracic piece was made and another one for the upper limb, resulting in an immediate corrected posture of the kyphotic attitude and an extension and supination of the UL. The kinetic program proceeded much more correctly after this orthotics. For axial hypotonia, a whole thoracic orthosis was tailored, which was also used in cases of spinal autotrophy II. In these cases with important kyphosis, the wearing of a tough classic corset will not ameliorate paravertebral hypotonia, while the sensory dynamic orthosis allows the active mobilization of the muscles.

Hoping that this kind of dynamic orthosis can be discounted by the Health Insurance House, we consider it to be a step forward in the process of active rehabilitation of the child.