L. van der Stam1, A. Kaindl2, K. Drossel1, C. Schmidt-Lücke3
1Charité Universityclinic, Social Peadiatric Centre of Neuropeadiatrics, Berlin, Germany, 2Charité, Clinic for Neuropeadiatrics, Berlin, Germany, 3MEDIACC, Berlin, Germany
Background: Contractures are one of the main complications of spastic movement disorders in children, leading to a limited passive range of motion (PROM). This functional impairment can be associated with discomfort and pain, difficulties in handling and care of affected individuals, and restricted participation in daily life activities. Stretching plays an important role in treatment of the affected joints. Controlled dynamic stretching (CDS) orthotic joints represent promising new devices to enhance existing therapy, but there are no data on this therapeutic option in children and adolescents.
Purpose: To analyze whether CDS orthotics reduce or prevent contractures of various joints in children and adolescents with the primary endpoint of clinically relevant improvement of passive range of motion (PROM).
Methods: In this single-center, observational, intraindividually-controlled study, children and adolescents were recruited in 2018-2019 at the Charité Center for Chronically Sick Children. Patients received CDS orthotics in addition to their regular multidisciplinary treatment. CDS orthotics were used for knee flexion (KF) and extension (KE), ankle dorsal extension (A), elbow extension (E) and wrist dorsal extension (WR). PROM and clinically relevant changes were assessed with neutral/zero-method and goal attainment scale (GAS) at baseline, primary endpoint 12 weeks (FU2), and secondary endpoint 12 months (FU4). Undesired events were monitored continuously.
Results: We treated 39 affected joints with CDS orthotics (13 KE, 10 W, 7 EE, 5 DE, 4 KF) in a total of 18 children (9 male, median age 9 years (range 5-15), main diagnosis cerebral palsy with concomitant complications. In addition to contractures, most patients had an increased muscular tone. At FU2 we detected a trend towards PROM improvement with 10°, SD 8,5° range [0°-30°], which stayed stable till FU4 with 10°, SD 11° range [-8°-70°]. Changes of absolute PROM in degrees were highly significant (p<0.0001) improved at both times of measurements, most successfully the KF orthotics.
The CDS orthotics were globally well tolerated; parents and therapists noted alleviation in care, positioning, transfers and increased activity in therapy. Pre-specified long-term goals were evaluated according to the Goal Attainment Scale (GAS) and improved with 64% at FU2, mostly on body function level of ICF. At FU4, this became 80%, at this measurements, most improvements were found at the level of activity and participation of ICF.
The CDS orthotics were globally well tolerated; parents and therapists noted alleviation in care, positioning, transfers and increased activity in therapy. Pre-specified long-term goals were evaluated according to the Goal Attainment Scale (GAS) and improved with 64% at FU2, mostly on body function level of ICF. At FU4, this became 80%, at this measurements, most improvements were found at the level of activity and participation of ICF.
Conclusion(s): This is the first study showing improvements in PROM attributed to CDS orthotics in the majority of joints after a short treatment period with consecutive clinical improvements of individually set goals in children and adolescents with chronic neurological conditions. Due to this observational study we have established to set guidelines for usage of the CDS orthotics for children and adolescents.
Implications: Contractures due to neurological or orthopedic complications
Funding, acknowledgements: Our study was supported by the Albrecht GmbH, the German Research Foundation (DFG, SFB1315, FOR3004) and Charité – University Medicine Berlin
Keywords: contractures, dynamic stretching, dynamic orthotics
Topic: Paediatrics: cerebral palsy
Did this work require ethics approval? Yes
Institution: Ethikkommission der Ärztekammer Berlin
Committee: Ärztekammer Berlin
Ethics number: eth-31/17-1
All authors, affiliations and abstracts have been published as submitted.
