gms | German Medical Science

20. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

06. - 08.10.2021, digital

Controlled dynamic stretching orthotics for joint contracture treatment in children and adolescents

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  • Lieske van der Stam - Charité Universitätsmedizin, SPZ Abt. Neuropädiatrie, Berlin, Deutschland
  • Angela Kaindl - Charité Universitätsmedizin, SPZ Abt. Neuropädiatrie, Berlin, Deutschland

20. Deutscher Kongress für Versorgungsforschung (DKVF). sine loco [digital], 06.-08.10.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. Doc21dkvf449

doi: 10.3205/21dkvf449, urn:nbn:de:0183-21dkvf4494

Published: September 27, 2021

© 2021 van der Stam et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background and status of (inter)national research: Contractures, limitations in the passive range of motion (PROM), are a common complication in neurological conditions. 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. Contractures are better to prevent than to treat, because no standard treatment algorithm exists but rather needs to be individually tailored. Passive manual stretching can prevent and improve contractures. Stretching is most effective using orthotics. Therefore, most children with spastic movement disorders depend on their orthotic aids to prevent orthopedic complications. Although controlled dynamic stretching (CDS) orthotics are promising new devices in contracture treatment, there is no data available regarding their efficacy in children and adolescents.

Question and objective: Analyze whether CDS orthotics reduce or stabilize joint contractures in children and adolescents with the primary endpoint of clinically relevant changes of PROM.

Method or hypothesis: We provided patients with contractures or the risk in developing contractures with CDS orthotics in addition to their regular multidisciplinary treatment in a single-center, observational, intra-individually controlled study. As primary endpoint PROM at 12 weeks (FU1) and 12 months (FU2) was assessed with the neutral/zero method, goal attainment scale (GAS) and subjective experienced were assessed at FU1 and FU2 as secondary endpoint.

Results: We treated 39 affected joints, divided in five subgroups, with CDS orthotics in 18 children (mean age 7.5 years, range 5–15). The median PROM for all joints improved from -15° to -1.5° at FU1 (p<0.001) and further towards 0° at FU2 (p<0.001). The CDS orthotics were globally well tolerated. Parents and therapists noted alleviation in care, positioning, transfers and increased activity in therapy. GAS goals have shown improvement for 80% of the pre-defined goals at FU2.

Discussion: 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.

Practical implications: Spasticity is an important variable in treating contractures and it has been shown that spasticity can be reduced by stretching. Untreated contractures caused by spasticity can lead to secondary orthopedic complications and pain and stretching treatment at an early age will influence growth and bone alignment, and enabling better gait parameter for children with cerebral palsy. The high GMFCS level V more than half our participants deal with, is correlated with multiple contractures and a higher need of external aid devices, such as an stretching orthotic.

Appeal for practice (science and/or care) in one sentence: Enable more treatment options to provide best individual tailored helping aids to support patient’s participation in life.