Is there any evidence that splints/AFOs actually help?

[FlynnRider]

Ds has diaplegic CP and has been wearing fixed AFOs for a year. In that time his ankle flexion has got worse despite intensive stretching twice a day. He also walks on his toes worse with his splints on than with them off. He probably achieves a heel strike 50-70% of the time without splints and maybe 25-50% with them on. I think he uses the splints as support to go faster eg to run on his toes.

His physio is keen for him to continue to wear the splints, mainly to keep stretching him throughout the day. However, I recently went to a gait analysis session and the guy there said that there is no evidence that AFOs actually help and in some cases make things worse eg reduce muscle strength. He suggested taking the splints off for 3 months to see what happens. I will discuss this with ds's physio but I kind of think we need to make our own decision on this as we get so many conflicting opinions from all the specialists we see, and we only see the physio for an hour every 2-3 months anyway.

I was wondering if anyone else has had this experience I.e. Splints making things worse or at least not helping. Or if anyone is aware of any evidence that they actually help? The gait analysis guy ( who I think is an orthopaedic consultant) felt that physios just use them as a kind of catch-all without exploring the evidence for/against them.

I did read some research or an article from some therapist who says they don't work well with some children and some I've seen who get horribly tight despite the AFOs. also children with SD who get dislocations despite all the stretching etc. Botox is a very good option. We have chucked the splints as DD could barely stand in them let alone walk. We rely on piedro shoes with heel cups for a better stand, but still tip toeing! I think they are better at providing hypermobile children with stability.

Thanks for this. Our physio is pro-splints and anti-Botox, and last year's gait analysis also said that Botox would not be recommended as a lot of his problems are due to muscle weakness/instability. So I feel like we are left with absolutely no options.

At the moment, wearing very light flexible shoes gives him the best walk eg like gym plimsoles, so I'm not sure how he would be in piedro boots, which he used to have before splints.

What do you mean by dislocations? How could splints cause/contribute to this?

I am just really confused. Desperate to do whatever is best for him in the long run but everyone says something different and I don't have complete faith in any of his therapists/doctors.

I hate feeling that I have to make an uneducated decision based on my gut instinct as none of the experts can give me a confident answer.

Flynn Have you tried support groups specifically for diaplegic CP?

Just a thought but there might be people around with more specific knowledge.

Also sometimes if you google the research you are looking for you can find it online. I have even emailed authors of research to ask for help and they nearly always want to share their vast knowledge

Good luck

Our son has hemiplegic cp. Only his right side is affected. He is nine and was diagnosed as a baby. He has a fixed splint as he toe walks etc, his left leg is also longer. He does specific stretching exercises every day but ONLY wears his splint at night and at home when watching tv etc. I have spoken with physio a lot about it as I agree (but I am not a qualified expert) that constant wearing of it would hinder his muscle development and also in our sons case, restrict what he can do and therefore have a baring on his general happiness and quality of life. DS is very active. He has also had serial casting, which whilst I think it did stretch his tendons etc, when it came off he was very unsteady due to the muscles weakening and having become reliant on the extra support. Therefore we have been reluctant to repeat. As with everything, no two cases are the same so I would say go with your instincts and see what a little break from the splint does.

I can't answer in full now as have people over but there are differing opinions. I've looked into it in quite a lot of detail. DS has spastic dip legit CP.

Will come back later on today

for ds2 it definitely helped maintain a good stretch & position.
He has spastic diplega.
He has had a break from splints to allow his muscles to strengthen 7 work for themselves but has had night splints throughout.
Stretching while in the bath every morning has been really helpful before putting the splints on.
I guess what works for some doesn't wok for others, if its not woking something needs to change.

Thanks everyone. Stupid question but how would I go about finding a support group for diaplegic CP? Couldn't find anything on google.

I had not thought about night splints. I wonder if that would be a good compromise, so he can develop his muscle strength during the day. I will ask his physio.

I will also do some more internet research.

It's very hard to go against the safety net of splints. I don't want to cause him long term damage by doing the wrong thing.

hairymaclary would love to hear what you have found out.

I get a lot of support from hemichat. I appreciate it's aimed at hemiplegic cp but might be worth asking if they know of any similar groups. Certainly they would help with the splint questions, development, education etc etc. worth a go?