Managing Cerebral Palsy Induced Spasticity

For nearly two decades, Ultraflex custom orthoses have provided the rehabilitation community with conservative management options for severe neuromuscular and/or orthopedic dysfunction. Recently, the company introduced two new joint mobilization systems for managing cerebral palsy-induced spasticity.

The HOPe1 (Hip Orthosis, Pediatric) is a variation of the traditional A-Frame brace incorporating an Ultraflex joint mounted to solid knee orthoses or knee-ankle-foot orthoses at mid-calf with swivel brackets. It can be used for pediatric patients needing night bracing post-multilevel Botox for spastic cerebral palsy or where abduction of the hip is needed.

The joint unit provides:

  • a 7.5 degree-increment abduction or adduction stop,
  • 7.5 degree-increment don/doff locks,
  • adjustable dynamic tension for abduction assist, and
  • adjustable internal/external rotation position.

hope1 ultraflex systemsThe solid KO or KAFO sections minimize point pressure, and patellar counter force strapping keeps knees in full extension (as cast). Components gently abduct to stable full maximum abduction, and bar length adjusts to achieve maximum abduction and allow for growth.

The HOPe1 is easier to don and provides better compliance than traditional A-frames. Quick release components add to this brace’s flexibility of use.

FirstFlex™ is a conservative treatment protocol combining custom bracing and neuromuscular electrical stimulation for select children with upper-extremity C.P.-induced spastic hemiplegia.

Patients, age 3-20, with mild-to-moderate spasticity in the scapula, shoulder and elbow and moderate-to-severe spasticity in the wrist and fingers who have been treated with FirstFlex have achieved significant gains in posture, strength and control of global arm-hand function without pharmacological injections or surgery.

The FirstFlex custom orthosis provides precise dynamic input to the complete spastic elbow-wrist-hand musculature, including pronator isolation.

The dynamic extension MCP finger pan postures, lengthens and strengthens the intrinsic hand musculature needed for grasp and pinch functions.

Patients treated with FirstFlex demonstrate improved reach, grasp and pinch with carryover improvement in daily activities: hair combing, dressing, and play.

A retrospective study covering seven years and a prospective study conducted over two years revealed marked improvement in appropriate patients. The research points to patient cognition, motivation and parental support as crucial ingredients in the treatment’s success. Research details are available through the Ultraflex internet site,

FirstFlex is not recommended for children with fixed capsular elbow or wrist contractures; extremely poor sensation; or prior wrist fusions, tendon transfers, or selective neurectomies.

To be effective, FirstFlex ™ program requires an extensive daily time commitment on the part of both patient and caregivers. Considerations also include psychosocial family issues as well as the daily logistics of scheduling two 30-minute treatment sessions and of donning the brace at bedtime.

For further information on these and other orthotic options for cerebral palsy management, contact our office today. LeTourneau Prosthetics is a leading provider of prosthetics, orthotics and knee braces to patients in Texas and Louisiana. Your initial consultation is complimentary.