Managing children born with cerebral palsy is a challenging business as clinicians strive to address a variety of issues, such as dystonia, hip migration, scissoring gait that interferes with ambulation, and hip adduction that limits independent sitting. The SWASH (Standing, Walking And Sitting Hip) orthosis tackles these difficult aspects of ambulating C.P. kids.
Though its primary application has been to benefit C.P. patients, this system is intended for use by any child whose adduction and/or internal rotation at the hip joint interferes with function or induces lateral migration of the femoral head. The SWASH brace has been proven effective for spastic diplegic and spastic quadriplegic children, even those with spina bifida.
The orthosis ensures variable abduction during both extension and flexion and therefore can support an active child in all postures encountered during an active day: standing, sitting, walking, crawling, even toileting. It can also be of value at night to retain hips in an abducted position or maintain stretch on tight hip adductors.
Though outwardly simple in appearance, the SWASH orthosis is capable of advanced biomechanical functions. It uses basic geometry to provide wide hip abduction when the wearer is sitting but narrower abduction when erect.
During ambulation, the brace maintains the legs virtually parallel, thus preventing scissor gait. By neutralizing destabilizing forces at the hips, this device also may improve overall trunk control and thereby facilitate upper limb function.
The orthosis also reportedly encourages some children to learn how to overcome pathological patterns of movement on their own.
How The Orthosis Works
When properly fitted, the SWASH stabilizes the hip and opposes excessive adduction and internal rotation. As the hip moves into flexion, the joint mechanism is guided into abduction, reducing scissoring gait while walking and improving balance while standing. When the child sits, the orthosis provides continuous abduction, resulting in a wider base and potentially a balanced posture without having to use hands for support. The wearer may then be able to concentrate better on other activities.
SWASH components include a padded waistband, connected in front by a pressure pad. Two joint assemblies attached on the posterior quarters are connected by shaped leg bars to adjustable thigh bands, which guide the legs in the desired position. The leg bars are free to rotate within the respective joint assemblies.
Contraindications to SWASH use include hip dislocation (total loss of contact between the femoral head and acetabulum), a hip flexion contracture of greater than 20 degrees, dynamic or fixed, and excessive external tibial torsion or foot progression.
The SWASH orthosis can be adapted for child growth – four sizes are available, from one for infants (to prevent hip subluxation) through two medium and one large size. The orthosis is easy to apply and remove and can be worn over or under clothing as desired.
Please call LeTourneau & Family Orthotics and Prosthetics today to learn more. We offer many of the newest orthotic applications for cerebral palsy patients. Our offices are conveniently located throughout southeast Texas in Beaumont, Nederland and Jasper. We look forward to seeing you!