Assistive Technology, Orthotics, Prosthetics, and Mobility
Seating and mobility
Match the wheelchair to posture and function: tilt-in-space manages pressure and tone, recline aids tolerance and catheterization, and power mobility supports exploration and cognition. Do not wait for independent sitting before trialing power mobility - children as young as 18 months to 3 years can learn cause and effect driving with training and a safe environment. Pressure mapping and a properly fitted cushion prevent ischial and sacral breakdown. Standers support bone density and hip alignment, and gait trainers provide repetitive stepping practice.
Orthoses
A solid ankle-foot orthosis controls equinus and stance; a hinged orthosis preserves dorsiflexion for children with adequate control; a floor-reaction orthosis resists crouch by creating an extension moment at the knee. Knee-ankle-foot orthoses address quadriceps weakness, and hip-knee-ankle-foot or reciprocating gait orthoses are used for higher-level paraplegia. Spinal orthoses may slow but do not reliably prevent progression in neuromuscular scoliosis. Monitor skin, check fit at each growth spurt, and reassess function rather than just alignment.
Prosthetics
Congenital limb deficiency presents as transverse or longitudinal deficiency; terminal overgrowth in the residual limb may require surgical revision. Socket volume changes rapidly with growth, so frequent refitting is expected. Body-powered prostheses are durable and provide proprioceptive feedback; myoelectric devices offer better cosmesis and grip but require training, maintenance, and funding. Rotationplasty converts the ankle into a knee for selected bone tumors.
Worked rule of thumb
Every orthotic or prosthetic prescription needs a functional goal written down - if the device does not change what the child can do, reconsider it.