​Hilal (front left) with his prosthetist and orthotist, Ms Liu Chang, (front right) and the Orthotic and Podiatry Service team at the KKH Paediatric Orthotic Centre.

Ten-year-old Hilal Mohamad Nizan is one of the children who are benefiting from one-stop care at the new Paediatric Orthotic Centre at KK Women’s and Children’s Hospital (KKH). Launched in November 2019, the facility provides a full range of orthotic services for infants and children with lower limb and spine conditions requiring assistive devices, and houses a fully-equipped workshop for the fabrication of custom orthoses, run by prosthetists, orthotists and technicians.

Since the centre’s initial operations in November 2018, the team has seen more than 860 patients, and provided more than 2,000 episodes of care.

An orthosis is an externally-applied assistive device, such as a brace or insole, used to support the musculoskeletal system and to improve function and mobility.

To manage his condition of spastic triplegic cerebral palsy, Hilal was fitted with a pair of customised bilateral ankle-foot orthoses in November 2019. These help him to walk with greater stability, and keep his feet and ankles better positioned, to prevent long-term contractures and deformities.

“Every patient presents individually and uniquely; even patients with the same condition. The new Centre enhances our ability to respond quickly to patients’ individual needs with a minimal turnaround time, and work directly with clinicians, surgeons and therapists on fine-tuning the orthotic support that the patient requires to function optimally at each stage of their life,” shares Mr Satyaki Sengupta, Deputy Director, Division of Allied Health Specialties, KKH.

“This consolidation of KKH’s paediatric orthotic services improves care coordination and integration, and enables closer monitoring of patient outcomes – contributing towards optimal clinical results and quality of life for patients.”

Providing paediatric orthotic services for nearly 20 years, the KKH team has seen a steadily increasing need for paediatric orthoses, due to greater awareness and earlier detection of paediatric conditions.

“Great benefits lie in early detection and intervention, including better results, functional improvements, and the prevention of the condition worsening in complex cases,” adds Mr Sengupta. “As Singapore’s first such one-stop paediatric orthotic facility, patients can have their consultation, fitting and adjustments done in one location, minimising their waiting and travelling time.”

“By continually improving the way we provide and coordinate care, we hope to further develop orthotic interventions and services to meet the evolving healthcare needs of children and better support the community.”

Delivering custom orthotic solutions for children

At KKH, orthoses are commonly used as part of multidisciplinary treatment for children with complex neuromuscular or orthopaedic conditions such as cerebral palsy, scoliosis, and flat feet that are severe or cause pain.

Orthoses are custom made for each child to serve a specific function for them, such as providing stability and support when walking, controlling the foot and ankle, or controlling curved spines. Depending on the child’s condition, the orthotic device may only need to be worn for a specific time, such as when the child is walking, or may need to be worn at all times.

Prosthetist and Orthotist, Mr Nigel Wong, sculpts a plaster model for an ankle-foot orthosis in the workshop at the KKH Paediatric Orthotic Centre.	Senior Prosthetist and Orthotist Technicians, Mr Guru Shaktiruben Balakrishnan (left) and Mr Muhammad Nabil Bin Mohd Jamil (right), fit a melted piece of plastic over the plaster cast to customise an ankle-foot orthosis.

In complex cases, the orthotist may need to work closely with the different specialists, including the orthopaedic surgeon, neurologist, neurosurgeon, physio- and occupational therapists, and nurses, to provide customised solutions for the optimal management of the child’s condition (Table 1).

Throughout the child’s growing years, their condition and outcome would need to be closely monitored. Any adjustments can be made to the fabricated orthosis or new orthoses fabricated and fitted, to accommodate the often complex and evolving conditions of a growing child.

Table 1. Customised orthoses fabricated by the KKH Paediatric Orthotic Centre and their functions

​Type of orthotic device ​		​Function
​Hip / Knee / Ankle foot orthoses	​	​Mainly used to manage neuromuscular or orthopaedic conditions such as cerebral palsy, stroke or severe bone deformities. The orthosis controls the position of lower limb segments to influence the child’s gait and to prevent the development of long-term deformities and contractures.
​Rarer, specialised braces		​These may include post-surgical braces, such as a paediatric torticollis collar and a cervico-thoracic immobilisation brace, as well as other complex orthoses such as pectus carinatum braces and more.
​Spinal orthoses		​Mainly used to manage scoliosis in children. For patients with neuromuscular scoliosis, the orthosis supports the patient’s body against gravity and delays the need for surgery. For patients with idiopathic scoliosis, the orthosis reduces the spinal curve in-brace, and prevents or delays the need for surgery.
​Foot orthoses / insoles		​Mainly used to manage painful flat feet in children, the orthosis influences the biomechanics of the foot and ankle, in order to reduce pain and increase function.