bracing

bracing (Full Version)

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PT in japan -> bracing (December 12, 2001 7:51:00 PM)
i am writing for info./advice. a client, 3.5-years-old with CP and cortical blindness. strength is fair, trunk and bilat. upper extremities. bilat hip and knee str. are also fair. she consistently demonstrates little desire to explore; indep. prone-pivoting, rolling, and ring-sitting. she maintains quadraped indep., and stands with the assistance of a fixed object 1-2 minutes with bilat. 20 deg. knee flexion. prone stander, completely upright is tolerated for 30 minutes. no observation of commando crawling nor weight shift. family reports child sits contently @ a low chair or prone/supine @ home throughout the day......little or no attempts to explore or self-care. feeding and dressing requires hand-over-hand assistance. i am writing from an overseas military installation where resources are quite limited. my question, are there specific criteria to brace??? kafo??? afo??? thank-you for any/all responses.

Andrew M. Ball MS MBA PT -> Re: bracing (December 13, 2001 2:22:00 AM)
Tough question to answer without seeing the child, but I'll give a few ideas and contrast with the approches of a few other leaders in the field: In general, I don't like to brace with an AFO until the child is able to pull to stand, and spends most of his or her day in that position. This is because if the child tends to spend the day in quadruped crawling around the floor, the effect of the AFO is to strectch out the collateral ligaments of the knee as the calcaneous seeks the floor. In cases of high tone, however, I've found pediatric physical therapists at Duke (Lara Case and Dawn Phillips in particular - both nationally recognized for their pediatric orthotic skills) to day brace despite functional status of the child. If bracing is to be done for heel cord length maintanance in a child unable to cruise at furniture, I suggest night wear only --- and a more comfortable plastic be used in AFO fabrication. I suppose they have thier reasons for fabricating AFO's for kids who can't yet pull to stand, but I can't think of one other than that not all pediatric therapists in this area know how to cast for pediatric orthotics. I've get to be able to understand or agree. I will say that their approach seems to be a more common approach among pediatric PT's. As far as your kid is concerned, you'll first need to figure out why she's crouched. Give her a little posterior pressure at the patellar tendon and see what happens. Does she resist getting upright? Try to get a sense of if this finding may be a compensation of fear --- lowing center of mass makes one more stable. A little bit of encouragement with a Cascade DAFE 3.5 (www.dafo.com) with maximum flexiblity might do the trick . . . but should ONLY BE USED WHEN SHE'S IN STANDING! Tone may also play a role. Is she crouched but also up on her toes??? (That would be unlikely, but possible). If so, other orthotic options may be more appropriate. Drew [This message has been edited by Andrew M. Ball MS MBA PT (edited December 13, 2001).]

Andrew M. Ball MS MBA PT -> Re: bracing (December 13, 2001 2:22:00 AM)
Tough question to answer without seeing the child, but I'll give a few ideas and contrast with the approches of a few other leaders in the field: In general, I don't like to brace with an AFO until the child is able to pull to stand, and spends most of his or her day in that position. This is because if the child tends to spend the day in quadruped crawling around the floor, the effect of the AFO is to strectch out the collateral ligaments of the knee as the calcaneous seeks the floor. In cases of high tone, however, I've found pediatric physical therapists at Duke (Lara Case and Dawn Phillips in particular - both nationally recognized for their pediatric orthotic skills) to day brace despite functional status of the child. If bracing is to be done for heel cord length maintanance in a child unable to cruise at furniture, I suggest night wear only --- and a more comfortable plastic be used in AFO fabrication. I suppose they have thier reasons for fabricating AFO's for kids who can't yet pull to stand, but I can't think of one other than that not all pediatric therapists in this area know how to cast for pediatric orthotics. I've get to be able to understand or agree. I will say that their approach seems to be a more common approach among pediatric PT's. As far as your kid is concerned, you'll first need to figure out why she's crouched. Give her a little posterior pressure at the patellar tendon and see what happens. Does she resist getting upright? Try to get a sense of if this finding may be a compensation of fear --- lowing center of mass makes one more stable. A little bit of encouragement with a Cascade DAFE 3.5 (www.dafo.com) with maximum flexiblity might do the trick . . . but should ONLY BE USED WHEN SHE'S IN STANDING! Tone may also play a role. Is she crouched but also up on her toes??? (That would be unlikely, but possible). If so, other orthotic options may be more appropriate. Drew [This message has been edited by Andrew M. Ball MS MBA PT (edited December 13, 2001).]

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