Orthotic care for children is different than that of adults for many reasons. Children sometimes have musculoskeletal issues that adults don’t, or the same issue may be treated differently for a child than for an adult. This is because children are still growing and their response to injury can be different. Children are also different to service because they can’t always communicate concerns, answer questions, wait, or cooperate while being examined. PWOP has experience in all of these areas and is able to successfully address and treat pediatric concerns.
Lower Extremity Bracing
The pediatric Ankle Foot Orthotic (AFO), or a shorter version SMO are often a custom brace fabricated according to the patient's foot and leg dimensions. It consists of a lightweight, flexible plastic shell that wraps around the back of the foot for control of foot positioning and alignment. It also incorporates a plastic shell that extends up the posterior side of the leg, which limits plantarflexion (motion greater than the 90 degree angle of the foot to the shin bone), prevents hyperextension (backward bending of the knee), and allows minimal toe-walking. It has plantar surface contours and other padding for control and a comfortable fit. The orthotic is useful for treating one or many of the following: little ankle control, consistent toe walking, excessive plantarflexion, strong hyperextension of the knee and/or a patient that has developed a walking pattern which needs correction.
- Stabilizes the ankle for weight-bearing.
- Corrects toe-walking.
- Stops excessive plantar flexion (motion where the foot may drop down like pushing the gas pedal)
- Prevents hyperextension (backward bending) of the knee.
- Indicated for patients that have already developed a pathological walking pattern.
- High muscle tone seen in children with Cerebral Palsy.
- Low muscle tone seen in children with Downs Syndrome.
- Other diagnosis that may be causing abnormal gait or improper alignment of the foot and ankle.
If your physician decides to use a scoliosis brace to help manage the curve from further progression, there are many options to fit your individual needs. Simply, there are braces with short durations of wear, typically the night time bending braces or the longer duration of wear, which includes a wearing schedule of 16 to 23 hours a day.
The most common night time braces are the Providence Brace and the Charleston Brace. Both of these braces can be fabricated by a series of measurements that are programmed into a CAD/CAM system that automates the creation of a custom mold of your body. Wearing time is only at night time and they are found to be very effective in managing idiopathic scoliosis due to their "over correction" design. You may hear these brace referred to as night time bending braces because they bend in the opposite direction of the scoliosis curve.
The other scoliosis braces are variations of custom TLSO braces. These braces are worn from 16 to 22 hours and utilize different principles for the same goal of maintaining a curve from further progression and decreasing the degree of the curve while wearing the brace.
Earlier designs included the Milwaukee Brace which was initially used as a post operative brace for scoliosis surgery. The surgeons and its designer also found the Milwaukee Brace effective during periods of managing scoliosis non surgically.
The Boston Scoliosis Brace was developed as an alternative to the "bulky" Milwaukee brace. The Boston Brace is a more "low profile type" of brace that can be worn easier under clothing. The principle behind the Boston Brace is its symmetrical shell pushing on the asymmetrical curves. Today, a Boston Scoliosis Brace can be designed with either their prefabricated brace modules, by taking a custom cast of the body, or by CAD/CAM measurements.
Pattern designed custom TLSO like the the Regnier-Cheneau brace or the Rigo-System-Cheneau-brace (RSC brace) are new interpretations of custom molded TLSO's found in earlier designs. These new principles to scoliosis management stems from research and development from the Europeans. These custom TLSO's will be used for more progressive scoliosis curves and work best when a custom cast is taken of the body for an intimate fit.
The main goal when having to wear a brace for scoliosis is to stop progression and reduce curves and rotation while in the brace. All of the braces above provide that common goal and there is not one design that is right for everyone. Design selection and execution of the proper design is the responsibility of the Orthotist. Determination of the best brace design requires collaboration from the treating physician, radiology reports, physical therapy evaluations (if available) and of course what you would use on a daily bases for bracing options. If you are looking for more information give our staff a call at (703) 368-7967 and your questions will be answered immediately so you can make an informed choice to your bracing options.
Mr. Garney gained experience in pediatric prosthetics while working at Otto Bock Health Care, in Minneapolis, MN, which is a world-renowned manufacturer of both upper and lower prosthetic components. By working as a prosthetic technician, Mr. Garney learned first hand the importance of product knowledge and application of prosthetic devices.