Dynamic Orthoses

Discussion

1.  In your opinion, is there enough evidence in this article for you to support the use of Dynamic Movement Orthoses (DMOs)?  Are there any questions you would like answered through research to increase your support for the use of DMOs?

• The therapists present felt that the study was weak (it was exploratory) and that some of the conclusions reached were a bit of a leap. 

2.  Have you had a client use a DMO or other fabric orthosis on any body part? What were some of the advantages or disadvantages or the orthosis?  What was the goal of the orthosis and did the child achieve the goal?

• Unfortunately, no therapists present at the meeting had had any experience with children wearing a dynamic orthosis.   One therapist had observed a child using Theratogs.  It was speculated that a therapist could try a theratog on a child to see if a DMO would be effective (which would need to be custom ordered).

3.  What other types of bracing (for any body part) are you seeing with your clients?  What is working, and what isn't?

• Therapists are seeing a lot of AFOs, DAFOs (dynamic AFO).  Therapists expressed that it is a challenge to know if the brace is doing what it is supposed to do, and if it is fitting well.

4.  What types of questions are you fielding from parents, caregivers and/or teachers in regards to bracing in general? What kinds of resources would be useful to you to help you address bracing concerns and questions?  What resources have you found that are useful to you?

• Therapists report that parents are asking the following questions:
  • Does my child need to wear their AFOs at home? (sometimes there seems to be an inconsistency of message between the physician and the orthotist about how long/often to wear the braces at home/school/community
  • What kind of socks should my child wear?
  • Should the brace be removed if the child is showing signs of discomfort?
  • How to don the AFO properly?
  • How do I know if the brace is fitting properly?
• Therapists reported that it would be useful to have some guidelines for AFO use-
  
  • how to tell if brace is fitting,
  • how long to wear,
  • when to contact the family/orthotist/physician,
  • general bracing principles and types of AFOs so it is easier to identify them and what the goals of different types of bracing are.

5.  The Professional Practice Team at the GRH is planning to develop some resources for clinicians about AFOs- general bracing principles, a "cheat sheet" differentiating various types of AFOs and nomenclature, a troubleshooting guide, and a decision tree (or several) for problem solving frequent bracing concerns.  If you have any AFO questions you would like to see addressed, please contact one of the members of the PPT so we can be sure to include this in the project.