February 2018

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Editor Message


Reflections on self-image

The first article I wrote for any LER publication examined the negative impact a therapeutic device can have on self-image, and how this can create a major barrier to patient satisfaction and adherence. (See “Sensitivity to self-image boosts O&P outcomes,” LER, April 2011.)

The article, which focused on adults, looked at findings of research and practitioners’ anecdotal experience that revealed how patients’ feelings about their device—more accurately, their feelings about themselves when they wear a visible orthosis or prosthesis—govern how likely they are to use the device as prescribed.

In children, who are still developing self-identity, viewing themselves, or being viewed by others, as “different” likely has even more of an unhelpful impact on self-image—and on adherence—than it does in adults. Why? One reason is the relative scarcity of media characters and toys with which kids who have a visible lower extremity condition can identify.

In “Media, toys, and games for kids with disabilities,” on page 15, writer Jill Dorson details one child’s campaign to see more kids like her reflected in toys, on bookshelves, and in other media, as well as three orthotic technicians’ contribution to the lack of such depictions: a storybook called “Beau and His New AFO.”

Their book is a great resource. More like it are needed, but if you don’t have time to write and illustrate one, there are still ways to help.

Children are likely to feel better about a device when they have a voice in how it looks, according to a survey of pediatric patients at Shriners Hospital for Children—Tampa in Florida. Results showed that children who had an orthosis with patterns and colors they’d selected had a more positive self-image, better peer acceptance, and, consequently, improved adherence, compared with peers who wore white braces.

In the digital age, orthotic and prosthetic personalization can be done quickly. The psychological payoff for kids—feeling better about themselves and their device—can be long-lasting.

By Emily Delzell, Senior Editor


Pitchers don’t get enough time for lower extremity strength recovery: Single-sport players need more rest days    

Current Little League pitching guidelines provide insufficient lower extremity strength recovery time in youth pitchers, even when they are pitching at submaximal pitch counts, according to research from California published in January.

By Katie Bell

Autism linked to between-limb asymmetries across the gait cycle: Gait pattern ID could help target therapy    

Recent findings from the University of Nevada, Las Vegas (UNLV), add to a growing body of evidence that autism spectrum disorder (ASD) is associated with significant gait asymmetry, suggesting movement quality should be part of the diagnostic and treatment processes for ASD.

By Keith Loria

Measures of ankle weakness reveal varied CMT gait patterns: Gait profile should guide orthotic design

Gait-pattern classification derived from functional measures of ankle weakness can be used to assess progression of Charcot-Marie-Tooth (CMT) disease and to guide clinical decision-making about treatment strategies, such as orthotic design and…

By Keith Loria


Update: Orthotic care and physical therapy for DMD

Lower extremity interventions can help boys with Duchenne muscular dystrophy (DMD) stay ambulatory for years—and improve outcomes in the condition’s nonambulatory phase.  Devices can address con­tractures and other issues, while stretching programs are key to maintaining flexibility.

By Hank Black

Media, toys, and games for kids with disabilities

Children use toys and media characters to spark their imaginations and cast themselves as the star of their own stories. Through play, they connect with other kids and dream about their future. Options are few, however, for kids who wear a device or otherwise look “different” to see themselves reflected during play.

By Jill R. Dorson