November 2016

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Editor Message

emily-delzell-196x198Making it personal

Personalized medicine, holistic care, and patient-centered management can all imply slightly different things, but beneath the differences one central tenet is the same—the importance of tailoring treatment to individual patients’ unique conditions, needs, and goals.

In this issue several articles discuss some of the varied ways in which lower extremity practitioners are taking an individualized approach to orthotic management of young patients, who are undergoing rapid physical changes, developing interests, and facing other childhood challenges.

Karl Barner, CPO, LPO, for example, notes in “Therapeutic play plus O&P care is a win-win for kids” (page 11), that attending some of his patient’s sports events and watching them in those environments helps him better understand their reality—and perhaps adapt their braces or orthoses for a better fit.

In “Path of least resistance: sequencing orthotic care” (page 17), experts note that how restrictive a device needs to be can depend on factors other than a child’s specific diagnosis, such as how much follow-up or physical therapy their personal situation will allow. If compliance or follow-up is likely to be limited, for example, keeping that child safe might mean heavier bracing makes more sense.

And, in “AFO effects on gastrocnemius underscore heterogeneity of CP” (page 7), the author of the study reviewed says her research highlights a need for adjustable, adaptive devices that make use of flexible design, smart sensors, and machine learning algorithms so they can change as the needs of the wearer change.

Whether it’s delving into a child’s personality to discover why they aren’t wearing their brace or getting parental feedback to understand how a child is functioning in a real-world setting, lower extremity practitioners have many opportunities to get to know their patients as individuals—and to adjust their care accordingly. Doing so can mean better outcomes—and happier, more active patients.

By Emily Delzell, Senior Editor


  • Early motor skills training in ASD improves locomotion, socialization

    Intense therapy creates quick gains – Intense motor skills interventions in young children with autism spectrum disorder (ASD) can significantly improve locomotor and other lower extremity skills in addition to socialization behaviors, according to a recent pilot study.

    By Peaches Scribner 

  • AFO effects on gastrocnemius underscore heterogeneity of CP

    Variations call for adjustable devices – Outfitting pediatric cerebral palsy (CP) patients with two types of ankle foot orthoses (AFOs) elicited various effects, as the medial gastrocnemius operating length in some—but not all—participants was consequently stretched while walking, according to a recent study.

    By Greg Gargiulo

  • Home-based ACL injury prevention program fails the compliance test

    Oversight, feedback may up buy-in –  The idea of injury prevention training in the comfort of one’s own home is appealing on many levels, and researchers at the University of Wisconsin-Madison are taking steps toward making that type of training feasible and effective for young athletes.

    By Chris Klingenberg


  • Therapeutic play plus O&P care is a win-win for kids

    O&P practitioners are working with recreational therapists to open doors to leisure activities for kids with lower extremity issues and other disabilities. By expanding their playtime experiences and skills, kids can boost their physical activity, mobility, self-confidence, and social connections.

    By Brigid Elsken Galloway

  • Path of least resistance: Sequencing orthotic care

    The higher profile the device, the more it perturbs movement, and sometimes kids reject such orthoses because of discomfort or unwieldiness. Starting with the least restrictive device and responding to subtle changes in children’s orthotic needs may improve outcomes and compliance.

    By Hank Black