COVER STORY
Bracing for Success as a
Team
Unique protocol for children with hypertonia relies on collaboration and commitment By CHRISTINE UMBRELL
O
RTHOTISTS ACROSS THE
NEED TO KNOW
A set of solid ankle-foot orthoses
• In the treatment process, teamwork is essential to ensure optimal intervention and goes beyond the therapist-orthotist relationship. Compliance relies on parent participation and support, particularly because the program requires an hour of daily strengthening exercises during the first couple of years. • Solid AFOs are recommended to avoid breakdown of the midfoot and tightness of the heel cord. Design should be based on the patient’s level of activity, extent of hypertonia, and failures and successes with previous AFOs.
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MARCH 2022 | O&P ALMANAC
PHOTOS: Courtesy of Lurie Children’s Serial Casting Program, Getty Images
• The team at Lurie Children’s Hospital designed a protocol for gaining and maintaining correction of equinus gait in children with hypertonia. Once full ROM is gained through serial casting, patients comply with four components that include the use of daytime AFOs, nighttime AFOs, strengthening exercises, and center of mass training.
country regularly treat pediatric patients who struggle with hypertonia, including patients with cerebral palsy (CP). These clinicians adopt a variety of methodologies to fit patients with different types of orthoses, often partnering with physical therapists—all with the goal of improving stability and mobility among patients with excess muscle tone. Clinicians at Ann & Robert H. Lurie Children’s Hospital of Chicago have experienced a significant level of success in gaining and maintaining correction of equinus gait in children with hypertonia. They adhere to a strict protocol that relies on serial casting, daytime and nighttime orthoses, and ongoing physical therapy,
