CREDIT:
Earn 3 contact hours (0.3 CEUs)
COURSE DESCRIPTION:
The IF, WHEN, and WHAT of orthotic decision making can be daunting when working with children as they are developing their first weightbearing and gait skills. Consider the benefits of early orthoses (protect ligaments, influence neuromotor patterns, encourage emerging gait/gross motor skills, support intrinsic foot muscles) as well as potential drawbacks & learn decision making based on stage of development, sagittal and coronal plane alignment, and overall individual factors.
LEARNING OBJECTIVES:
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Determine coronal versus sagittal plane alignment impairments and potential orthotic solutions for each
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Differentiate delayed and emerging postures/skills from those requiring orthotic intervention
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Integrate individual findings to create a detailed orthotic plan: timing of intervention, custom versus off the shelf, dosage, integration with other interventions
AUDIENCE:
Therapists working with the birth to three population.
SCHEDULE:
- Evidence-informed practice for early orthotic recommendations
- Challenges to evidence-based practice
- Defining “effective”
- ICF Model
- Balancing competing goals
- Short-term bracing for long-term goals
- Relevant Evidence
- Excessive pronation
- Limited dorsiflexion
- Weakness
- Neuroplastic changes
- Impact on developing systems: developmental kinesioplasticity
- Framework for early orthotic intervention: Why do we use orthoses early in life?
- Protect ligaments for a lifetime of use
- Influence neuromotor activation for emerging motor patterns
- Support gait and functional gross motor skills for on-time mobility
- Begin weightbearing in an efficient length-tension ratio of the foot intrinsic muscles
- Defining Orthotic Groups
- Group 1: Foot orthoses
- Group 2: Supra-malleolar orthoses
- Group 2+: SMO +
- Group 3: AFOs with motion
- Group 4: Solid AFOs
- Group 4D: Dynamic solid AFOs
- Group 5: Sagittal plane only
- Coronal Plane Decision Making
- Key question: What support is required in the coronal (and transverse) planes to allow dorsiflexion to occur at primarily the talocrural (ankle) joint?
Patient groups:
- Neutral hindfoot
- Pronated hindfoot
- Supinated hindfoot
- Special considerations for early intervention decisions: monitoring for emerging skills, timing of orthotic intervention
- Sagittal Plane Decision Making: Orthotic Design and Posting
- Stability and shock absorption
- Establishing developmentally therapeutic gait for gastroc-soleus range of motion
- Developing an individual, comprehensive orthotic plan
- Systems screening
- Personal factors
- Delay versus long-term health condition
- Funding: weighing commercial, off-the-shelf, and custom options, in light of the individual family’s options and priorities
- Orthotics and disability identity
- Dosage
- Minimizing negative impacts of orthotic intervention on Activities, Participation, and Personal Factors
- Alternatives and adjuncts: foot intrinsic strengthening, taping, and more
- Insuring an enriched sensory experience for positive neuroplastic influence despite orthotic use
Case examples and discussion
Post-test
Amanda Hall, PT, MPT, PCS, began teaching clinical education with serial therapeutic casting courses, and has since developed additional coursework based on an integrative approach to treatment for patients with pediatric and neurological health conditions. Her clinical practice is at the Rehabilitation and Specialized Care of Children’s National Hospital (formerly the HSC Pediatric Center) in Washington, DC, where she specializes in treating “outliers” and patients with complex presentations. Her framework is grounded in PNF principles, therapeutic alliance, neuroplasticity, manual therapy, therapeutic gait, and developmental kinesioplasticity. Her framework has a strong focus in patient-centered treatment and adaptive design. As a result, she has received international media attention as the “Madcaster.” Notable presentations include the Combined Sections Meeting of the American Physical Therapy Association, the APTA Pediatrics Annual Conference, and at the National Institutes of Health. She graduated with her Master of Physical Therapy from the University of Washington in 2001 and received her Board-Certification as a Pediatric Clinical Specialist in 2010.
Financial Disclosure: Amanda Hall receives an honorarium from Education Resources, Inc.
Non-Financial Disclosure: Amanda Hall has no relevant non-financial relationships to disclose.
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