Pediatric Physical Therapy published a systemic review on the efficacy and evidence of using orthoses for children with hypotonia. Ten articles met the inclusion criteria although none were Level I evidence (evidence from properly designed randomized controlled trials).
The results found that data was reported for body structure and activity components, but not participation outcomes. Overall, the current evidence suggests that foot orthoses and supramalleolar orthoses may benefit children with hypotonia but the evidence is low level.
The researchers concluded that many unanswered questions remain regarding orthotic use for children with hypotonia such as: when is the optimal time to introduce orthoses? Are foot orthoses or supramalleolar orthoses more efficacious? Should orthoses be combined with physical therapy?
What has your experience been regarding the use of orthotics and children with hypotonia? Based on my experience, the orthotics helped with biomechanical alignment but not necessarily function. At times, the orthotics have hindered function in order to maintain proper alignment.
Reference: Weber, Anna PT, DHS; Martin, Kathy PT, DHS. Efficacy of Orthoses for Children With Hypotonia: A Systematic Review. Pediatric Physical Therapy: Spring 2014 - Volume 26 - Issue 1 - p 38-47. doi: 10.1097/PEP.0000000000000011
6 comments:
I use orthotics in hypotonic children only if there is a decrease in function and/or pain from malalignment. Even then, I use the least restrictive orthotic possible - I'm a firm believer that wrapping a child in plastic up to their knee is almost never indicated, and can only be prohibitive. Using these guidelines, though, I see substantial improvement in balance and power (as judged by how far they can jump, push off during running, etc.)when a hypotonic child is wearing the appropriate orthotic.
Thank you for sharing your experiences Monica.
I agree with Monica. I look at the alignment of the trunk and lower extremity, as well as assessment of the amount of pressure needed for correction of alignment at the forefoot and the hind foot in trying to determine the least restrictive level for an orthotic. Trying different levels of support and gauging the impact on function is invaluable. Given that alignment influences muscle recruitment order, it's a challenge to strike the balance between supporting better alignment for activation while interfering as little as possible with mobility.
I agree with Monica. I assess the alignment at the trunk and lower extremity as well as the foot, looking from the top down as well as the bottom up. The amount of pressure needed for correction of the hind foot vs the forefoot can also be an important piece of information when trying to determine the least restrictive amount of support. Given that alignment influences muscle recruitment, it's always a challenge to try to balance the optimal alignment for activation with the least amount of impact on joint restriction.
Thanks for the post!
Excellent points Shelley. It is so difficult in the school system since the child just arrives with the orthotics. One can only wish that different level of support could even be trialed. In all my years as a school based physical therapist I have only seen a handful of SMOs.
What are your thoughts on Sure Steps? I agree with all of you least restrictive best option!
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