Exciting Floor Reaction Responses #1

Exciting Floor Reaction Responses #1

John Izak, CPO

Isn't it exciting that we work in a profession that shares its technology at the grass roots level to improve our level of care ( Most of all for the children).
Here is the first summary. I am excited to try.

Any parameters or technical tips would be much appreciated.

John Izak CPO Philadelphia





Yes and my colleagues thought I was crazy but it worked beautifully as planned! My patient was an adult S/P CVA w/ weak quads and a crouched gait. I also used an adjustable plantar stop to tweak the final setting. B.A., CP
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      Yes, I have used the Tamarack joints as plantarflexion assist joints on
CP children with crouch gait many times. I have found it very effective and
allows a smooth, quiet gait. I do not use the lowest durometer pediatric
version for this purpose, they fatigue too quickly in this application. I
keep the plastic rigid so not to deform from the stress. I allow wider
relief medially and laterally at the malleoli to allow for the the spreading
of the Tamarack during dorsiflexion.
Tom Colburn CO

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 We have done this several times at Royal Brisbane.
The tamaracks tend to flog out quite quickly, so initial
results need to be followed up with regular review.
It does work to a fair degree with small children
Mark Holian
Dir O&P
Royal Brisbane Hospital

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 It wont work--you need a dorsi-stop. If you want an articulated ankle to
allow for some plantarflexion, but still provide a knee extension force in
mid-to-late stance try this:

Use a DAAJ-make sure the stirrup is molded into the footplate (lotsa stress
there to break rivets).

Or use a joint such as a free motion Gaffney (that will function well in
compression) and add a 1 dacron strap to the posterior to act as a
dorsi-stop.

If you really wanted to use a rubbery joint, get the neutral Tamarack and
limit dorsi-flexion by having the plastic of the footplate contact the
plastic of the shank anterior to the joint. This places the joint in
tension, which it can resist reasonably well.

I've done all of these and prefer to use the Gaffney with the dorsi-stop
strap.

Hope this helps,

Troy Fink, CO
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I think you'll find that the child will overcome the tension and crouch.
We have doubled up on hinges both sides...this allows a bit of flexion but
for mild and I mean mild..it has worked very well. Sounds a bit weird but
we've used two Tamaracks side by side, medial and lateral. This is not an
original idea on my part but it has worked on very mild cases. Good luck.
Molly Pitcher CPO
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I dealt with this problem a lot in my clinical practice. While I agree a
lower profile orthosis would be better, I wonder - have you tried a KFO with
offset joints (Otto Bock) and knee extension assists, free ankle with
stirrup attached to a footplate? I made a video (long since deteriorated
with age) and was astonished at the transformation of gait of these
patients.

Best of Luck,

Bob Brown, Sr., CPO, FAAOP
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SOMEONE PLEASE HELP ME WITH OUR SPANISH FRIENDS

 Hello:
Porfavor le/les pido que toda información que me mande
a mi correo electrónico lo hagan en idioma español, ya
que no manejo otro idioma.
desde ya le/les voy a estra muy agradecido

atte Ramiro



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    Re: Your question about using Tamarack assist joints (reversed) on
pediatric AFO's to resist weak quads/crouch gait:

    I think there is a possibility for that to work for smaller children
(first
decade), but you should be using the medium or large size to generate enough
moment to significantly assist the child's knee extension. If you try it,
please let me know how it works.

Marty Carlson
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