Re: DMD night splint
Vikki Stefans
Description
Collection
Title:
Re: DMD night splint
Creator:
Vikki Stefans
Date:
2/12/2003
Text:
I felt I needed to make a comment, because in Duchenne AFOs are rarely
used for walking and it is very important this is well known; in general
because of the biomechanics of gait with their proximal weakness anything
that blocks plantarflexion will cause and increase in falls if the chld
can walk in it at all. KAFOs are generally needed when ambulation without
bracing becomes impossible and this is pursued.
Also, many with Duchenne's have rather large calves, and I think whatever
you try to use for prevention of equinovarus contracutre, there will
always be at least a few who will require custom molded orthoses for this
purpose.
I do find that in many cases bracing and stretching are very effective as
long as they are continued, adn that is the mainstay of our program here.
Some centers advocate elective surgical intervention around age 7 to
transfer posterior tib to be an everter and dorsiflexor and this has been
a reliable way to prevent late severe fixed deformity as well.
Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans, travel agent extraordinaire. Every mom is a
working mom!- OK, dads too. Other address: <Email Address Redacted>
On Tue, 11 Feb 2003, Bob Lin wrote:
> Good morning all. In regards to the recent inquiry re a successful
> pre-fab night splint for the DMD patient as a prophylaxis to heel cord
> contracture my suggestion would clearly be the PRAFO by Anatomical Concepts
> Inc. This line of pre-fab night braces also affords the best
> ambulation and accomodation of potential ML deformity(varus/valgus)
> using the PRAFO-EV. This design has been studied by the gait lab at
> Ct Childrens Medical Center on 8 hemiparetic patients (kinetics and
> kinematics) and proven to be most effective in the aforementioned
> parameters. This paper is being finalized for publication in JPO in the
> very near furture. I hope this helps your inquiring therapist. Bob Lin
>
> -----Original Message-----
> From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>]On
> Behalf Of Macchi
> Sent: Monday, February 03, 2003 11:09 PM
> To: <Email Address Redacted>
> Subject: [OANDP-L] DMD night splint
>
>
> Dear Colleagues,
>
> A physical therapist I work with is interested in using off-the-shelf
> night splints to maintain the ankles of young DMD patients in a neutral
> position. These children have no deformities yet, but she wants to avoid
> or delay the development of equinovarus contractures.
>
> What brands and models of devices do you like for these cases? Are
> these easy to don? Do they require much adjustment to fit well? Does
> night splinting have an effect on the development of equinovarus
> contractures in the DMD population?
>
> Thank you for your assistance.
> Sincerely,
>
> Kevin Felton, CO, LO, FAAOP
> Education Coordinator, Orthotics Department
> Texas Scottish Rite Hospital for Children
> 2222 Welborn Street
> Dallas, TX 75219-3883
> voice: 214-559-7440
> fax: 214-559-7473
> website: www.tsrhc.org
> email: <Email Address Redacted>
used for walking and it is very important this is well known; in general
because of the biomechanics of gait with their proximal weakness anything
that blocks plantarflexion will cause and increase in falls if the chld
can walk in it at all. KAFOs are generally needed when ambulation without
bracing becomes impossible and this is pursued.
Also, many with Duchenne's have rather large calves, and I think whatever
you try to use for prevention of equinovarus contracutre, there will
always be at least a few who will require custom molded orthoses for this
purpose.
I do find that in many cases bracing and stretching are very effective as
long as they are continued, adn that is the mainstay of our program here.
Some centers advocate elective surgical intervention around age 7 to
transfer posterior tib to be an everter and dorsiflexor and this has been
a reliable way to prevent late severe fixed deformity as well.
Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans, travel agent extraordinaire. Every mom is a
working mom!- OK, dads too. Other address: <Email Address Redacted>
On Tue, 11 Feb 2003, Bob Lin wrote:
> Good morning all. In regards to the recent inquiry re a successful
> pre-fab night splint for the DMD patient as a prophylaxis to heel cord
> contracture my suggestion would clearly be the PRAFO by Anatomical Concepts
> Inc. This line of pre-fab night braces also affords the best
> ambulation and accomodation of potential ML deformity(varus/valgus)
> using the PRAFO-EV. This design has been studied by the gait lab at
> Ct Childrens Medical Center on 8 hemiparetic patients (kinetics and
> kinematics) and proven to be most effective in the aforementioned
> parameters. This paper is being finalized for publication in JPO in the
> very near furture. I hope this helps your inquiring therapist. Bob Lin
>
> -----Original Message-----
> From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>]On
> Behalf Of Macchi
> Sent: Monday, February 03, 2003 11:09 PM
> To: <Email Address Redacted>
> Subject: [OANDP-L] DMD night splint
>
>
> Dear Colleagues,
>
> A physical therapist I work with is interested in using off-the-shelf
> night splints to maintain the ankles of young DMD patients in a neutral
> position. These children have no deformities yet, but she wants to avoid
> or delay the development of equinovarus contractures.
>
> What brands and models of devices do you like for these cases? Are
> these easy to don? Do they require much adjustment to fit well? Does
> night splinting have an effect on the development of equinovarus
> contractures in the DMD population?
>
> Thank you for your assistance.
> Sincerely,
>
> Kevin Felton, CO, LO, FAAOP
> Education Coordinator, Orthotics Department
> Texas Scottish Rite Hospital for Children
> 2222 Welborn Street
> Dallas, TX 75219-3883
> voice: 214-559-7440
> fax: 214-559-7473
> website: www.tsrhc.org
> email: <Email Address Redacted>
Citation
Vikki Stefans, “Re: DMD night splint,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/220594.
