DMD night splint responses

DMD night splint responses

Kevin Felton

2/12/2003

Thanks to all who took the time to respond to my question about DMD night
splints. I'm still not sure which direction to go here, as I've received
some conflicting advice.

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>

The responses:
-------------------------------------
I have a practice which is made up of about 90% pediatrics. I have
worked with similar cases numerous times through the MDA. I do not find
that any of the off-the-shelf braces work very well. The reason for
this is simple; The off the shelf braces cannot fit the foot and ankle
intimately enough to get a good purchase. As a result, it is possible
to maintain a neutral or dorsiflexed position, but gaining medio-lateral
control is very difficult. Think that you would be much better to
discuss the option of custom fabricated AFOs. We usually line them with
a thermo-foam and use a lateral t-strap to control the supination. If
you articulate the ankle, you can add stretching straps which extend
from the plantar aspect of the toe plate extension up to the medial and
lateral aspect of the proximal strut. I know that this is a bit
different than what you asked for, but I really think that it is a
better approach.

Hope that this helps.


Bernie Veldman
BOC Orthotist
Midwest Orthotic and Technology Center
<Email Address Redacted>
www.surestep.net
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I've had may years practice with multiple-handicapped children,
including a very active MD clinic over a period of 20 years. The clinic
was directed by a progressive, devoted, clinical neurologist.
    Your PT is on the right track: prophylactic night splints are
effective, especially with respect to two essential considerations;
     * Static splinting alone is not effictive. However, when combined
with elastic traction (shock cord) during sleep, the result is very
gratifying, if applied conscientiously throughout the growth years.
    * Positioning of the feet with respect to each child's foot structure
is essential. (The importance of this cannot be exaggerated.)
    If you find the above of interest, it would be easier for me to send
you specific details via Fax.
    Chapter 9 of my book on control of the foot/ankle complex, is devoted
to the prophylactic, orthotic management of MD.

     Best regards, John Glancy,CO

(My comment:
This book is available from AAOP at:
<URL Redacted> )
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We use SOCs sized orthoses of children from RJ Industries for many of our
kids.
Dan Snelson, CPO, FAAOP
Shriners, Los Angeles
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Boston Brace Soft AFO (comes in Ped sizes as well)

Jonathan Breux CO CPed
---------------------------------------------------------------

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
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original question:
 > 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?