Managing Pediatric Gait Dysfunction

Functional Bracing with Adjustable Dynamic Response (ADR) only from...

Managing Pediatric Gait Dysfunction

New Technology For a more natural gaitAdjustable Dynamic Response (ADR) optimizes gait outcomes by addressing the entire gait cycle with• Adjustable muscle augmentation • Smooth/natural rollover• Unrestricted motion when desired • Clearance in swing• Customized stability in stance

dence and community access are now available to the developing child with movement and posture disorders.

Clinical Presentations:Crouch gait typesEquinus gait typesVariants of crouch and equinus

Treatment Specialties:Spastic hemiplegic, diplegic, and quadriplegic cerebral palsy (GMFCS Level 1 - 4)Spinal cord pathologyIdiopathic toe walking syndromePost-strokeChallenging neurological and developmental conditions

Age Groups:Pediatric/adolescent patients up to

Biomechanical Rationale Adjustable muscle augmentationrockers. Compression of the posterior channel augments the tibialis anterior in early to mid stance. Compression of the anterior channel augments the gastroc-soleus in mid to late stance. Changing the restraint levels are accomplished with simple set screw adjustments. Orthotists can make further

t presentation by adjusting elastomer length.Unrestricted motion

dynamic restraint is not adequate.Customized stability in stance - ADR selectively augments and provides support for the tibialis ante-rior and gastroc-soleous muscles and alters their response to ground reaction forces (GRF) as needed;

support the mid-foot and transfers GRF to the toe lever. The custom interface provides support

Smooth/natural rollover0-40º; ADR allows for improved knee-ankle-foot biomechanics with ROM that is stabilized. ADR may maximize speed at a reduced energy cost.Clearance in swingfoot clearance during swing.

“I have more endurance and I can walk further.”“It helps me keep up with my friends.”“My leg doesn’t go without it.”“It is much better than my other braces. It helps me feel more aligned and things don’t hurt as much.”

Adjustable Dynamic Response (ADR) Brace?

“Gait is improved – she’s able to walk longer distances without fatigue and being in pain - definitely has less hip and knee pain.” “She wears the brace all the time except when she is sleeping. She has much more compliance with this brace than any other of her braces.” “It’s comfortable and attractive. It was nice that she could pick out her color pattern.”

Adjustable Dynamic Response (ADR) Brace?

Comprehensive Orthotic Management for the Growing Child with Spasticity and/or LOMing braces provide precise dynamic stimulus (low-load prolonged stress - LLPS) and proper posturing

of increased muscle length and strength motion and stability

work together to promote/facilitate the movement patterns required for functional gait. Please refer to the following suggested general guidelines for brace design and selection based on the rehab team’s clinical assessment.

To learn more: Call: 800-220-6670 Visit:

hysician's rehab team. Although there are many variants to equinus and crouch, these guidelines address 1) weakness plus dynamic spasticity and

ent at any time (ADR), (2) change the dynamic angle of tibial inclination at any time (ADR), (3) preserve and improve range of motion at rest (therapuetic)

General Guidelines for UtraSafeGait™Common

ClinicalPresentations*

Common Clinical Measurements CommonClinical Goals

ADR Component Channel Adjustments

Early Childhood Equinus

(Extension Gait Moment) Soleus Spasticity with rear,

mid, and/or forefoot deformities

Late Childhood Equinus

(Extension Gait Moment) Soleus Spasticity

with rigid foot deformities

Earlier Childhood Crouch

(Flexion Gait Moment) Hamstring and Gastroc-Soleus Spasticity with

rear, mid, and/or forefoot

deformities

Late Childhood Crouch

(Flexion Gait Moment) Hamstring and Gastroc-Soleus

Spasticity with rigid rear, mid, and/or

forefoot deformities

R1 and R2 StrengthFirst (Heel)

Second (Ankle)Third (Toe) Rocker

Manage Gait (ADR) Improve Muscle Length (Therapeutic/Stretching)

Functional/Day Bracing (UltraSafeGait™ADR)

Posterior Elastomer

Posterior Stop

Anterior Elastomer

Anterior Stop

Therapeutic/Stretching Bracing

night and/or at rest**

UltraflexSolution/Rx

UltraflexSolution/Rx

R1: < 15°

R2: within normal limits

R1: < 5°

R2: < 15°

R1: popliteal > 30° ; gastroc

< 5 R2: within normal limits

R1: range equal to or < R2 R2: popliteal >30°

gastroc-soleus < 5°

Weak tibialis anterior and gastroc-soleus

Weak tibialis anterior and gastroc-soleus

Weak hip extensors, quadriceps, and gastroc-soleus

Weak hip extensors, quadriceps, and gastroc-soleus

First: mid or forefoot contact Second: no tibial progression Third: possible rollover at toe

First: mid or forefoot contact Second: no tibial progression Third: possible rollover at toe

First: full, mid, or forefoot contact Second: too much hip

mid-stance Third: early heel rise (crouch with no heel contact)

First: full, mid, or forefoot contact Second: too much hip

mid-stance Third: no heel rise (crouch with constant heel contact)

Achieve Heel First Rocker, Tibial Advancement, Control Knee Hyperextension

Achieve Heel First Rocker, Tibial Advancement, Control Knee Hyperextension; Lengthen Soleus

Improve First Rocker, Create Knee Extension Moment in Mid to Late Stance, Block Toe Third Rocker

Improve First Rocker, Create Knee Extension Moment in Mid to Late Stance; Lengthen Hamstring and Gastroc-Soleus

Rx:Molded ADR AFO w/Anterior Proximal Shell and SMO (recommended with rigid toe plate)

Rx: Molded ADR AFO w/Posterior Calf Shell (consider SMO for comfort

to patient)

Rx: Molded ADR AFO w/ Posterior Calf Shell and SMO

Consider Rx:

Recommended Rx:

ConsiderRx:

Rx:Molded ADR AFO w/Anterior Proximal Shell (consider SMO for comfort and heel

to patient)

Near to fully compressed

Little to no compression needed

Little to no compression needed

Near to fully compressed

Near to fully compressed

Near to fully compressed

Little to no compression needed

Little to no compression needed

Only if posterior elastomer compression alone does not control knee hyperextension

Only if anterior elastomer compres-sion alone does not

knee extension moment in mid to late stance

Only if anterior elastomer compres-sion alone does not

knee extension moment in mid to late stance

Only if anterior elastomer compres-sion alone does not

knee extension moment in mid to late stance

Usually none needed

Only if posterior elastomer compression alone does not control knee hyperextension

Only if required for swing clearance and initial contact with heel

Only if required for swing clearance and initial contact with heel

Add Therapeutic KO CM section with UQR to ADR AFO with Posterior Calf and pre-tibial shell - total day/night crouch solution - see below Recommended Rx:

with UltraQuickRelease™

Total day/night crouch solution

• Therapeutic custom molded KO section for lengthening hamstring and gastroc-soleus

creating knee extension moment• Easily disconnect KO from ADR AFO with a quick release feature

Compliance

ambulatory activities as tolerated but should be removed during sleep. Ambulatory activities may include running, jumping, squatting, bending, and kneeling. Patients may need to gradually work into wearing

fort, irritation, or rubbing caused by the orthosis to their orthotist.)

Delivering Patient Inspired Solutions

Component FeaturesDescription

• Recommended for patients up to 110 lb (medial and lateral joints together)• Continuously adjustable:

• Adjustable Dynamic Response muscle augmentation:

*Components come with a limited lifetime warranty.

Adjustable DynamicResponse (ADR) Ankle Joint Dually adjustable dynamic stance phase control for motion with stability

wide selection of custom interface designs and colors available

PosteriorElastomer Channel

Stop Channel Stop Channel

AnteriorElastomer

Channel

Reference1. T Bowman. Managing Gait Deviations with Adjustable Dynamic Response. The Academy Today. March 2008.

©2009 Ultraflex Systems Inc.

Focuses more on the ability of the patient than the disability1

Call to set up an in-service training session: 800-220-6670

ADR Component Adjustment Based on Patient Presentation

Setting the Channels

Posterior Elastomer ChannelCompress to augment tibialis anterior at initial contact(Resist foot slap/equinus and promote heel-ankle rockers in early stance)

Anterior Elastomer ChannelCompress to augment the gastroc-soleus from mid-stance to pre-swing

promote smooth second and third rockers in late stance)

Create a rigid stop for patients as desired (Variable stop, 0-40º as needed; please see inside chart, General Guidelines for UltraSafeGait™, for stop usage by gait pattern type)

Note: Red Nylock patches on adjustment screws will prevent screws from backing out once adjusted.

insurance providers.

U.S. and International Patents Pending

900-00-017, Rev. 1