December 2012

SureStep: A stabilizing force for low-and high-tone pediatric patients

By Andria Segedy

For a dozen years South Bend, IN-based SureStep has been finding solutions to help stabilize standing, walking, and running in the hypotonic and hypertonic pediatric population, said founder Bernie Veldman, CO.

SureStep began with a design for a supramalleolar orthosis (SMO) that Veldman developed while employed by another company. That company wasn’t interested in pursuing the product, so Veldman bought the rights and started SureStep.

“The SureStep SMO encourages development of upright gross motor skills, intrinsic musculature, muscle strategies, and movement patterns, rather than immobilizing the foot,” he said. “SMOs and UCBLs [University of California Biomechanics Laboratory] by their very designs are intended to put the foot into a neutral position. Traditional bracing uses static positioning in an effort to manage feet, but SureStep uses compression of the foot and ankle to create stability rather than pushing the foot into one static position.”

Veldman’s dedication to research and design is reflected in his original mission to meet the needs of the low muscle tone pediatric population whose challenges  might otherwise go unnoticed.

“The low-tone hypotonic population is larger than the hypertonic population or kids with cerebral palsy. They are slower to stand, slower to walk, or not stable enough to stand,” he said, adding that if you didn’t know the children were hypotonic, you wouldn’t know why they had these challenges.

Veldman said the SureStep SMO will always be SureStep’s biggest mover. In 2013, however, three new products will make clinicians take notice, he said.

Criss-Crossers three-quarter length spandex pants, expected to hit the market in summer 2013, will create an audio alert for parents in another room when their child is W-sitting.

An off-the-shelf HEKO (hyperextension knee orthosis) in four sizes will give orthotists and parents an opportunity to test whether a prefabricated device could substitute for a custom-made version to solve their child’s walking and running challenges.

The prefabricated HEKO, which will be available in early 2013, is both less expensive than custom devices and will make reimbursement easier, Veldman said. “Many payers will pay for a custom knee orthosis only when a patient cannot fit in a prefabricated knee orthosis. And some require a diagnosis of knee osteoarthritis to cover a custom-fabricated orthosis. Many pediatric patients have not been able to get third-party funding for custom-fabricated HEKOs,” he said.

In spring, a sandal built to accom­modate any ankle or leg brace will join SureStep’s pediatric footwear line.

“Almost immediately after introducing our SureStep children’s footwear, which are made for children who wear any type of lower extremity bracing, we began receiving requests for a sandal line,” he said. “These will be cute, fashionable sandals made specifically for children who wear lower extremity orthoses.”

In addition to its pediatric footwear line, SureStep also offers nine forms of ankle, knee, leg, and torso bracing.

“When you think about a child with low tone, they have looser joints, hypermobile joints,” Veldman said. “Their feet collapse inward, their muscles don’t pull evenly, and it puts them at a biomechanical disadvantage to run and jump. Braces push them up to go back to the correct position.”

The inherent problem is that even when a correct position can be achieved statically, it may not be maintained when the child starts to move.

SureStep’s solution is the use of a uniformly thin plastic, which allows for a much more even distribution of pressure, while still allowing some movement.

“Through this compression we can facilitate stability in the foot. I would compare it to a water bottle. If you put water in a glass bottle, the rigidity of the glass doesn’t allow the bottle to change position,” he said. “A plastic bottle however, has a degree of flexibility, even when full of water. The hydrostatic pressure created by the water helps stabilize the bottle much more, but doesn’t create rigidity. We want to stabilize the foot, but still allow movement. That’s what creates the normal gait for these kids versus a marching, steppage gait.”

The SureStep SMO was originally developed for children with hypotonia. Newer products like the Indy 2-Stage AFOs (ankle foot orthoses) incorporate the SMO, and, with the addition of the AFO, also address the hypertonic population, Veldman said.

“The Indy 2-Stage AFOs supplement the SureStep SMOs, with which they are paired,” Veldman said. “The Indy 2-Stage uses the SureStep SMO to stabilize the foot and ankle, allowing the normal, natural intrinsic movements, but the exterior AFO reduces the ability of the SMO to move excessively. In this way, we can address children with higher extensor tone. This also allows the SureStep SMO to be used independent of the AFO for transitional skills and other activities where the AFO could be too restrictive.”

Andria Segedy is a freelance writer in Huntsville, AL.

Article sponsored by SureStep.

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