August 2014

Orthotic success stories: Four cases in a series

By Megan Smith, CO

case-study-addie-chartCase Study One: Addison

Addie was prescribed SMOs (supramalleolar orthoses)  when she was aged 18 months and  presented with developmental delay, hypotonia, and pronation. Prior to receiving her SMOs, she had been pulling to stand for four months and cruising for three months. She had just begun to take some independent steps, but was still very unstable.

Addie started pulling to stand around age 14 months (five months delayed) and had mastered walking with one hand held at age 18 months (six months delayed). Prior to receiving her SMOs, her gross motor skills rate of change (months/skills) was .61, compared to .43 for a typical child of the same age.

After receiving her SMOs, Addie gained gross motor skills much faster, at a rate of .52, compared to 1.03 for a typical child of the same age. By the end of the study, Addie was walking backward and running, and had closed the gap to be only two to three months behind her peers. She gained three months of skills in four months.

case-study-addie-pics


case-study-sawyer-chartCase Study Two: Sawyer

Sawyer was prescribed SMOs (supramalleolar orthoses) at age 18 months, when  he was demonstrating pronation, hypotonia, and ligamentous laxity. He was pulling to stand and cruising but not yet standing independently. In addition to the SMOs, he received physical therapy once a week for the duration of the study.

On the day he received his SMOs, Sawyer was cruising and taking some steps with both hands held for assistance. Relative to a typical child, his developmental delay was eight months. Four months later, he was walking with a medium guard and narrow base of support. He had mastered eight to nine months of gross motor skills in four months, putting him about three to four months behind his peers. His gross motor skills rate of change (months/skills) after receiving his SMOs was .28 compared to .51 for a typical child of the same age.

case-study-sawyer-pics


case-study-Jeremiah-chartCase Study Three: Jeremiah

Jeremiah was prescribed SMOs (supramalleolar orthoses) at age 15 months, when he was demonstrating pronation, hypotonia, and ligamentous laxity. He was pulling to stand and cruising but not yet standing independently. In addition to the SMOs, he received physical therapy once a week for the duration of the study.

On the day he received his SMOs, Jeremiah was cruising and taking some steps with both hands held for assistance. Relative to a typical child, his developmental delay was six months. Four months later, he was walking with a low guard and narrow base of support. He had mastered eight to nine months of gross motor skills in four months, putting him about one to two months behind his peers. His gross motor skills rate of change (months/skills) was .34 compared to .51 for a typical child.

case-study-Jeremiah-pics


case-study-kate-chartCase Study Four: Kate

Kate was prescribed SMOs (supramalleolar orthoses) at age 18 months, when she was demonstrating pronation and hypotonia. She was pulling to stand, cruising, and taking some steps with trunk support, but not yet standing independently.

On the day she received her SMOs, her developmental delay was eight months compared to a typical child. Immediately after receiving her SMOs, she started to stand independently and take steps with just one hand held. Three months later, she was walking with a low guard and narrow base of support. She had mastered eight months of gross motor skills in three months, ultimately putting her three months behind her peers. Her gross motor skills rate of change (months/skills) was .25 compared to .51 for a typical child of the same age.

case-study-kate-pics


Background: Each child in this case series was assessed every other week for 16 weeks (12 weeks for one patient who moved out of state) to determine mastery of items 23, 26-28, 30-39, 41, 42, and 45 (ranging from “pull to stand” to “run”) on the Peabody Developmental Motor Scale. Test instructions were modified as needed for children to understand them. Parents were included in each session and encouraged to play with the child in order to demonstrate the targeted skills. Graphs illustrate age of mastery for each item number for the hypotonic child compared to a “typical” child, with linear trend lines illustrating rate of change, and demonstrate the improved mastery of skills after prescription of SMOs.

 

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