In Step With Pediatric Hypotonia – 2013

Click on image to download the complete supplement in its original form PDF

Click on image to download the complete supplement in its original form PDF

Sponsored by an educational grant from SureStep

Editor Message

Jordana's TweetsFor a parent, the only thing more frustrating than knowing something isn’t quite right with your young child is hearing that nothing can be done until the underlying cause of the symptoms is identified. Luckily, parents of children with hypotonia can be spared the latter frustration.

As we detail in this special publication, early intervention in children with hypotonia—sometimes as early as in the neonatal intensive care unit—is not only possible but strongly recommended by experts, even in the absence of an underlying diagnosis.

A combination of physical therapy and orthotic management can help toddlers with hypotonia overcome developmental delays in gross motor skills, sometimes to the point of surpassing the development of unaffected children. Clinicians have been seeing these types of positive outcomes in children with hypotonia for years, and now researchers are beginning to quantify and document the results.

surestep-logoBut too many pediatric lower extremity practitioners lack a detailed understanding of hypotonia, its effect on gait, and the therapeutic options that are available. This special issue, packed with evidence-based information as well as personal success stories, will go a long way toward bridging that gap.

And that means more children with hypotonia, with or without underlying diagnoses, soon will be cruising, walking, running, and playing right along with their peers.

By Jordana Bieze Foster, Editor


An unexpected path, an invaluable perspective

For this family, one tiny extra chromosome led to a journey of self discovery
When our son was born, we prayed for a healthy baby with 10 fingers and 10 toes. Our prayers were answered. Three years later, those same prayers were said for baby number two. And, once again, our prayers were answered.

By Suzi Klimek


Understanding Hypotonia

Diagnostic challenges should not delay clinical intervention
Hypotonia, or abnormally low muscle tone, is by itself not a disorder but a symptom of an enormous array of issues—many of which can be difficult to diagnose accurately. Even in the absence of a specific underlying diagnosis, however, children with hypotonia can benefit from clinical intervention.

By Christina Hall Nettles

Gait: The Cornerstone of Intervention

Quantifying the effects of hypotonia starts in the clinic
Effective management of children with hypotonia requires an understanding of how the condition affects gait. Clinicians typically rely on their professional experience when discussing the effects of hypotonia on gait in pediatric patients, partly because they trust that experience, but also because so little research has actually elucidated these effects.

By Cary Groner

Orthotic Solutions for Children with Hypotonia

New research underscores years of positive clinical results
When it comes to orthotic management of pediatric patients with hypotonia, the medical literature is only beginning to document the effectiveness that clinicians have been reporting anecdotally for years.

By Cary Groner

Orthotic success stories: Four cases in a series

Each child in this case series was assessed every other week for 16 weeks to determine mastery of items 23, 26-28, 30-39, and 41 (ranging from “pull to stand” to “walk fast”) 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 ...

Sponsor Message

You get what you give

When my wife Pam and I started this incredible journey, we did it with passion and faith. SureStep was founded with a passion for improving the lives of children with special needs. And we have always had faith that we will get what we give.



SureStep HEKO Hinge, SureStep DA Hinge, SureStop, SureStep Free Motion Hinge & SureStep Dorsiflexion Assist Band


SureStep shoes have been custom designed specifically for children who wear orthoses. Their wider, deeper heel, toe box and instep allow for adequate room and a comfortable fit. The unique tread promotes intrinsic movement and flexibility while a special “cut-line” allows for easy shoe modifications.


The SureStep TLSO has redefined spinal management. The soft, flexible plastic serves well to create improved upright positioning, while still allowing for slight movement in all planes.

Criss Crossers & De-Rotation Straps

The first and only device developed to discourage w-sitting, Criss Crossers use a unique audio cue to remind children to change their position.


SureStep HEKO is the first and only pediatric hyper extension knee orthosis to incorporate a 4-axis knee hinge, for smooth, anatomically correct flexion and extension. This exceptional device provides localized control of the knee, preventing hyperextension, valgus and varus, while allowing full flexion and extension.  With adjustable extension stops, the HEKO offers up to 30 degrees of adjustability.

Pullover & Advanced

The SureStep PullOver is an amazing tool that not only facilitates improved stability of the foot and ankle complex using a  SureStep SMO, but it is also the only SMO that incorporates a true dorsiflexion assist through the use of a removable proximal strut.

Indy 2 Stage

A uniquely designed orthosis developed to help children reach their potential. This exceptional “orthosis within an orthosis” allows for the SureStep SMO to be utilized independent of the AFO. Children can work through a variety of transitional skills without impeding normal muscle function.

BigShot/BigShot Lite

A growing child means eventually outgrowing the original SureStep SMO. The BigShot and BigShot Lite are the perfect solutions for older children who still need the stability of SureStep.

SureStep SMO

The SureStep SMO remains the most advanced method of controlling excessive pronation and providing stability to the hypotonic population. Suitable for patients up to 80 lbs.