In Step With Pediatric Hypotonia – 2014

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

Mobility and More

1Limb-Jordana-nolabelAt the most basic level, mobility is about getting from point A to point B. But, for many children with hypotonia, it’s about so much more.

It’s about independence. It’s about confidence. It’s about maintaining strength, fitness, and healthy bones. It’s about not being excluded from activities enjoyed by their typically developing peers.

And improved mobility may have even more benefits in those children whose hypotonia is associated with social and behavioral developmental delays. New research has identified an association between motor skills and sociobehavioral milestones in children with autism spectrum disorder, who often present with hypotonia (see “The Importance of Gross Motor Skills,” page 12).

This suggests that early intervention to improve gross motor skills—including orthotic devices and physical therapy—may also help certain children interact more comfortably with others. That won’t come as a surprise to the clinicians and parents who have personally seen it happen.


This special issue is filled with evidence-based information and personal success stories illustrating how effective interventions can enhance mobility in children with hypotonia. That could literally be the first step toward drastically improving a child’s quality of life. Not to mention their ability to get from point A to point B.

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.

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…

By Cary Groner

The Importance of Gross Motor Skills

Early intervention can help provide a solid foundation – Many kids with Down syndrome, autism, and other neurological conditions may experience biomechanical limitations in the form of delayed development of gross motor skills. One of the drivers of that delay can be hypotonia.

By Shalmali Pal

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 (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 …

By Megan Smith, CO

Sponsor Message

Defining Culture

“Enriching and transforming lives through compassionate care and innovation” is our company mission statement. As our focus is on the pediatric special needs population, it’s pretty easy to stay attentive to that mission.


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.

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.

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.

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.


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.

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.


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.


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.


SureStep HEKO Hinge, SureStep DA Hinge, SureStep Rivet Press, SureStep Free Motion Hinge & SureStep Dorsiflexion Assist Band