September 2013

Orthotic success stories: Four cases in a series

By Megan Smith, CO

casestudy1aCase Study One: Aniyah

Aniyah was born three months premature, and at the beginning of the study she presented with developmental delay, pronation, and hypotonia. She was prescribed supramalleolar orthoses (SMOs)  at 13 months old, at which point she was pulling to stand but not yet taking independent steps. In addition to the SMOs, she received physical therapy once a week for the first eight weeks of the study. Her parents reported that Aniyah wore her SMOs an average of 12 hours a day, six days a week.

On day one of the study, after receiving her SMOs, Aniyah was cruising and taking some steps with hands held, but was very unstable and had a very wide base. Compared to a typical child, her developmental delay was about three months. Four months later, she was very steady while wearing her SMOs (though still unsteady without them), walking with arms down and swinging, and trying to run. She had mastered eight to nine months of gross motor skills in four months, ultimately putting her about one month ahead of her typical peers.

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casestudy2aCase Study Two: Colin

Colin was prescribed supramalleolar orthoses (SMOs) at 16 months old, at which time he was demonstrating pronation, hypotonia, and significant ligamentous laxity. He was pulling to stand but not yet taking independent steps. In addition to the SMOs, he received physical therapy once a week for the duration of the study. His parents reported that Colin wore his SMOs an average of 12 hours a day, seven days a week.

On day one of the study, after receiving his SMOs, Colin was cruising and taking some steps with hands held, but had a very wide base. Compared to a typical child of the same age, his developmental delay was about six months. Four months later, he was walking with a narrow base and low guard, and was stable while walking on grass, uneven surfaces, or transitional surfaces. He had mastered eight to nine months of gross motor skills in four months, ultimately putting him about two months behind his typical peers.

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casestudy3aCase Study Three: Corwin

Corwin was prescribed supramalleolar orthoses (SMOs) at 16 months old, at which time he was demonstrating pronation and hypotonia. He was pulling to stand but not yet taking independent steps. In addition to the SMOs, he received physical therapy once a week for the duration of the study. His parents reported that Corwin wore his SMOs an average of 10 hours a day, seven days a week.

On day one of the study, after receiving his SMOs, Corwin was not walking. Compared to a typical child of the same age, his developmental delay was about six months. Four months later, he was walking quickly (almost running) with a narrow base and arms at his sides, and was stable even while carrying objects or while walking on grass or uneven surfaces. He had mastered eight to nine months of gross motor skills in four months, ultimately putting him about two months behind his typical peers.

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casestudy4aCase Study Four: Hayden

Hayden was prescribed supramalleolar orthoses (SMOs) at 15 months old, at which time she was demonstrating pronation and hypotonia. She was pulling to stand but not yet taking independent steps, and was very cautious in everything she did. In addition to the SMOs, she received physical therapy once a week for the duration of the study. Her parents reported that Hayden wore her SMOs an average of 12 hours a day, seven days a week.

On day one of the study, after receiving her SMOs, Hayden was not walking. Compared to a typical child of the same age, her developmental delay was about five months. Four months later, she was walking independently and fairly steadily, with a relatively narrow base and low to medium guard. She had mastered eight to nine months of gross motor skills in four months, ultimately putting her about one month behind her typical peers.

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Background: 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 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 supramalleolar orthoses (SMOs). The cases will be presented in September at the O&P World Congress in Orlando, FL.

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