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LEARNING OBJECTIVES
Upon completion of this chapter, the reader will be able to:
Identify the indications and contraindications for common lower extremity orthoses.
Design an evaluation specifically for determining lower extremity orthotic needs of a child.
Compare and contrast how intervention philosophies based on biomechanics and motor learning may influence orthotic decisions, including when to introduce and dosage.
Summarize the key concepts for patient/caregiver education when fitting a lower extremity orthosis.
Appraise the evidence for lower extremity orthotic efficacy for children.
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The use of lower extremity orthoses to address standing and gait deficits in children with movement system dysfunction has been a part of the standard of rehabilitation care for decades. However, newer materials (eg, plastics) and application of contemporary understanding of motor learning theories have led to a paradigm shift in the past 10 to 15 years. This chapter will cover the traditional understanding of orthotic intervention as well as newer concepts that are emerging. Various orthotic styles and their indications, precautions, and contraindications will be discussed along with a review of the current evidence for the efficacy of each style of orthosis. Gaps and controversies in our current evidence will also be explored.
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Important factors for determining which style of orthosis to be used will be discussed. This will include common examination techniques as well as important biopsychosocial factors to consider in order to provide family-centered care. Outcome measures to monitor the effects of orthotic intervention across all domains of the International Classification of Functioning, Disability, and Health (ICF)1 will be identified along with their advantages and disadvantages.
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The logistics of how to obtain an orthosis and work with an orthotist to obtain the best individual solution for each child will be discussed along with guidelines for how to evaluate the fit, how to educate the patient and caregiver about proper use, and when to refer the family back to an orthotist. Finally, this chapter will explore how an orthotic intervention fits into the bigger picture of the child’s physical therapy plan of care. Several case studies will be included to help the reader apply the concepts in this chapter.
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The word orthosis is a noun, and its plural form is orthoses. The term orthotic is an adjective and frequently used incorrectly. Using the term orthotic to refer to the actual device is slang and technically incorrect. To refer to the specific brace or device, the correct term is orthosis. The adjective form is correctly used when it is describing a noun, such as orthotic device or orthotic intervention. Although this may seem to be a minor point, all physical therapists should strive to use technically correct language. Unfortunately, much of the peer-reviewed literature contributes to the confusion by using the term orthotic incorrectly.
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Orthoses may be rigid or ...