Making Sense, Part F

We’re lead to believe that once your child’s been stuffed into one of these orthotic get-ups, she's just minutes away from moving like an Olympic gymnast. As for what additional help she may need to reach such heights, well -- good luck looking to the manufacturers' web sites for answers. I've found most of 'em to be "mostly cloudy" on the subject. As if that part of the equation were no big thing.

THAT PART of the equation is where the child-in-her-device meets up with the physical therapist (PT) and actually GOES TO WORK on trying to improve balance, stability and /or limb motion; where the PT and orthosis apply light-to-moderate CORRECTION as the child is encouraged to move the way she was designed to move. And CAN move. Even though she may have learned, through non-use, not to.

How are things supposed to go? How is the therapy supposed to help /work?

In theory:

Sensory information that is associated with (let's call it) a "corrected movement", and that originates in the muscles, tendons, ligaments, etc., gets routed to the central nervous system (CNS) which then takes sort of a neurological snapshot of that corrected movement. After enough of the same snapshots, the CNS starts to send corrected instructions back to those body parts. The corrected movement becomes learned. 

It's ultimately about trying to imprint patterns. Patterns a child can call upon at will to function effectively in the world.

*  *  *  *  * 

Without going into detail (for example, about how weak and tight muscles are aided and supported by proximal muscles):

I can see how these orthoses...these devices that compress and gently guide muscle groups...could very well help to facilitate correct movement. The rationale for their existence and use as neuromotor retraining devices now makes sense to me. I see no reason not to continue looking into them for my daughter.

Before I buy, though, I want to know more. More about how to increase the likelihood she'll benefit. More about how to proceed with caution. I want to keep from becoming too optimistic. These are just fabrics, after all.

I'm reminded of a line from TheraTogs’ site: “Each child or adult with CNS dysfunction presents hundreds of variables that comprise a unique constellation of sensory, motor, skeletal, joint, and muscular factors.” These have to – somehow, someway – be taken into account.

More to come on that.

Making Sense, Part E

Much of the language used to describe the material properties of the orthoses on our list revolves around “force” words: Pressure. Rebound. Compression. Stretch. Resistance. An orthosis mechanically compensates by changing the outside forces acting on a body, or body part. I suppose that's its primary function.*

In our case, we have...

Six (6) different orthotic devices, six (6) different force-related profiles. For some reason my mind wants to lump 'em into two (2) categories:

1. Those that are primarily compression devices. A Benik vest, elastic therapeutic tape**, compression sportswear, and SPIOs all work based on (the application of) uniform pressure.
   
2. Those that biomechanically guide in addition to compress. With these you get more push and pull, and you get the ability to vary and pinpoint forces -- all thanks to the use of specialized connectors. (TheraTogs employ elastic straps that "Velcro back" onto the garment itself. The TheraSuit incorporates elastic bands. When the latter is used in conjunction with a Universal Exercise Unit, the wearer may be exposed to higher-load forces.)

Another distinction comes to mind, something to do with duration. Each of the primarily-compression-devices, along with TheraTogs, provides a prolonged force. They can be worn all day. A TheraSuit, on the other hand, is designed for shorter bursts of work.

So we have these devices that represent different strategies for influencing, altering and manipulating forces. To what ends? What purposes do their functionalities serve? What good can compression and biomechanical guidance do for kids with CP? 

See next post.

*To allow the skin to "breathe" could be considered a secondary function, and one that speaks broadly to comfort. (which, obviously, has to be taken into account)

**doesn't fit very neatly into this category, I realize