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.

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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 

Making Sense, Part D

By “give more shape to…a disordered product landscape” I mean look for ways to group and classify the on-body devices I've been referencing since Making Sense, Part A. 

Here’s a listing of said devices: 

1. Benik vest 
2. elastic therapeutic tape 
3. TheraSuit (a.k.a., PediaSuit and NeuroSuit)
4. compression sportswear 
5. SPIO (Stabilizing Pressure Input Orthosis)
6. TheraTogs
7. wearable robot 

What are these things? Can we make broad generalizations about their forms and functions?

One of the first things to jump out at me is the fact that these are orthoses, devices designed to “support or correct the function of a limb or the torso.” All but one of 'em, that is. The wearable robot, as conceived by Miguel Nicolelis, has orthotic properties but it's more of a neuroprosthetic device. I’m going to de-list it now for that reason.

Let’s focus, then, on the first six devices -- starting with their forms, i.e., their physical characteristics, and looking for common threads.

Threads.
Hmm...
Fabrics.

These are technical textiles. Maybe homing in on their MATERIAL makeup could help us make sense? Here are some key words and phrases associated with each: 

1. Benik vest: vented neoprene; Terry lined; thermoplastic or aluminum panels 
2. elastic therapeutic tape: cotton strip with adhesive back 
3. Therasuit: breathable; soft; dynamic; hooks and elastic connectors 
4. compression sportswear: form-fitting; made from spandex 
5. SPIO (Stabilizing Pressure Input Orthosis): Lycra; dynamic and multidirectional stretch 
6. TheraTogs: inner foam layer; Velcro sensitive outer layer for affixing elastic strapping

Generalizing: We’re talking about things that are breathable, that have elastic--stretchy--rebound--compression--characteristics, and that, in a couple of cases, have the capacity to have other stretchy things attached to them. 

What about SIZES and SHAPES? Over which areas are they applied?  

1. Benik vest: whole trunk/ torso 
2. elastic therapeutic tape : supplied in rolls and can be applied practically anywhere
3. Therasuit: can cover whole body if all components (e.g., optional arm attachments) are used 
4. compression sportswear: shorts, tights, t-shirts, socks, sleeves and /or underwear 
5. SPIO (Stabilizing Pressure Input Orthosis): up to full-body coverage
6. TheraTogs: also up to full-body coverage

I made an earlier connection between these devices and a pair of hands. Hands have their own material and size-and-shape properties. The fact, for example, that I used to be able to safely align my daughter’s trunk using both hands -- but now that she's twice as tall, I can't -- is a SIZE thing. The fact that my hands can make subtle, real-time adjustments relative to her place in space is a more of a MATERIAL thing.

What am I getting at? Orthotic devices are like hands, but they're different. They’re different than things we call "clothes". They’re different than body casts. They're different than tattoos and other stuff with which we adorn ourselves.

Form follows function. 

Trying to make sense of the functions these forms serve will be the subject of the next post.

Making Sense, Part B

Before I venture into things like if and how the previously mentioned (see Making Sense, Part A) devices and methods work, the promises they may or may not hold, etc., let's start with some definitions.

Note: What follows is based on stuff I was able to readily grab from the Web. I haven't critically reviewed it or made much effort to make it my own. Ergo you ought to look at these as provisional, i.e., tentative. At best. 

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• Benik vest: a neoprene orthosis that's meant to provide upper trunk support (to help a child remain in a sitting position, for example, for an extended period of time) and proprioceptive input. Available with malleable aluminum stays or moldable thermoplastic panels for additional support and protection. [ www.benik.com ]

• Kinesiology tape (more generally known as elastic therapeutic tape): a cotton strip with an acrylic adhesive used for treating athletic injuries and a variety of physical disorders. For our purposes, the product is used therapeutically to facilitate underused muscles or to limit or encourage a specific motion at a joint.

• TheraSuit. NeuroSuit. PediaSuit: a breathable, soft, dynamic orthosis based on the Adeli Suit. Consists of a vest, shorts, knee pads and specially adapted shoes with hooks and elastic connectors that topographically mirror flexor and extensor muscles, trunk rotators and the lower limbs. The suit works as an elastic frame surrounding the body to hold it in proper physical alignment. It also serves to facilitate or inhibit certain movements, assist with the development of optimal posture, help with or supplement the restoration of proprioception, and provide resistance (to increase the strength of the patient).

• Compression sportswear: form-fitting garments usually worn by athletes. They may be shorts, tights, t-shirts, socks, sleeves or underwear and are often made from a spandex-type material. Among other things, these purportedly reduce muscle movement and vibration, and focus the direction of the muscle.

• SPIO (Stabilizing Pressure Input Orthosis): a dynamic bracing system made of a special Lycra blend material that provides a multi-directional stretch with a strong rebound factor. Uses patented compression ratios and design. SPIO is designed to assist stability and provide feedback through deep pressure and tactile stimulation. Advertised to improve functional movement possibilities, limb and body position sense, and general stability and balance.[ www.spioworks.com ]

• TheraTogs: "a live-in exo-muscular system". Made from a patented, proprietary material with an inner foam layer that grips the skin and underlying soft tissues, and a Velcro-sensitive outer layer to which clinicians can affix elastic strapping, a.k.a., the external muscle of the system. Typically worn under normal clothing, TheraTogs replicates successful manual sensorimotor training techniques and enables the wearer to engage in routine activities with improved joint alignment, all day long. [ www.theratogs.com ]

• Wearable robot: a neuroprosthetic device that will allow paralyzed patients to use a BMI (brain-machine interface) to control movements of a full-body exoskeleton. Motor signals will control actuators distributed across the joints of said exoskeleton. Force and stretch sensors distributed throughout the exoskeleton will generate a continuous stream of artificial touch and proprioceptive feedback signals to inform the patient's brain of the device's performance. As for the details of the silk-thin suit itself, I'm having a hard time finding any. I'll keep my eyes open.

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There. We're makin' progress. Some pictures are probably in order soon.