2020 Patient/Family Conference: Orthotics/Bracing for CMT
Charcot Marie Tooth Association・2 minutes read
The speaker, an orthotist at the CMTA Center of Excellence in Boston, focuses on AFOs for CMT patients to improve gait, balance, and confidence in walking. Various types of AFOs, particularly carbon AFOs, are discussed as effective tools in restoring ankle stability, aiding in propulsion, and preventing fatigue for CMT patients.
Insights
- AFOs play a crucial role in restoring normal gait and balance for CMT patients, addressing issues such as foot drop, impaired balance, and muscle weakness. Various types of AFOs, including ground reaction AFOs and carbon AFOs, offer significant benefits by improving stability, muscle function, and confidence in standing and walking.
- Proper training and guidance are essential when using AFOs to optimize their effectiveness, as patients may maintain previous gait patterns out of habit or safety concerns. Ground reaction AFOs, particularly carbon AFOs, have shown to enhance muscle strength, balance, and reduce fatigue during walking, emphasizing the importance of correct posture, muscle activation, and pelvic motion for confident walking.
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Recent questions
What are AFOs for CMT patients?
AFOs aim to restore normal gait and balance.
How do AFOs improve balance?
AFOs enhance stability and confidence in standing and walking.
What types of AFOs are available?
Various AFO designs cater to different needs.
How do AFOs impact gait phases?
AFOs assist in swing and stance phases of walking.
How do AFOs benefit CMT patients?
AFOs improve walking speed, confidence, and balance.
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Summary
00:00
Improving Gait and Balance for CMT
- The speaker is an orthotist at the CMTA Center of Excellence in Boston, focusing on CMT patients.
- The speaker's interest in CMT began when he encountered numerous CMT patients at Mass General Hospital.
- The program's focus is on what to expect from AFOs for CMT patients.
- AFOs aim to restore normal gait and balance for CMT patients.
- CMT patients may experience foot drop, impaired balance, lateral ankle instability, fatigue, and painful high arches.
- Most CMT patients have an anterior cavus foot and may suffer from hammertoes and lack of confidence in walking.
- Normal gait involves good walking speed, propulsion, pelvic motion, steady head and shoulders, natural arm swing, and dynamic balance.
- Gait is divided into swing phase and stance phase, with a focus on toe clearance and three rockers for proper foot movement.
- Balance relies on muscle strength, vision, vestibular function, and proprioception, which is often compromised in CMT patients.
- Ground reaction AFOs can improve balance and proprioception for CMT patients, enhancing stability and confidence in standing and walking.
13:21
"Enhancing Walking with Various AFO Designs"
- Various types of AFOs are discussed, including a solid ankle AFO, IDEO, simple silicone SAFO, ground reaction AFOs from Allard, DR3, Double Helix, exoskeleton AFOs, and custom articulated AFOs.
- These braces aid in the swing phase of walking, particularly helping with toe pick up, which is 40% of the gait cycle.
- Managing stance phase is crucial for CMT patients, focusing on the three stance phase rockers: first rocker, second rocker, and third rocker (heel rise).
- Achieving heel rise (third rocker) is responsible for 70% of propulsion in walking, leading to better gas mileage and reduced fatigue.
- Different AFO designs offer varying levels of support for the stance phase rockers, with carbon AFOs being highly effective in restoring ankle stability and aiding in propulsion.
- Carbon AFOs help strengthen muscles by allowing them to work more normally, leading to improved muscle size and strength.
- A comparison between identical twins with and without AFOs shows the significant impact of ground reaction dynamic carbon AFOs on walking speed, confidence, and balance.
- Ground reaction AFOs provide more benefits than traditional AFOs placed behind the leg, offering better support for propulsion and balance.
- Training is essential when using AFOs, as patients often maintain their previous gait patterns due to habit and safety concerns, necessitating guidance to optimize the brace's effectiveness.
26:30
Optimizing gait with AFOs: Key strategies
- Patients need to experience corrected gait with AFOs in a safe environment during initial training in the office.
- Military analogies are used to explain correct posture and muscle activation with AFOs.
- Gorillas' posture is contrasted with soldiers' to emphasize muscle activation differences.
- Contralateral arm swing is crucial for powering legs during walking.
- Pelvic motion is key for confident walking, with emphasis on side-to-side motion.
- AFOs put feet on automatic pilot, ensuring restoration of stance phases and consistent movement.
- Carbon AFOs improve balance, dynamic balance, and reduce fatigue during walking.
- Ottobock Reaction plus AFOs are recommended for patients with foot weakness but minimal deformity.
- Stance control KAFOs may be necessary for patients with weakness above the thigh.
- Carbon AFOs can enhance balance and confidence, aiding in activities like golfing.
39:39
Pediatric Bracing: Preventing Deformities, Enhancing Balance
- Bracing is crucial for pediatric populations to prevent deformities and enhance balance.
- Orthotists can use inserts in shoes to counteract predicted deformities in children.
- Early orthotic treatment can prevent fixed deformities in ankles from progressing.
- The Arizona brace, originally for arthritis, immobilizes the foot and may not be ideal for Charcot-Marie-Tooth disease.
- The TurboMed brace, designed for foot drop, is durable and suitable for active individuals.
- Ground reaction braces like the Hanger IDEO or Fabtech PDE are effective for balance and propulsion.
- The Allard BlueROCKER is durable but may break, with alternatives like the NEURO SWING AFO available.
- Ankle fusion can impact balance and strength, potentially requiring a carbon AFO for support.
- For severe supination, the Allard BlueROCKER or Ottobock Reaction plus are recommended AFOs.
- Custom foot orthotics can alleviate pressure on lateral struts in AFOs, with medial struts as an alternative solution.
52:29
"Improving Stability with Ground Reaction Braces"
- The speaker has weak thighs and experiences frequent falls due to knee instability, currently using a basic white propylene brace that goes under the knee.
- Ground reaction can be optimized with different types of braces, such as a custom dynamic carbon AFO that extends up to the knee and has an extended footplate for better stability.
- To prevent knee buckling, it is recommended to use a brace that extends up to the top of the tibia for maximum leverage.
- Ground reaction braces can also improve balance, allowing the user to stand without support and look upwards.
- Ground reaction AFOs are generally not necessary for children under 10, except for unique cases like idiopathic toe walking, where they can be beneficial in breaking the habit.
