Sunday, August 16, 2015

AFO's and Cerebral Palsy: Do or Don't?

Although it remains one of the main issues / topics discussed during almost every family meeting or training session, I haven't quite given AFO's (all orthotics in general) the attention it deserves.  The general perception on this issue is, for the most part, driven by untuition.  In other words, the feet are distorted so let's do something to straighten (or fix) them.  Despite this intuition, the same question arises with alarming regularity:

"Should we use them or not?"  

I have never been a big fan of blanket responses...meaning that there is very little I can answer with a short "Yes" or "No".  With respect to AFO's, the reality of what you should do will reveal itself once you walk yourself through a series of steps and practical questions.  This is to say that, the question of "should we or shouldn't we" is far to simplistic...this needs to be examined with a more comprehensive process and the "answer" is distinct for every family.

Every family will need to flash this question through their own "prism" and ultimately decide what is best for them and their shared value system...which is why I find it is much more efficient to avoid blanket responses and set a specific framework of understanding and examination so that every family will ultimately arrive at the most productive response.  The first practical question to ask yourself is:

What is (are) your specific intention(s) of using AFO's? 

AFO's (and orthotics) have been a rehabilitation option for hundreds of years.  The main difference / evolution has been that the materials used are lighter, customizable, and more efficient to manufacture...however the general mechanical premise is the same.  I mention this for a specific reason:

If the intention / objective of using AFO's is to reverse or "fix" a biomechanical distortion, this would be an over-simplification of a vastly more complex situation.  

Meaning that, historically there has been no significant evidence or research that points to the premise that AFO's reverse biomechanical distortion.  We then come to the next level of questioning and formulation:

If they do not reverse or fix anything, what use do they serve?

Again, the issue isn't whether they are good or bad, but how they are used and to what end.  AFO's are excellent adjuncts / complements to larger rehabilitation strategies for children who are either ambulatory or who demonstrate some level of weight-bearing (partial) directly on their feet.  Therefore...

AFO's are extremely valuable when the main objective is additional support and safety within a larger rehabilitation strategy for walking improvement / development.  

Foot Orthotic with Knee Orthotic
In other words, they can provide a significant window of opportunity to amplify and/or expediate the development process by imposing a small amount of support to otherwise weak articulations so that the ENTIRE biomechanical organism (the whole body) can engage and interact as a it is meant to do.

In some cases, this formulation can be overwhelming...and whereas more information is usually helpful, sometimes it can confuse as opposed to clarify.  Therefore, I can break down the process into something that is likely to be more user-friendly and easier to process.

Helpful "Do / Don't" Checklist

1. The use of the AFO associated with pain or discomfort.  DON'T

2. The use of AFO's results in more enagement and interaction with the environment.  DO

3. Is your child relatively functional and have some general weight-bearing ability already in place?
Yes --- DO
No --- DON'T

4. My goal is to reverse deformities in the foot. --- DON'T

5. The use of AFO's are part of a larger strategy. --- DO

In reality, this "checklist" is quite generic...but it serves to amplify the central premise that AFO's are neutral to the question of good or bad...right or wrong.  It is the specific intention that sets the framework for their efficient use.  It is easy to get caught up in the laws of contradiction...which is to say that, if their use is GOOD then their non-use is BAD.  The law of contradiction is a reality that simply states if one thing is 100% good all the time, then the opposite to that action is bad 100% of the time...which is far from the reality.

Again, this formulation is something that MUST be put through each family prism.  Therefore, it is perfectly acceptable that my very perspective is dismissed and discarded...but the issue is not convincing or "conviction" as such, rather to ensure that decisions are made VIA some form of analysis and exploration as opposed to the more simplistic (and perhaps convenient) mechanisms.  

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