AFOs and pre-crawler

My niece had a traumatic birth and was on life support for the first week of her life. She is now 13.5 months old and has crushed all the early predictions.

She was able to sit at about 10 months of age, and can now sit up from laying down and go back to the floor again. It sometimes takes a little while for her to get her legs around the front.

She has been diagnosed with mild CP (cerebal palsy), and has muscle tightness in her legs and she points her toes and her feet twist in (sometimes not all the time). She has recently been given AFOs (the hard plastic splints from toes to below knees) to lengthen her achilles. She is meant to wear them all the time, except when in bed.

The AFOs make it harder for her to do the things that she has finally learnt how to do, e.g. go from laying to sitting. I wonder if they will upset her development, even temporarily. They will also make crawling harder bc of the way they hold her feet at 90deg.

I also worry about them causing muscle weakness.

Any others have experience with AFOs in those not yet walking? crawling?

Ta,

Kate

Hi Kate, I'm a physio, although I haven't worked with children in a long time.

From what I recall, they won't be a problem. They will temporarily make things a little harder, as she'll have to find new ways of doing things she's already worked out. But even in the short term they are of huge benefit to her. Crawling is a very variable skill, some babies don't do it at all, some do it in very different ways. What is important is that all babies will walk - so the AFO's are preparing her legs for the vital skill of walking. It's more important that she's physically in the right shape to walk rather than worrying about crawling and sitting at this stage. If she doesn't wear the AFO's she is likely to develop contractures, meaning her feet will stay pointed. And it is impossible to walk if only your toes touch the ground. So, the answer is, developmentally those AFO's will help her. And they won't cause muscle weakness.

Hope that helps!

Hi Feathertop

Thanks for your advise. I recognise that the AFOs are giving her better anatomical position for walking, and that of course is our ultimate goal, but that is probably awhile off.

I have been reading up on Doman Therapy (What to do about your brain injured child? Glen Doman -horrible title but really interesting book), where they found that it is really important for babies to go through all stages of movement, even for short periods.

Children that that put in calipers and all sorts of contraptions actually did worse than those who went hope and spent more time on the floor going through the different stages at their own pace. I believe he was the guy who started patterning therapy for those with brain injuries.

Have you heard of Doman Therapy at all?

I had AFOs as an older child (different reason), and i know if you are wearing them all the time that they can cause muscle weakness bc you learn to rely on them.

I would also be interested to hear if there were any other parents whose littlies had AFOs from a young age.

Thanks again for your reply,

Kate

Hi Kate, I haven't heard of Doman therapy, do you know where it comes from (US, UK etc)? Is he a dr, physio, surgeon? I'm going to pop off and do some more research now, this is very interesting!

Pretty sure Glenn Doman is from the US. He is a doctor. I have misplaced his book at the moment but will take another look. His book is available thru Amazon if you want to read the abstract.

Have done some hunting Kate, and haven't found much at all. I can't find any published articles written by him on two major medical literature search engines. I have found a couple of mentions of Doman therapy which say it was proposed in the 60's - does that sound right to you? Unfortunately the only article I have found so far says that his theory has been discredited.

Have you heard of Bobath therapy at all? It is a really interesting technique, very widely practiced and applied to children in particular with neurological problems.

Thanks Kate, have had a look at Amazon now, he's got tons of books out hasn't he? But I'm afraid he doesn't have any research published in the peer reviewed medical literature at all (I've looked in the US National Library of Medicine and the National Institutes of Health). I would have to say I'm quite sceptical after reading some of the info available, to be honest it sounds like one mans theory rather than a well recognised and researched approach. I wouldn't place any value at all on any outcomes supposedly achieved from this therapy approach given that he hasn't subjected his work to peer review at all. Sorry. If I was you I'd look into the Bobath approach, it is developmentally focussed and also looks at stages of development and movement precursors (eg you crawl before you walk). I know that probalby wasn't what you wanted to hear, but I do wish your niece all the best and it sounds like she's overcome some enormous hurdles early on to be doing so well now.

Doman Therapy originated in the 1960s, and is still running in the US through The Institutes for the Achievement of Human Potential. I looked Doman G up on Pubmed, and was also surprised at the lack of articles published by him. There are are a few from 2004-5 but largely theoretical, and there is one from 1960. There are other papers that mention Doman but largely as an alternative therapy.

One criticism i have found of Doman, is that to follow it completely and thus get 'optimal' results, it requires many hours every day for an extended period. I don't know how practical this is, and if you don't do it properly, are you to blame for your child not reaching potential? I do like his theories though!

I will look into Bobath. I haven't heard of that, but googling it, it sounds similar to Doman. There were also parents who had tried both. Is this practised in Australia? Victoria?

Thanks so much for your time,

Kate

Hi Kate,

Yep Bobath is well recognised in Australia, the Australian Physio Association holds Bobath courses regularly. I used to also work with a speechie who had extensive Bobath training and worked at the Bobath centre in the UK, she was fantastic with children with disabilities. There is an Aussie Bobath association, perhaps they could provide some information? You might also be able to find a Bobath trained physio on the APA website. Is your niece in Melbourne?

Not in Melbourne, but in rural Victoria.

Thanks for your help.

I have a vague feeling she is up near me, northeast?