Helping Kids Be Kids: Optimizing Outcomes for Pediatric Patients

Ian Green was just three years old when the unthinkable happened. He suffered a traumatic brain injury after accidentally pulling a large television set onto himself. His doctors said he’d never walk or talk again.

Thanks to a comprehensive team approach to pediatric rehabilitation and mobility, a unique knee ankle foot orthosis (KAFO) was custom fabricated for Ian. Now a rambunctious six year old, Ian isn’t just walking, he’s running.

“When I started working with him, he was still in a wheelchair,” says Ian’s orthotist, Nikki Hooks, CO, BEP, FAACPDM, a regional director and clinician at Ability Prosthetics & Orthotics Greenville and Spartanburg, South Carolina, patient care centers. “We designed a specialized KAFO to help Ian out. His orthosis can be used as a KAFO to help with knee and ankle control or, with the pull of a pin, can become an AFO. This gives a lot of adjustability within a single orthosis.”

Ian’s physical therapist takes the above-knee section off when working with him on gait training and quadriceps strengthening. “The AFO controls Ian’s ankle,” Hooks explains. “It provides drop foot correction in swing phase and a stable base of support in stance phase. In other words, the KAFO helps create a safer and more energy-efficient gait pattern for Ian. The above-knee section controls the knee, prevents further injuries, and improves his stability when he’s not being supervised by his therapist.” This has been especially helpful for Ian because he tends to hyperextend his knee when he’s running, walking, and doing other upright activities.

This type of hybrid KAFO can also be beneficial for pediatric patients with Charcot-Marie Tooth, stroke, increased tone, or weakness, Hooks says. However, she stresses, designing orthotic solutions for pediatric patients is not a one-size-fits-all process. “A generic treatment plan just won’t work because the pediatric patient population is so varied. You really have to think through the entire process, including the external and internal factors that are part of the patient’s treatment plan.”

When designing an orthotic solution for one of her pediatric patients, the first thing Hooks does is find out what the patient’s, parents’, and therapist’s goals are. She then determines what type of orthosis would achieve those goals and provide the biggest biomechanical benefit. She makes sure the final orthosis she provides is as lightweight and easy to put on as possible. “If it’s thin, lightweight, and easy to put on, it’s usually easier to get into a shoe,” she says, which can go a long way toward achieving patient compliance.

In some instances, achieving patient compliance means choosing a solution that may not be the most biomechanically beneficial for the patient.

“If the patient or the parent says, ‘We’re absolutely not wearing that,’ sometimes having a backup plan is better. We want the patient to be compliant and reap the benefit from what we’re doing. So sometimes that trade-off makes all the difference,” Hooks says.

“The treatment goals and the desired clinical outcomes for these patients are very different than a typical adult stroke patient or a lower-limb amputee. Patient presentations differ greatly, with sometimes one side or both sides involved, and sometimes upper limbs also requiring attention,” she says.

Serving as part of a multidisciplinary care team is a key aspect of Ability’s approach to achieving successful outcomes for pediatric patients. “We work closely with the physical or occupational therapist who is also treating the patient. This allows us to design and fit an orthosis that will best support the clinical outcome as seen by the O&P profession, the therapist, and the patient.”