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The Use of Ischial Weight Bearing Knee Ankle Foot Orthoses to Progress Standing and Ambulation Abilities in Children
Christa Weigel1, Sara Beyler2, Laurey Brown1
1Division of Rehabilitation, Department of Physical Therapy, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Aims:
To use a case series to define readiness criteria and outline a collaborative process for application of ischial weight bearing knee ankle foot orthoses (IWB-KAFOs) for individuals with spinal muscular atrophy (SMA).
Methods:
Five individuals with SMA receiving disease modifying therapy (DMT) were included in this retrospective case series. All were able to sit hands-free but unable to stand unsupported. Each individual received IWB-KAFOs for participation in dynamic standing and supported ambulation with an assistive device. On-going collaboration between providers for optimal fit, alignment and use were imperative for success. The 2-min walk test and 10-minute walk/run test were performed as functionally applicable. Additional outcomes for participation in typical environments were recorded based on parent and participant perception.
Results:
All achieved hands-free standing at initial fitting of IWB-KAFOs and progressed to ambulation with an assistive device within four months. Individuals achieved varying distances and speed over time. Supervised ambulation provided an alternative strategy for exercise and increased functional participation across environments.
Conclusions:
For individuals with SMA post DMT meeting the defined readiness criteria, use of IWB-KAFOs can be a successful adjunct to rehabilitation care to improve standing participation and engagement in the home and community settings.
