Dynamic bracing: elastics for patients with cerebral palsy, muscular dystrophy and myelodysplasia

Conventional bracing places constraints on the determinants of gait, which in the borderline patient, may derange gait as much or more than the postural deformity being treated. A small number of children with cerebral palsy, spina bifida, and muscular dystrophy were treated with below-knee orthoses (BKO) along with elastic bracing of the remainder of the limb. The elastics were used to augment muscle power in weakness, oppose spastic muscles, supply antagonism to unopposed muscle, and improve function. The key elements in this system include proximal attachment of elastics to the below-knee orthosis resultin in effective knee action independent of foot control; variable 2-joint function of elastics; and emphasis on a BKO-shoe combination, which positions the knee in front of the ankle at midstance. Because a small number of components are employed to produce a variety of actions, an understanding of the mechanics fo gait is needed for the rational application of this method of treatment as well as for the selection of suitable patients.