HANDS-ON SESSION
Gait Optimization & Training for Pediatric Orthotic Users
As a continuation of the Gait Society's hands-on session from last year's AAOP Annual meeting, this session focused on the crucial realm of tuning and gait training in orthotic care for pediatric patients. Led by Donald McGovern, CPO, FAAOP, Shirley Ryan Ability Lab, attendees learned strategies to tune AFOs and provide gait training for optimal mechanics, prevention of habitual gait deviations in pediatric orthotic users, and patient outcomes.
McGovern reminded attendees that, "Joints are formed more by muscular forces than by the pull of gravity." Notably, a child's skeleton is predominantly composed of cartilage, a flexible and resilient tissue. The process of ossification, or the conversion of cartilage to bone, initiates in specific areas of the skeleton. Among the tarsal bones, the heel takes the lead in this ossification process. In girls, this transformative stage typically begins between the ages of 4 to 6, while in boys, it commences slightly later, around 5 to 9 years of age. These developmental milestones highlight the dynamic and gender-specific nature of skeletal maturation during childhood.
McGovern underscored the multifaceted influences of environmental and personal factors on pediatric orthotic users, emphasizing the pivotal role of orthotists in not only fitting but also fine-tuning orthoses to optimize function. Attendees were equipped with tools to discern common gait deviations, assess and refine gait patterns, and employ effective gait training techniques, including verbal cueing.
McGovern's insights highlighted the dynamic nature of pediatric orthotic care, where continual adjustments are paramount to accommodate the evolving needs of growing bodies. Case studies illustrated the transformative impact of early intervention and comprehensive therapy on long-term functional outcomes, showcasing the synergy between orthotic interventions and physical therapy.
As an example, McGovern told attendees that the alignment of bones plays a pivotal role in achieving balanced muscle development, influencing the formation and structure of the skeletal system. Optimal bony alignment contributes to muscular balance, fostering a positive impact on bone development. Furthermore, proficient walking patterns contribute to the stretching and strengthening of muscles. In turn, the ability to walk effectively becomes a therapeutic element in itself. The success of physical therapy, particularly when initiated early in a child's development, yields significant results. However, the crucial factor in the effectiveness of these interventions is the support of a family dedicated to the treatment process.
Through a blend of theoretical frameworks and practical applications, participants gained a comprehensive understanding of the nuanced balance between orthotic tuning and gait training in nurturing optimal gait mechanics and skeletal alignment in pediatric orthotic users. This session illustrated the evolving landscape of orthotic care, where orthotists play a pivotal role not only as providers of devices but also as facilitators of holistic, patient-centered care journeys.