A New Item for the Spina Bifida Program
Wallace Motloch, C.O.(c)
As the spina bifida program has developed at the Ontario Crippled Children's Centre increased attention has been given to the design of devices to meet the specific needs of this group of children.
Earlier products of this program that have been previously reported1,2,3, are the caster cart, the standing brace, the orthopodium, and the gear-type reciprocating brace. An evolutionary pattern has been evident in many of these devices as they have been modified and improved. For the benefit of those who may not have seen the earlier reports, the characteristics of these devices are summarized below:
The Caster Cart
The caster cart (Fig. 1 ) is used for the very young child prior to and in conjunction with bracing. Its specific areas of usefulness are:
It facilitates movement from place to place, both indoors and out, hence it motivates the child to activity and mobility
It improves sitting balance while protecting the desensitized skin of the legs and buttocks
It encourages good play position
It helps develop independence
It aids in upper-limb and trunk strengthening
The Standing Brace
This item (Fig. 2 and Fig. 3 ) has been used effectively for children in the age-range of two to four years. The design has been more or less standardized and the local commercial brace shop has manufactured a number of the devices for use in the Centre's training program. Three sizes appear to be all that are required and when a child has outgrown one size it can be used over again for a different patient. With this device the child can learn standing balance and achieve a swing-through gait with parallel bars or a parallel walker. It permits the assessment of the child in an upright position and evaluation of his readiness for formal gait training and a definitive brace. The advantages of the brace are that it is light, strong, stable, and can be fitted with little or no adjustments. Its chief disadvantage, of course, is that the child cannot sit down.
Since the standing brace has to be removed for sitting, a new design which included knee joints was developed. This modified device, called an "orthopodium" (Fig. 4 ), consists of a light platform to which standard shoes can be fastened quickly. Two lateral tubular supports extend vertically from the platform and curve inward above the hips to the level of the base of the sternum. Knee supports are attached to each upright tube and a broad webbing band supports the seat. The bars are joined at the apex by a quick-release fastener so that with a single motion the sternum pad and the knee support can be swung away and the knee joints released for flexion.
The brace was designed to be worn over clothing so that it can be removed very easily. No attempt has been made to hide or disguise its function.
The Gear-Type Reciprocating Brace
The current model of the gear-type brace (Fig. 5 and 6 ) is designed to facilitate reciprocal gait. The hip joint is mounted to a laminated back panel and fits into the small of the back. The leg segments are coupled in the brace joint with a pair of gears arranged so that flexion of one leg causes extension of the other. A clutch has been added to provide uncoupling for sitting. Ankle splints are fitted to provide a firm base of support for walking.
Although a few steps can be taken without any walking aids other than the brace, crutches are typically used in a four-point gait pattern.
The latest item being developed for the spina bifida program is the parapodium (Fig. 7 ).
This brace is similar in many respects to the orthopodium previously described but differs in that joints are provided at the hips as well as at the knees. Standard shoes are held in the foot plate by a spring-loaded clamp. The upright bars are connected by an anterior crossbar to which the knee pads are attached. The proximal ends of the side bars are connected by a back panel made from 1/16 in. aluminum sheeting. The panel is made in two pieces (left and right) to provide width adjustment. The inside of the panel may be padded to fit the patient and Velcro straps are used to fasten the chest pad.
The unique feature of this brace is the means used to lock and unlock the hip and knee joints. In Fig. 7 the brace is shown in the upright position with the folding handles extended. These handles are used to rotate the upright bars and thus rotate the hip and knee joints. For standing, the joint axes are aligned in the A-P direction. When rotated 90 deg. to the M-L position, the joints are free to flex for sitting, as shown in Fig. 8 . When not in use the handles fold flat along the bars.
The brace may be used in lieu of the orthopodium in cases of pelvic obliquity and/or scoliosis requiring firm support of the trunk.
Wallace Motloch, C.O.(c) is associated with the Ontario Crippled Children's Centre Toronto, Canada
1. Hamilton, Elizabeth, and W. M. Motloch, "The Toronto standing brace," Inter-Clin. Information Bull., 8:7-12, Apr. 1969.
2. Annual Report, Orthotic Research Unit, Ontario Crippled Children's Centre, Toronto, Oct. 21, 1968.
3. Annual Report, Orthotic Research Unit, Ontario Crippled Children's Centre, Toronto, Dec. 15, 1969.