Dynamic Flexible Compression Bracing: A New Generation of Orthotics
Nancy Hylton, PT, LO
Stabilizing Pressure Input Orthosis (SPIO) is a part of a new generation of ultra flexible bracing systems which are designed to provide intimate and precise somatosensory information and dynamic stabilization to assist active alignment, postural control, balance and movement control, in persons with neuromotor impairments.1 Rather than having directional or counter-force control panels with varying angles of pull, SPIO is designed to provide even circumferential compression to the trunk and extremities. This helps the wearer achieve active midline control and balance of movement, via balanced stability and even deep pressure input. Other dynamic stabilization bracing systems in use at Children's Therapy Center of Kent (CTC) include circumferential supra-malleolar Dynamic AFO (SMDAFOs), Neoprene and molded polyethylene knee extension orthoses, 2 mm polyethylene custom molded derotational TLSOs, ultra thin circumferential custom molded wrist-hand orthoses, custom contoured medium density foam seating and lying support systems, and sensory level vibration and electrical stimulation.
Exploration with Neoprene compression preceded our use of SPIO in the 1980's at CTC. Neoprene bracing for a pediatric CP population was developed in association with BENIK, Inc. (www.benik.com). Our success with Neoprene bracing for hands, trunk and extremity stabilization led to the exploration of lighter weight and more breathable compression fabrication materials.
The dawn of SPIO came from the ingenuity of a single parent, Cheryl Allen, as she explored therapeutic support "garments" for her 2 adopted disabled sons. Using her sons as test subjects, she explored different types of elastomeric fabrics and finally discovered a specific multi directional stretch Lycra-blend material with unique properties and very strong "rebound memory". It was soon realized that a double layer shoulder-trunk-hip orthosis fabricated of this unique Lycra provided as much, if even more, improved active trunk-head centering, balance and movement control as the Benik neoprene vests previously used.
In the same way, a double layer SPIO upper arm compression band worked equally well as the neoprene compression band for my son with Spastic Quadriplegia. Compliance was better in both situations, because the SPIO was much more comfortable to wear, and it produced minimal restriction of tri-planar movement.
The SPIO compression system was patented in 1994 by the Allens and all custom fabrication was done by Cheryl Allen during this period. In 2006, the SPIO system, including patents, compression specifications, and company assets was purchased by CTC, because Cheryl was no longer able to continue the business of orthosis fabrication. Currently, the SPIO system can be found at www.spioworks.com.
SPIO bracing appears to work by providing enhanced sensory input to deep pressure and precise touch receptors, which interface with 3-D body awareness necessary for active balance and movement control. These receptors are part of the epicritic somatosensory system, along with proprioception and vibration, supporting the function of environmental exploration and learning within the CNS. Its counter-part, the protopathic system, including general tactile and pain receptors is designed for survival, ANS and cortical alerting.
Total body 3-D representations, located in the premotor strip and along the medial parietal central gyrus, receive one to one area specific input via the epicritic somato-sensory system. Redundant representation, on the three additional central gyrus areas, probably allows significant re-leaming possibilities for those with extensive parietal lobe sensori-motor damage. Any bracing or therapy system which provides enhanced somato-sensory input to proprioception, deep pressure, precise touch and vibration receptors should positively impact motor control, balance and active stability.2
I also speculate that hard-wired Central Pattern Generator (CPG) mechanisms may be partially responsible for some of the immediate changes in active centering and motor control, which are seen in the donning of SPIO compression in some individuals. Because the CPGs are hard-wired mechanisms, which make our movement control easier, they are not learned, but are present at birth.
The CPG for locomotion is the most studied and understood of the CPGs. It is a reciprocator which is activated via the locomotor center in the reticular formation of the brainstem, and it requires specific typical somato-sensory and biomechanical factors to become and remain active. The CPG related to "fidgety movement, has been mostly studied in pre-mature infants and newborns, and causes us to make small movement adjustments that assist balance, body awareness and motor control.3
The lengthening-shortening reactions, which underlie balance and righting mechanisms, appear to follow the same rules as other CPGs; and early research in the development of typical sitting balance in infants suggests it might also be a CPG.4
SPIO, and other dynamic stabilizing support systems, may provide the needed sensory and biomechanical environment necessary to access these CPG mechanisms, which are oriented around active midline biomechanical alignment and muscular stabilization.
Typical active postural and movement strategies, such as erect trunk, alignment of body over feet, and tri-plane micro-movements connected to balance, activate CPG mechanisms. Because the CPGs are active movement systems, they do not respond to passive or stiff orthotic support. Instead, any orthotic support, that restricts small graded increments of typical tri-planar movement, tends to deactivate dynamic stability and the CPG mechanisms, and thus, make active movement control more difficult.
Since May of 2007, SPIO flexible compression orthoses have been available in an ever increasing number of standard sizes. Prior to that time, they were all custom fabricated to patient measurements. Custom fabricated SPIO orthoses are still available for those special situations where standard design or standard dimensions are not appropriate.
SPIO double layer compression TLSOs are currently available in 9 different standard sizes from 41cm chest measurement to 77cm chest circumference. This orthosis is very helpful in persons with axial instability and poor shoulder-trunk-hip control due to hypotonia, spastic and athetoid CP. Improved head, shoulder, trunk, hip control is generally seen within minutes in persons who are helped by this type of orthosis. For this reason, standard small, medium and large sized SPIO TLSOs also serve as very useful trial orthoses, helping practitioners to determine if flexible compression is a helpful therapeutic modality for a particular patient.
Although the standard style and sizes offer excellent support in most cases, SPIO compression TLSOs can be customized by adding extra abdominal diagonal reinforcement panels (often more helpful for conditions such as "prune belly syndrome"), or even a third layer of compression for a larger individual.
A custom-to measurement orthosis is also often necessary for persons who are extra slender or extra wide, for the length of their trunk segment. It is possible to narrow the back panel significantly with either custom or standard SPIO Compression TLSOs for persons who are prone to overheating, though this has rarely been a problem in our more than 15 years of experience using these orthoses. The SPIO fabric is very breathable and comfortable to wear.
Whether the front panel is customized or standard, it is also possible to use it in connection with a custom molded back panel, for severe trunk collapse or emerging or dynamic scoliosis. At CTC, we typically use a Neoprene panel with attached thin aqua-plast (fabricated to measurement by www.benik.com which is easily heat moldable, using a standard iron, with the person in prone. This custom moldable back can be modified, later, as necessary. In more complex situations, we have also combined a SPIO compression front with a custom molded thin polyethylene or copolymer back and side panel, with very good results.
In older teenagers or adults, a SPIO Compression TLSO can be fabricated to custom measurements, double layer, with or without added abdominal reinforcement, in a slip on body suit style with cap sleeves and partial front zipper opening. One 28 y.o. woman with moderate spastic diplegia stated that this orthosis made it "possible for her to manage a full work day without back pain and increasing spasticity" over the day.
Single layer Upper Body Orthoses are available in 12 standard sizes; Lower Body Orthoses are available in 17 pants standard sizes. They have proven very helpful in persons with sensory awareness deficits which impact motor control and functional skills. They appear to provide an enhanced "sensory edge" to the body part they cover. Used in combination with a SPIO Compression TLSO, it provides a very helpful sensory connection from the trunk to lower part of the body for improved function in upright. Double layer stabilization provides a much increased stabilization to the lower trunk and pelvis. Double Layer Lower Body Orthosis, in our experience, has been useful in providing improved hip and leg stability and movement control in persons with moderate to severe Spastic Diplegia.
SPIO Upper Body Orthosis can also be customized, by adding diagonal abdominal reinforcement or similar reinforcement across the scapular area. We recently custom fabricated a double layer shirt with a single layer sleeve and narrow Neoprene back closure for a young infant with a large thoracic lymphangeoma. The baby immediately was able to push up on forearms in prone and actively balance more easily in supported sitting. A modified SPIO Upper Body Orthosis has also proved very helpful in the treatment of congenital Brachial Plexus Injury. A double layer sleeve orthosis generally works better to provide scapular and arm stability in older children or adults.
The combination of SPIO Upper Body and SPIO Unitard Orthoses provides double layer stability to the shoulders, trunk and hips with single layer enhanced sensory awareness to arms and legs. This combination of orthoses has proven very helpful for persons with Spastic or Mixed Quadriplegia, who have sensory awareness deficit, negatively impacting their balance, active stability, motor and tone control. Persons with Rett and Angelman's Syndrome have profound sensory awareness deficits which contribute to their motor control impairments and also often respond very positively to this type of SPIO support. Enhanced deep pressure input appears to provide significant benefit in sensory body awareness to these persons and circumferential axial compression helps them with stability and balance impairments.
Testing to see if deep pressure compression is helpful to balance and movement control can be accomplished with "SPIO assessment kits" or light pressure wrapping with a typical elastic sport bandage. If deep pressure input is helpful, changes in tone control, movement and balance control are often noticed immediately or within a few minutes. Therapy sessions are ideal situations for trial of this type of orthotic support as therapists are trained to assess changes in motor function and control. Functional changes with SPIO deep pressure support bracing are often very obvious to parents and teachers, as well. Especially in persons with sensory awareness deficits, effects of SPIO Compression are best tried within their typical environment. At a local facility of children on the Autism spectrum, it has been very helpful to do our assessments with therapists, teachers and parents, as well as, the children involved.
Nancy Hylton, PT, LO
Children's Therapy Center of Kent
10811 Kent Kangley Road SE
Kent, WA. 98030
For more information contact
Children's Therapy Center of Kent
- Shumway-Cook, A., Woollacott, M., Motor Control: Theory and Practical Applications, Lippincott Williams & Wilkins, 2000.
- Class study, "The Brain in Three Dimensions," Shelby Clayson, OTR, MS, Professor Neuro-Physiology, Pacific Luthern Univ., Tacoma, Wa. 1998.
- Cioni G, Prechtl HFR, "Preterm and early posterm motor behavior in low risk premature infants", Early Hum Dev . 1990; 23:159-191.
- Hirschfield H, Forssberg H, "Epigenetic development o4 postural responses for sitting during infancy", Exp Brain Research , 1994: 97:528 -540.