Dynamic Stability

Bracing for Improved Dynamic Stability: Assisting Active Positional Control, Movement and Balancing

There are a variety of braces and adaptive devices available for children with neuromuscular disorders. Choices between such items are sometimes monumental in their scope, especially because cost constraints prohibit trying every possibility. The framework from which we approach bracing or adapted positioning often contains multiple and dynamic information bases which are not always consciously apparent. My focus here is to define two different basic frameworks which are commonly used and sometimes indiscriminately combined. I will also describe some options within the dynamic framework which I have explored on my nearly 30 year journey as a therapist.
When viewing bracing and adaptations as a whole, there are at least two standard primary goals.
1. ORTHOPEDIC - The more traditional and standard view of bracing and positional adaptations has come out of an orthopedic concept of control in a specific "ideal" position. For example, 90 degrees at the ankle for AFOs or 90/90/90 for adapted seating are fairly standard positional ideals in this approach. Bracing in hip abduction and flexion also follows this line of reasoning. This approach to bracing and positional control has been used for at least 50 years and still predominates for children with neuromuscular and musculoskeletal disorders. Braces of this type are mostly made of rigid materials in an attempt to control position more precisely.
2. DYNAMIC - A relative newcomer is the whole field of dynamic or therapeutic bracing for improved movement and balance control. These have most often been developed out of therapist initiative because of their focus on active movement. Fabrication materials have varying degrees of flexibility in order to permit some amount of movement to occur within the bracing system. Focus is on assisting active movement, postural control and balance rather than maintaining a static position. From the point of view of the more standard types of bracing, these systems can appear flimsy and non-functional in maintaining "ideal" positions of joints. Perhaps it is necessary for a paradigm shift in order for some who have become deeply entrenched in another point of view to begin to explore this approach.
As a pediatric therapist my goal has always been to find new and better ways of assisting movement and postural control and balance to better approximate what we view as typical. I refer to "typical" only because it also appears that these ways of moving are in most cases the most efficient and least energy consuming. When such movement isn't possible, then the goal shifts to efficiency and minimized energy consumption as important functional parameters. This particular exploration will share several useful developments in the area of dynamic or therapeutic bracing. Though the applications are quite divergent in nature, the central core of purpose for each of these systems is the same. It is in understanding better that central core of dynamic stability and dynamic control that will hopefully lead us foreword on an exciting adventure in new possibilities for persons with sensorimotor, neuromuscular and musculoskeletal deficits. It is my opinion that we have just begun to see the tip a huge iceberg of possibilities in this area.