Tuesday, October 20, 2009

Growing into another set of AFOs

This is ALWAYS a struggle...trying to get a new pair of AFOs to work when E grows out of her old pair.

So, here is my current dilemma: basically, we got her new pair, but for lots of reasons, I don't like them. We're trying out the DAFO model. E's previous pair are made of very hard plastic and have some interesting straps to keep her feet down (especially her right foot)--but they work very well. I'm putting together my best side-by-side comparison, to try to convince myself (and everyone else) that I am not crazy.

The Model: DAFO (new, pink) vs. AFO (current, purple) (this took forever to put together! Sorry the details are so small!)

As you can probably tell from the previous posts, E has issues with standing up straight and putting her feet flat. Why on Earth would you create a brace at an angle that promotes her stance in a crouch position?! E has to fight the DAFO to stay upright. The DAFO inner plastic is soft, so it is more "comfortable" but it also allows her to wiggle out of the shoe, no matter how tight you make those velcro straps. And I have put them on TIGHT. Her old AFOs are very rigid, but with the ingenious inner strap she really stays down in the brace. The same strap does put a lot of pressure on the top of her ankle, but she normally does not complain about it, and with a nice tongue to dissipate the pressure, we haven't had any problems (aside from growing out of these braces).

The Motion: DAFO (new; top vid) vs. AFO (current; bottom vid)

Tonight, I tried very hard to get E to move in both sets of braces for a comparison. She didn't want to cooperate, so this footage was shot after a long evening of bargaining. She's not at her best here. Her new braces (and shoes) are bigger and heavier than her old pair (that's always true) so she typically drags for a while. Still, I think she drags both feet, and spends more time with her knees bent (especially the right) with the DAFOs. AND, after less than 10 minutes of being upright, E is out of both the left and right DAFOs by .5 and 1.5 cm, respectively. After 10 minutes with her AFOs, she's out of the right by about .5 cm, and totally in the left one.

The Pros and Cons: DAFO vs. AFO
DAFO (new, pink): Pros--easier for school staff to understand how to take on and off, dissipates pressure well with soft plastic
Cons--heels slip out, braces are bulky and harder to fit in sneakers, badly hinged, encourages crouch (?), heavy
AFO (current, purple): Pros--light, holds E in well, fits in shoes relatively easily
Cons--difficult to put on, straps and velcro easily wear and tear

Am I crazy?


Meadow said...

Wow Amy, this is a tough one to figure out. My Peyton (just turned 3) has AFOs with straps like your new pink DAFOs, hard plastic. She must not have quite as much of an issue with crouching, but she isn't really even walking steadily with a walker yet, so it's tough to make a comparison.

Although E seemed to follow directions pretty well in your video, I always think it's tough to make a decision based on behavior if you know your kid is tired. I didn't notice a *huge* difference in the two videos, but then I don't know E, you know?

When we first got our AFOs, Peyton stayed in them wonderfully, then after a while she started to pop out a bit. Our orthotist added pads to the toebed, which it looks like are also on yours, but also a little half-circle/oval pad on the very bottom of the top piece right at the back, positioned over the heel. It really seems to help keep Peyton in her braces so much better. Maybe try something like that?

Good luck!

Erin said...

Have you asked Elena which ones she prefers? She might have a pretty strong opinion, which could definitely help you make a decision.

Yesterday I had to go to a client’s office for the day, so I had to dress up. I wore the lowest, most stable heels I have because my knee is still a work-in-progress. Even with my conservative choice of footwear, walking was not very comfortable, so I avoided it as much as possible, and when I was walking I was distracted by the discomfort. Later, when I was able to change into sneakers, I felt immensely better, and was able to do quite a bit of walking all over DC without much thought or trouble. My point is that the happier and more comfortable you are in an activity, the more you are going to do it, enjoy it, and not worry about it. Perfection of form, strength, etc., can follow from there.

Anonymous said...
This comment has been removed by a blog administrator.
Luci said...

Would it be possible to take a video from the side. It is often a lot easier to see changes there.

It is hard to tell but i am wondering if the DAFO gets her feet a bit flatter on the floor? it looks like she has more flexion at the ankle in the new DAFO - is this to get a bit of a stretch on her calf? it might be instead of serial casting to stretch the calves for a while?

just thought sof why i would put orthotics like that on. did the physiotherapist/ ortotist explain it to you at all??