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Big Strides in Technology for Pint-Sized Independence

“Tuning” is a revolutionary approach to orthotics that Marianjoy is using, and has been using it since the procedure was published two years ago. It is making a big difference for patients like Maya, who has made tremendous progress with her ability to walk in just a year. “It’s really changed her life,” says Isabelle, Maya’s mother.

As Maya cruises down the hallway with her crutches, she wears a confident smile while her therapists and mother clap for her. It’s hard to believe that just a year ago, Maya couldn’t even stand on her own. Maya was born with a developmental disability that causes toe-walking. This rapid improvement is thanks in large part to the new technology the Marianjoy Pediatric Team is using: Tuned Ankle Foot Orthosis Footwear Combination (AFOFC, or “tuning” for short).

Maya, now six years old, has been coming to Marianjoy for serial casting since she was two. Serial casting is a common practice involving putting a tightened muscle area—usually an elbow, wrist, knee, or ankle—into a cast for one to six weeks. The plaster or fiberglass cast stretches out the affected muscle group and is a non-invasive alternative to surgery. Maya has always been enthusiastic about her therapy, even as a toddler, thanking the therapists the first time she was casted.

Although casting was helping Maya, Dr. Mary Keen, Medical Director of Pediatric Rehabilitation at Marianjoy Rehabilitation Hospital, was inspired when she came across the new Tuned AFOFC technology published by Elaine Owen of the Child Development Centre in the UK. She recognized it as something that could vastly improve gait challenges for Marianjoy’s pediatric patients—like Maya—especially in conjunction with the serial casting Marianjoy was already doing.

Tuned AFOFC is the process of selecting and adjusting the design features of the orthotic and footwear so that the AFOFC achieves optimal performance in gait. Owen says that using Tuned AFOFC correctly can result not only in improved gait, but also standing balance, posture, activity, and participation for patients. In addition, the technology can normalize joint or bone deformities; muscle length, strength, and flexibility; as well as motor learning.

This technique relies on the cooperation of a comprehensive team consisting of a doctor, therapists, and orthotics manufacturers. “Not every hospital can achieve success with this method,” says Ginny Girten, Pediatric Program Liason and physical therapist. “Marianjoy is ideal for this approach because our philosophy is already so team-based in its approach; it is a natural solution.” Once Owen published her findings in 2010, Dr. Keen orchestrated training for the Marianjoy Pediatric Team to learn the new process.

Already long-time partners of Marianjoy, Scheck & Siress was the perfect orthotics company to partner with for the new Tuned AFOFC procedure, and a representative received training with the pediatric team. Scheck & Siress and other tuning-trained orthotics companies custom-make the orthotics for each patient, and they adjust the equipment as needed when patients’ bodies change from improvement or growth.

This procedure is especially instrumental for children because of their constant growth—in fact, Maya comes in every few months. “Maya was popping out of her braces all the time before, but not anymore,” says Isabelle Townsend, Maya’s mother. “We really trusted Dr. Keen, so we took her recommendation.” Owen, herself, acknowledges that the new technology challenges traditional beliefs; the seemingly simple process is actually revolutionary.

“This is changing a lot of kids’ walking,” Girten asserts. Through slow-motion playback from the pediatric department’s sophisticated video camera, made possible by funds raised by the Marianjoy Auxiliary, the whole team is able to analyze the patient’s gait together, watching for things like heel strike. They are then able to determine the effectiveness of a brace, down to less than a single degree of inclination. “This is much more dynamic,” adds Girten. “It’s the best approach to using orthotics that I’ve seen and the outcomes are impressive.”

Maya was one of Marianjoy’s first patients to try the new approach, and they saw improvement right away. “She quickly developed the ability to stand on her own without support, which she had never been able to do before,” says Trinette Carney, physical therapist. “We’re changing our therapeutic approach as she’s changing.” Maya comes in every few months for tuning, since she is making so much progress and growing so quickly. She has gone from a 15% raise before starting the Tuned AFOFC procedure to 10%. Now, she only uses a walker for security, and she is able to walk with crutches. The team’s current goal for Maya is a longer stride length and a better heel strike. “It’s all about ‘perfect practice,’” says Girten. “The tuning allows the patient to walk properly, which trains the muscles to continue growing and working that way.”

Maya is just like many girls her age: she has a special fondness for pink and princesses, and she swims and dances. Soon, with the improvements from Marianjoy’s AFOFC, Maya may be walking just like other girls her age, too.