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Orthotics and Children with Hypotonia

Pediatric Physical Therapy published a systemic review on the efficacy and evidence of using orthoses for children with hypotonia. Ten articles met the inclusion criteria although none were Level I evidence (evidence from properly designed randomized controlled trials).   

The results found that data was reported for body structure and activity components, but not participation outcomes.  Overall, the current evidence suggests that foot orthoses and supramalleolar orthoses may benefit children with hypotonia  but the evidence is low level. 

The researchers concluded that many unanswered questions remain regarding orthotic use for children with hypotonia such as: when is the optimal time to introduce orthoses? Are foot orthoses or supramalleolar orthoses more efficacious? Should orthoses be combined with physical therapy?

What has your experience been regarding the use of orthotics and children with hypotonia?  Based on my experience, the orthotics helped with biomechanical alignment but not necessarily function.  At times, the orthotics have hindered function in order to maintain proper alignment.  

Reference:  Weber, Anna PT, DHS; Martin, Kathy PT, DHS. Efficacy of Orthoses for Children With Hypotonia: A Systematic Review. Pediatric Physical Therapy: Spring 2014 – Volume 26 – Issue 1 – p 38-47. doi: 10.1097/PEP.0000000000000011