Disability Sport Development Conference. #PlayParticipateEnjoy

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1 Disability Sport Development Conference #PlayParticipateEnjoy

2 The Management of Neurological, Musculoskeletal and Postural Conditions within the Sports environment using Dynamic Movement Orthoses Dan Severn - Clinical Manager DM Orthotics Ltd

3 Dan Severn Children s Physiotherapist & Clinical Manager at DM Orthotics Ltd Background BSc (Hons) Sports Science, BSc (Hons) Physiotherapy Currently in third year of MBA (part time)

4 Session outline 1. Development and theory behind the DMO 2. Practicality and reasons for use of the DMO range 3. Development of DMO in the sports environment 4. New products and R&D

5 The development of DMO 1960 s Wrapping athetoid patients with crepe bandage

6 Dynamic Movement Orthoses (DMO) Customised orthoses: Truly dynamic Base layer and reinforcement panelling comprised of elastomeric fabrics Reinforcements enable: Selective positioning Application of force

7 Neurological Used in the management of a range of paediatric and adult conditions Examples: -CP (Attfield et al 2008) -MS (Betts 2006) -Post CVA (Gracies et al 2000)

8 Musculoskeletal Used in in the management of a range of paediatric and adult conditions Examples: Shoulder subluxation (Matthews et al 2011) Scoliosis (reduce Cobb angles)(matthews et al 2006) Pelvic pain in athletes (Sawle et al 2013)

9 How do they work? The orthoses are just fabric so why do we get the effects? Sensory / proprioceptive input from the tightness of the base material (McNair and Heine 1999) Biomechanical positioning from the elastomeric panelling which allows for force application which aids in correcting positioning Enhance stability (Matthews et al 2011)

10 The aim is to:- Facilitate more efficient movement and / or positioning Improve function / awareness

11 Why choose a DMO? The use of DMOs compliment therapeutic intervention by: Positively influencing tone Reducing muscle imbalance/preventing deformity Improving posture and postural control Optimising biomechanical advantage Providing relevant experience to maximise potential Not restricting movement Supporting therapy: Facilitation Positioning Support Active exercise

12 When have DMO s been used? Individually designed orthoses that address specific neurological and functional requirements have been used in the following conditions; Cerebral Palsy CVA Traumatic Brain Injury MS Downs Muscular Dystrophy SMA Charcot Marie Tooth ADHD Retts Spinal Injury Hypermobility syndrome DCD Parkinsons Autism

13 The products

14 Summary of benefits Improved proximal stability to aid development of distal function / control Improved posture Cosmesis Normalised tone Reduction in swelling Reduced involuntary movements Improved dynamic function and independence Improved breathing leading to improved speech Improved self care and social skills Enhanced handling Carry over effect

15 Adult Case studies

16 Paediatric Case studies

17 Assessment and Prescription

18 How to assess for DEFOs

19 At the assessment What are the objectives? Which area of the body are you wanting to control? Determine which Key Points of control are needed to facilitate more normal movement or symmetry of posture. Does re-positioning improve function? Which areas respond to sensory feedback How much facilitation is required? What is the level of compliance and tolerance? What are the daily living needs of the patient? Are there any feeding issues?

20 Considerations/precautions Poor compliance Low motivation Poor temperature regulatory system Circulatory disorders Skin disorders Respiratory disorders Skeletal fragility Gastrostomy

21 Reinforcements

22 Reinforcements Layers of Lycra can be added to the garment to exert more pressure on any muscle/muscle group affect muscle imbalance Number of layers added depends on how much pressure/facilitation is necessary Reinforcement kept away from areas like the axilla, popliteal fossa, etc. to avoid rubbing

23 How do I know when to reinforce? If there is improvement in joint alignment through minimal handling around the trunk then there is no need to reinforce. If you need to exert more pressure over a specific area to achieve correction then consider reinforcing To alter COG and forces on a joint To increase somatosensory stimulation of specific musculature and increase activity If there is a fixed deformity then there is probably not much point in reinforcing unless it is to prevent further deterioration but rigid splinting may be required for this

24 Trunk side flexion Side flexion / postural scoliosis Short abdominals on opposite side, Iliocostalis and Spinalis short same side Multifidus weak Use TCP Side panel reinforcement to reinforce the opposite side to way of leaning

25 Shoulder Protraction If less control over shoulder protraction is needed Use TOS with TVN Large over the shoulder reinforcement with V neck line

26 DMO Development into Sport

27 Development into Sports MSK development for use in rehab Cross over into CP Sport Disability sport Sophia Warner Athlete 2012 Olympics

28 Individuals have different challenges and test our orthoses in hard environments We are driven to improve our orthoses and are pushed by individual users and clinicians.

29 I got through about three different types of carbon fibre splints, but because I was so active, I kept breaking them. They just didn t last, or weren t flexible enough to allow me to do the things I wanted to do. Tom Watts

30 CP England U19 s DMO user accessed DMO via the NHS

31 DMO - Sports Development The following have been developed from research in conjunction with Universities and or Sports Organisations.

32 REPS PRO Shorts - Incorporating the Results into a DMO

33 REPS Pro Double Shoulder Support - Bilateral Shoulder Orthosis

34 REPS Pro Plantar Fasciitis Sock

35 REPS Pro Diving Glove

36 The future for DMO

37 Sam I can definitely walk better and further because taking steps is a lot smoother. Instead of my foot curling around after each step I can take one step after another more naturally.

38 Sam s Mum The conversion to FES and the DMO e-step has really made a difference to his walking pattern. It s really improved his confidence as his mum, it s great to see.

40 References and Research

41 Arumugam, A., Milosavljevic, S., Woodley, S., & Sole, G. (2012). Can application of a pelvic belt change injured hamstring muscle activity? Med Hypotheses, 78(2), doi: /j.mehy Attfield, S. F., Nicholson, J., & Morton, R. E. (2008). Evaluation of stability of Lycra soft orthoses using 3-D kinematic analysis. Orthopadie-Technik Quarterly, English Edition, IV, 7. Bayley, I. (2014). Instability Classification (Stanmore). Retrieved from Shoulder Doc website: Betts, L. (2006). Lycra orthoses and their use in MS. Way Ahead, 10(4), 2. Borghuis, J., Hof, A. L., & Lemmink, K. A. (2008). The importance of sensory-motor control in providing core stability: implications for measurement and training. Sports Med, 38(11), doi: / Crawford, F., & Thompson, C. E. (2003). Interventions for treating plantar heel pain. Cochrane Database Syst Rev(3), Art. No.: CD doi: / CD Ficek, K., Rzepka, R., Orawczyk, T., & Zotnierczyk, Z. (2008). Groin pain in athletes - clinical experience. Journal of Human Kinetics, 19, Gracies, J. M., Marosszeky, J. E., Renton, R., Sandanam, J., Gandevia, S. C., & Burke, D. (2000). Short-term effects of dynamic lycra splints on upper limb in hemiplegic patients. Archives of Physical and Medical Rehabilitation, 81. Holmich, P., Uhrskou, P., Ulnits, L., Kanstrup, I., Bachmann Nielsen, M., Munch Bjerg, A., & Krogsgaard, K. (1999). Effectiveness of active physical training as treatment for longstanding adductor-related groin pain in athletes: randomized trial. Lancet, 353, Ide, J. M., S.; Yamaga, M.; Morisaw, K.; Takagi, K. (2003). Shoulder-strengthening exercise with an orthosis for multidirectional shoulder instability: Quantitative evaluation of rotational shoulder strength before and after the exercise program. Journal of Shoulder and Elbow Surgery, 12(4), 4. Kraemer, W. J., Bush, J. A., Newton, R. U., Duncan, N. D., Volek, J. S., Denegar, C. R.,... Sebastianelli, W. J. (1998). Influence of a compression garment on repetitive power output before and after different types of muscle fatigue. Sports Medicine, Training and Rehabilitation, 8(2), Lafuente Guijosa, A., O'Mullony Munoz, I., de La Fuente, M. E., & Cura-Ituarte, P. (2007). [Plantar fascitis: evidence-based review of treatment]. Reumatol Clin, 3(4), doi: /s x(07) Lee, D., & Vleeming, A. (1998, November 19-21). Impaired load transfer through the pelvic girdle. A new model of altered neutral zone function. Paper presented at the Proceedings of the Third interdisciplinary world congress on low back and pelvic pain., Vienna, Austria. Mattacola, C. G., & Lloyd, J. W. (1997). Effects of a 6-week strength and proprioception training program on measures of dynamic balance: a singlecase design. J Athl Train, 32(2),

42 Matthews, M., & Crawford, R. (2006). The use of dynamic Lycra orthosis in the treatment of scoliosis: A case study. Prosthetics and Orthotics International, 30(2), Matthews, M. J., Payne, C., & Watson, M. (2011). The use of a dynamic elastomeric fabric orthosis to manage painful shoulder subluxation: A case study. Journal of Prosthetics and Orthotics, 23(3), Matthews, M. J., Watson, M., & Richardson, B. (2009). Effects of dynamic elastomeric fabric orthoses on children with cerebral palsy. Prosthetics and Orthotics International, 33(4), McNair, P. J., & Heine, P. J. (1999). Trunk proprioception: Enhancement through lumbar bracing. Archives of Physical and Medical Rehabilitation, 80, Mens, J., Inklaar, H., Koes, B. W., & Stam, H. J. (2006). A new view on adduction-related groin pain. Clinical Journal of Sport Medicine., 16(1), Mens, J. M. A., Vleeming, A., Snijders, C. J., Koes, B. W., & Stam, H. J. (2001). Reliability and Validity of the Active Straight Leg Raise Test in Posterior Pelvic Pain Since Pregnancy. Spine, 26, Michael, J. S., Dogramaci, S. N., Steel, K. A., & Graham, K. S. (2013). What is the effect of compression garments on a balance task in female athletes? Gait Posture. doi: /j.gaitpost Rathinam, C. B., S.; Spokes, G.; Green, D. (2013). Effects of a lycra body suit orthosis on a child with developmental coordination delay: A case study. Journal of Prosthetics and Orthotics, 25(1), 4. Riddle, D. L., Pulisic, M., Pidcoe, P., & Johnson, R. E. (2003). Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am, 85- a(5), Roxas, M. (2005). Plantar fasciitis: diagnosis and therapeutic considerations. Altern Med Rev, 10(2), Sawle, L., Freeman, J., Matthews, M., & Marsden, J. (2013). The Grumbling Groin: A Novel Approach. SportEx Medicine, 55(January), Ulkar, B. K., B.; Cetin, C.; Guner, R.S. (2004). Effect of positioning and bracing on passive position sense of shoulder joint. British Journal of Sports Medicine, 38, 4. Warner, J. J. P., & Caborn, D. N. (1992). Overview of shoulder instability. Crit Rev Phys Rehab Med 4, Yasukawa, A. M., P.; Guilford, A.; Mukherjee, S. (2011). Case study: Use of the dynamic movement orthosis to provide compressive shoulder support for children with brachial plexus palsy. Journal of Prosthetics and Orthotics, 23(3), 6. Zazulak, B. T., Hewett, T. E., Reeves, P. N., Goldberg, B., & Cholewicki, J. (2007). The Effects of Core Proprioception on Knee Injury: A Prospective Biomechanical-Epidemiological Study. American Journal of Sports Medicine, 35(3),

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