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Building Function, Building Hope: Orthotic Management of Pediatric Spinal Cord Injury
Life, as they say, can turn on a dime. One of the everyday pleasures in a child's life—a car trip, school football game, or bounce on a trampoline—can end with a disastrous snap. Partial or complete spinal cord injury (SCI) currently affects as many as 63,000 American children, according to the Christopher & Dana Reeve Foundation, with consequences that can begin with neural deficit or paralysis and extend to a lifetime of secondary medical problems.
Orthotists work on the front lines of SCI treatment, from applying halos in intensive care units to customizing functional electrical stimulation (FES) devices that can reroute interrupted neural pathways. Such clinicians' foresight must include not only the pediatric patient's current needs, but the possibilities of serious complications or—more hopefully—gradual improvement. This article offers a glimpse into some expert practitioners' own best practices for orthotic management of pediatric SCI.
Ronald Triolo, PhD, is a senior career research scientist at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio, where he directs the Advanced Platform Technology (APT) center, a VA Rehabilitation Research and Development (VARR&D) center of excellence. He is also a professor of orthopedics and biomedical engineering at Case Western Reserve University, Cleveland. He told The O&P EDGE about some projects he is working on that have already demonstrated major potential benefits for people with spinal cord injury (SCI), especially children.
Much of Triolo's work combines functional electrical stimulation (FES) devices with orthoses. The FES devices his teams use, some of which include implanted electrodes, can access muscles that aren't always reachable with surface stimulation. Triolo says, "We're able to stiffen the knees, hips, and trunk and provide enough power to raise people out of their wheelchairs and into a standing position. And we've been able to swing the limbs forward and generate stepping motions." Such devices may be particularly effective for children, Triolo says, because "taller and heavier people are asking those small number of [FES-stimulated] muscles to do more work."
