What is your opinion on braces like Ankle Foot Orthosis (AFO)?
Recently, one of my clients’ parents asked me this question. Here’s her email as written.
“My daughter’s physiotherapist (PT) is now recommending that we try AFOs because the tightness in her right calf is causing her to hyper-extend her knee when standing and misaligning her shin when squatting, which can be bad in the long term.
I don’t want my daughter to miss opportunities to learn to use her right leg naturally (make connections) but I also don’t want her to hurt her knee or ankle due to misalignment.
I am a bit down because I feel her PT doesn’t think it is possible to reduce her tone and help her learn to move without a brace. I was curious if you thought a brace could be a good thing or if we should wait.”
Here’s my response to her…
“It’s not uncommon for physiotherapists (PT) to recommend AFOs to address tightness of the calf muscles because of the way we were taught in PT school. Without an in-depth understanding of neuroplasticity and given the limited tool set most conventional physiotherapists were provided with, AFOs become a choice by default.
Your daughter hyper-extending her knee in standing is most likely due to her nervous system not being optimally organized. As such, she has no choice but to use excessive extensor tone to support herself. This usually happens when a child is made to stand before they are ready, hence the need for braces, standers and other external supports to allow the child to stand with a proper alignment.
It might sound counter intuitive but the physiotherapist is essentially adding to the problem (hyper-extension of the knees) she is trying to solve (with AFOs).
It sounds like your daughter will need more time and with the appropriate help she can learn to organize her body more effectively for balance in an upright position. Her muscles could then be freed up to do the job they are supposed to do, that is, to move!
When your daughter is provided with the sensory and motor information she needs to figure out how to use her ankles and feet, she can gain mobility at her ankles. How fast she will respond to the Anat Baniel Method depends largely on the extent of the spasticity she is currently experiencing.
I have worked with a lot of children that were using AFOs. Usually after a period of working with me using the Anat Baniel Method, most children get rid of their AFOs all together since they then have the opportunity to learn to use their ankles and feet.
Ultimately this is your decision. I hope this information is useful. If you’d like to read more, Anat Baniel has written an article on the use of AFOs on her website here.”
Note: Names have been omitted to maintain privacy.
