Korthotics | Physiotherapy Orthotics | Ambulatory and Teaching Aides

DMO (Dynamic Movement Orthoses)

Dynamic Lycra Orthoses now re-branded as Dynamic Movement Orthoses (DMO) are a relatively new approach to managing abnormal tone and neurological dysfunction. The aim is to improve functional abilities through the application of an orthosis designed to meet individual needs and objectives.

Each orthosis is made to measure to achieve a snug fit as it is believed that increased pressure on certain muscle groups and improved proprioception via the snug fit of the orthoses leads to better awareness of the affected part of the body. The resistance created by additional layers of reinforcing material adds a biomechanical influence to the improvement in control of movement. As well as improved function from better posture, improved proximal / distal stability and reduced involuntary movements; other benefits may include pain relief, decreased associated reactions, easier transfers and improved therapy sessions. Over time, the desired effect would be to experience the improvement in function and control of movement when the orthosis is removed - i.e. carry over the effects experienced when wearing the orthosis.

The onset of this carry over effect and the factors affecting it's duration is dependent on the individual patients presentation and reaction to the treatment. The orthoses range from a glove for improved hand / upper limb function to a full body suit for whole body involvement. The style and design of the orthosis is based on the wearer's ability and their functional objectives at the time of assessment. An Orthotist and/or Therapist assesses, measures, fits and reviews each orthosis.

Patients with neurological dysfunction as a result of cerebral palsy, stroke (CVA), head injury, multiple sclerosis and other neurological conditions may benefit from wearing a orthosis.

Compliance is an essential part of this treatment both for those wearing the orthoses and those caring for the wearer. i.e. parents, carers, teachers, therapists. Without acceptance of the daily regime of donning and doffing the orthosis, treatment will not work.

Dynamic Lycra® Suits

Where improvement in proximal stability is required a suit may affect hip position & trunk stability and benefit patients with:

Low underlying tone
Poor sitting ability
Hyper kyphosis of the thoracic spine
Shoulder protraction linked with low tone
Movements associated with athetoid and ataxic cerebral palsy
Neuropathic Scoliosis
Mobile Idiopathic Scoliosis
Spasticity with underlying low tone

Before and after a dynamic Lycra ® suit.
The patient presented with choreo athetosis and a wind swept pattern.

The individual orthosis designs allow prescribers to work with complex postural presentations such as neuropathic scoliosis - here the aim is to maintain or reduce the curve using a layer(s) of material panels specifically positioned to encourage the spine to realign itself. A real alternative to more rigid bracing.

In the X-ray shown a 31° curve was reduced to an 18° curve and the child showed improvement in upper limb function & head control

Dynamic Lycra® Gloves

Where improvement in upper limb function is required a glove may affect gross and fine motor skills and the posture of the arm:

Abduct the thumb

Extend and encourage control of fingers

Extend the wrist

Extend the elbow

Encourage supination of the forearm

These orthoses have been used in the treatment of hemiplegia, quadriplegia, cerebral vascular accidents, trauma and now in some cases of multiple sclerosis and Parkinson's disease.

Before and after a dynamic lycra ® glove. The patient presented with hemiplegia & hypotonia.

The glove may feature a long or short sleeve depending on the involvement of the whole arm. As well as the functional improvements, the patient may benefit from a reduction in dynamic contractures and the hemiplegic arm may be lower and straighter when walking. Gloves may be used in conjunction with a Dynamic Lycra® Suit or Arm Sleeve.

Before and after a dynamic ® lycra glove. The patient presented with Charcot Marie Tooth

Before and after a dynamic lycra ® glove. The patient presented with Hemiplegia post stroke.

Dynamic Lycra® Shorts & Leggings

Where improvement in pelvic stability, hip & knee extension and the treatment of gait patterns is required, these orthoses may benefit patients with:

diplegia - flexed pattern walking
low tone
hemiplegia

The individual orthosis designs allow prescribers to specifically treat the affected limb independently.

At fitting and after 2 1/2 years in dynamic lycra ® leggings. The patient presented with diplegia and flexed pattern walking. At initial fitting some internal rotation was still evident, a second layer of reinforcement was applied. After 2 1/2 years the leggings were withdrawn.

The aim of these orthoses may be to encourage a more upright standing position, reduce a 'scissor' gait / internal rotation of the leg and reduce walking effort.

Leggings may be used in conjunction with other orthoses such as Ankle Foot Orthosis, Dynamic Ankle Foot Orthosis and insoles.

Compression Therapy

Lycra burns orthoses are bespoke compressive orthoses made to patients specific requirements. They provide even and constant pressure to the burn site. This pressure therapy is used in conjunction with massage, as part of the hospital multidisciplinary approach, to help prevent scars becoming raised. A lack of pressure allows scar tissue to develop forming a hypertrophic scar (raised red scar).

Pressure is a means of helping to prevent, reduce and control hypertrophic scar tissue forming following full/partial thickness burns. Once supplied for the first time they are worn 24 hours a day and only removed washing and massage. Initially patients are monitored very closely. Once accustomed to the garment padding or extra layers of material can be added were additional pressure over scars is required.

The burns orthotics is usually worn for approximately two years or until the scar tissue is flat and paled in colour with no (redness indicates the scar tissue is still active). During this time skin must be massaged and creamed to help break down and soften scar tissue.

The use of a silicone-based sheet (mepiform) can be applied to the skin under the garment, which also helps to soften the scar tissue.

In order to achieve the best results parents need to understand the importance of pre, massage, mepiform and cream to achieve the best cosmetic result.

For more information: www.dmorthotics.com