The Secret to Your Child Having a Meaningful Orthotic Experience

We all want to achieve goals. When we achieve our goals we feel a sense of fulfillment, meaning, and motivation to make more goals. I have seen orthotics help many kids achieve their goals, and I would like to share a secret with you that I believe can make your child’s orthotic experience more positive and meaningful.

 

I’ve been providing kids with orthotics for 15 years, and in that time my clients have taught me that the first priority of my job is not to make them orthotics, but to help them achieve their goals. Whatever their goals are, whether it’s to walk, or to take away pain, or to help get shoes on easier. The orthotic does not motivate the kids to successfully achieve their goals. The kids inner motivation to achieve their goals makes the orthotic successful. That’s why my main job is to support and listen to the kids and their families. By identifying their goals, then working with and supporting the needs of the client to achieve that goal, I give them input and share control of the orthotic experience. The more I listen, the more I share control of the orthotic experience with my clients. And this is the key because when people have control over what they are doing they will usually engage with, interact, and enjoy that thing much more than if they had no control over it. So the question is how can we as orthotists share more control of the orthotic experience so our clients can continue to engage with their orthotics in meaningful ways in their daily life, rather than just in a clinical or therapeutic setting. I would like to answer that question by sharing with you a few insights which I believe will help clients and their families feel more of a sense of engagement with their orthotics.

 

The first is social media. It is getting so easy to make meaningful connections through social media like facebook, instagram, twitter and snapchat. Orthotists must begin to embrace these mediums in order to show our clients and their families that orthotics are not just another piece of medical equipment, but they are a part of their personal story. And right now social media is the best place to tell your stories. Whether it’s posting pictures on instagram or participating in a facebook group, these are all ways of sharing your story. My first attempt at providing a forum for my clients to share their stories was by creating a character named Mo the SMO. Mo transforms from an actual SMO into a kid friendly cartoon character. I’m hoping kids and families will relate to Mo in a fun and easy way and include him in their journey by connecting with other people, and sharing how they make orthotics a fun and important part of their life.

 

Secondly, I believe that apps, which are specific to families of children with special needs, can really improve engagement with orthotics. Obviously, the content of the app is critical to making this work, but if it is engaging enough it can change the idea of wearing an orthotic from “it’s best when not seen” to “I’m proud to wear an orthotic”. I recently created a free app based on Mo the SMO, which has special needs specific photo stickers that clients and families can use on pictures they’ve taken. Thus allowing them to create customized images of their unique journey and achievement of important milestones to share with friends and loved ones. For information about “Team Mo” check out the “Mo the SMO” page on my website.

 

The next way my company, Toronto Orthopedic Appliance Services, shares control of the orthotic experience with our clients is we offer to make custom images on all custom orthotics. This gives the client and their families the freedom to choose any image, colour, or design to put on their orthotics. Some families even create their own design. Truly making it “one of a kind”. While doing this does take some extra equipment, time, and experience with graphic design, Toronto Orthopedic offers this service for free because we feel it is an essential part of the orthotic experience. Everyone is very excited to see the finished design at the delivery day “reveal”. The kids look forward to showing off their new orthotics to their friends and family. Before social media came along this was the only way we could help our clients tell their story, and even now it is still the most effective way of engaging our clients and families and creating enthusiasm for wearing the orthotics.

 

The last idea I wanted to share with you is something that is not as easily accessible at this time (as the first three things) but it will definitely be a game changer once it is more commonly available. This medium is 3D printing. Currently, 3D printed prosthetics are being made and shared by anyone with a 3D printer. The software and design files are free, and the cost of printer materials is relatively inexpensive. Even the cost of 3D printers have come down, and will continue to come down, making accessibility to this technology easy for someone to get into, even if it’s as a hobby. Even though I believe that an orthotist should be intimately involved in the assessment, manufacturing, and fitting of orthotics, this technology will make it possible for a client or their family to do all of this themselves. Ultimately, a client who designs and manufactures their own orthotic will be much more engaged with it, will want to wear it, and will see it as a positive addition to their life.

 

As orthotists it will be our challenge in the coming years to figure out how we can work with all of these new technologies in order to engage our clients in their orthotic journey by providing them a more meaningful orthotic experience. I always look forward to hearing from you, and appreciate any feedback you may want to share, so please don’t hesitate to contact me at hello@danielpecorella.com. Thanks!

 

 

What to expect at your child's first orthotic clinic assessment

Your child has been referred to an orthotic clinic at a children's treatment centre (CTC) or hospital. Maybe they have been referred from your doctor/pediatrician/orthopedic surgeon or maybe from a physiotherapist or occupational therapist. Most times these referrers will give you a general reason for recommending an orthotic assessment. Sometimes your doctor will send you with a specific orthotic prescription. Don’t be worried if you don’t get a lot of information about orthotics before your appointment. Your doctor or therapist is not an orthotics expert. They make referrals to the orthotic clinic so that an orthotics expert (otherwise known as a certified orthotist) can assess your child and make an appropriate orthotic recommendation.

 

Orthotic Clinic Benefits

There are many benefits of attending an orthotic clinic at a CTC or hospital (versus the orthotist’s office). Most orthotic clinics will have an attending pediatric physiotherapist (PT) who specializes in working with children, who works with the orthotist. This is advantageous to your child because the PT will ensure that your child’s physical development and age appropriate milestones are taken into consideration when making the orthotic recommendation. Another benefit is that if your child is currently working with a PT or Occupational Therapist (OT) at the CTC or hospital, or has been seen by them before, the orthotist will know what functional goals your child is working on and the orthotic can be made to assist them in achieving those goals. Also, other medical information which relates to your childs function can be shared with the orthotist at these clinics in order to help make the best informed orthotic recommendation. Another important benefit of attending orthotic clinics at a treatment center or hospital is the follow up. By being a client of the CTC you will have someone help to ensure that your child’s needs are followed up with even if you are not currently receiving treatment.

 

Orthotic Clinic Walk Through

Arriving

When you arrive at the CTC or hospital the first thing you’ll need to do is sign your child in at the reception desk, and let them know you’re there for the orthotic clinic. The orthotist or therapist will come to get you and your child in the waiting area at your scheduled appointment time. Sometimes there are delays, so please be patient. If the clinic is running late and you need to get a message to the clinic team, the receptionist will be able to assist you. On the other hand, if you are running late or need to cancel your appointment please call as soon as you can. There are many kids waiting for these appointments, and the clinics are usually pretty full, so the more we know who’s coming or not the more kids we can help.

 

Assessment

Next, you and your child will be taken into an assessment room or area where you’ll typically be joined by an orthotist and a therapist. The most important thing in these assessments is that you and your child are as comfortable as possible. If you or your child is uncomfortable in the assessment room or area please let someone know and we can usually find another room. Then you will be asked some questions about your child’s medical history and your goals and concerns. This may be a short discussion or it may take some time. Here it is important to let us know your expectations for the orthotics. We will do our best to meet your expectations because the orthotics need to fit into your life, but if we can’t it’s important that you know the limitations of the orthotics as well. I have written a blog post titled “ The Family Friendly Orthotic Checklist” that you may want to check out before your appointment. There is a free checklist that you can download onto your phone or print out in order to give you some ideas about how the orthotic will work that you can bring into the assessment.

After the initial discussion we will want to assess your child’s strength, function, alignment, and range of motion. If it’s an assessment for lower extremity orthotics then we will want to see your child’s feet and legs, and if possible we will want to assess them while standing, walking, and other age appropriate movements such as cruising or pulling to stand. For this part of the assessment it helps if they are wearing shorts or loose pants which can be rolled up over the knees. Once we know your child’s medical history and get an idea of what they are physically capable of then we will make an orthotic recommendation. This recommendation will be made in order to improve biomechanical alignment, help to achieve functional goals, and meet your expectations and needs whenever possible. Obviously, orthotics are made to help people, but it’s equally important that they fit into your life as well, because I have seen many well made and helpful orthotics go unused simply because the family didn’t know how to fit them into their life.

 

Funding

Once the orthotic recommendation has been made we will discuss your funding options. We will let you know if you are eligible for government assistance, what percentage the government assistance will cover, and what percentage or amount you will be responsible for. We can email or mail you a quote if needed for private health insurance. And we will provide you with assistance and information regarding how to fill out any extra funding forms if they are required. If you live in Ontario, please read my blog post for more details about funding for orthotics in Ontario. My business, Toronto Orthopedic Appliance Services, requires payment and all completed paperwork at the delivery appointment.

 

Casting

At this point if you are financially covered for the orthotics and you wish to move forward we will have to cast or measure your child in order to have a model (or measurements) from which to make (or order) the finished orthotic from. If your child requires casting in order to make the custom orthotic please see the pictures below for a visual description of the casting process. Here are a few other things you will want to know about casting.

-One cast usually takes twenty minutes to set up and remove.

-Once the cast is set it comes right off.

-It does not hurt. Your child may cry during the casting, but the process is not painful. It is totally normal for a child to express fear through crying. The casting process may frighten your child because a stranger is in their personal space and preventing them from moving where they are being casted. Your child will be comforted by having you there. Over the years we have found the following strategies work well to help the kids and parents have a positive casting experience.

-Have the child sit in your lap (or sit next to your child if they can’t be in your lap). This will give your child a sense of comfort and safety, which they will not feel if they are sitting on their own.

-Bring something that helps to soothe or distract your child. Videos, music, snacks, stuffies, bubbles, etc. I’ve used them all and if all else fails I’ve been known to sing to the kids while casting (in which case you may want to bring earplugs!).

If these strategies don’t work and the child is extremely frightened or upset and unable to keep still enough to get an accurate cast we will recommend trying again at a future appointment. The cast is not worth your child having a difficult experience. In these cases we suggest to the parents to play with their child’s feet and pretend to cast them using towels or socks at home, in order to help the child get used to the procedure.

 

Next Steps

Once the casting is done we will schedule a delivery appointment, and you will be reminded what paperwork or payment is required. Finally, and for some most importantly, if your child is getting a custom orthotic you can usually choose an image or design to have on the orthotic. My company, Toronto Orthopedic Appliance Services creates free custom images and designs for every kid’s orthotic. This allows the kids and their families to choose any image they want, or they can even design it themselves. The kids love having their orthotics personalized, it makes them unique and fun, and everyone is excited to see the new orthotics at the delivery day “reveal”.

Hopefully this has helped you get a good idea of what to expect at your first orthotic clinic appointment. We understand that it is a lot of information to absorb, so if any questions or concerns pop up for you please don’t hesitate to contact a member of the clinic, and we will do our best to help you. If your child will be receiving an orthotic at the next clinic I have written a follow up to this blog post titled “What to expect at your first orthotic clinic delivery appointment”. It will give you some helpful tips for what to bring and not to bring to that appointment so that you and your child get the most value for your time.

 

Introducing Mo the SMO

Who is Mo?

Mo the SMO is a kid friendly character designed by Daniel Pecorella (an orthotist and an owner of Toronto Orthopedic Appliance Services) to inspire, inform and connect children with special needs and their families and friends. Mo’s mission is to make wearing orthotics awesome and fun!

 

The benefits of joining “Team Mo”

Mo’s motto is get inspired, get informed, and get connected. Be part of “Team Mo” today by downloading the free app “Mo the SMO Cam”, and join in on instagram and facebook. “Mo the SMO Cam” is the only camera sticker app designed specifically for kids with special needs and their families. Use it to add custom made stickers to your photos in order to express your unique experiences in a fun and easy way. Then share these photos with your family, friends, and the rest of “Team Mo”.

Download the "Mo the SMO Cam" from the App Store and make awesome pictures today!

Download the "Mo the SMO Cam" from the App Store and make awesome pictures today!

Help build the “Team Mo” community and share your experiences by adding hashtags to your photos, and win prizes!

-See the amazing things kids with special needs are doing at #mothesmo and #smoknows.

-Help Mo share useful information, tips and tricks about shoes, socks and orthotics at #mostips, and #shopaholicmo.

-Find people in your area to connect with at #moswhere.

Participate in the interactive comic “The Adventures of Mo the SMO”. Mo wants your help to continue his story. To read the comic and for more information on “The Adventures of Mo the SMO” visit http://bit.ly/2aHR8IW.

 

Have fun and start sharing!

 

The 8 item checklist for how to make your orthotic experience more family friendly.

You have an amazing child with special needs. You are busy. You have a never ending list of appointments to juggle. And now you get referred to an orthotist who will assess your child for an orthotic. You’re unsure what an orthotic is (because you haven’t read my “What is an orthotic anyways?” blog post), how necessary it is, and where it should fall on your list of priorities. Despite all of this you decide to go to the orthotic appointment and see if it will be worthwhile and helpful to your child. This is the mindset most parents visit me with, and it’s completely understandable. This is why I created the family friendly orthotic checklist, so you can keep these points in mind, on your phone, or in your pocket when you’re at your next orthotic appointment.

 

When considering orthotic treatment it is always important to consider the effect the treatment will have on your child and your family. Orthotists are trained to include a family needs assessment into any orthotic prescription, which will take certain aspects of the client’s life into consideration, but these are usually more related to the activities the client will be performing with the orthotic. The family friendly orthotic checklist dives deeper into a client’s daily routine and effects on family life. Please keep in mind that it may not be possible to incorporate each item on the checklist into the orthotic without compromising its functionality, but it never hurts to ask. Many orthotists I know are very creative and enjoy a new challenge, so maybe you’ll inspire them to create a new solution for you.

 

Family friendly orthotic solutions will meet the following criteria:

- Easy to get on and off

- Easily fits footwear

- Lightweight

- Comfortable

- Durable

- Multifunctional

- Custom images

-Help access to funding

Download the short version of the checklist now!

 

For most clients and their families being able to get the orthotic on and off easily is crucial to wearing the orthotic. If the orthotic is being put on by a family member or caregiver the orthotic should have some markers which show that it is on in the proper position. Two simple markers I use in my practice is to drill holes in each side the heel plastic, and to mark where the end of the toes should be. As the child grows this mark won’t be as accurate, but it will help for a few months. At this time most of the straps being used in orthotics are Velcro. It is the most easy to use and functional type of strapping. Unfortunately it is not the most durable. If durability and ease is required having a stronger material backing the Velcro is a good solution.

 

Being able to put the orthotics on and off independently is an important milestone and life skill for some kids, so it is important to ask what hand the client will use so the straps can be placed on the side that will make it easiest to do up. For children who are using above ankle orthotics (SMO’s) typically you will need to do the straps on the orthotic then put it in the shoe. However, I have designed an above ankle orthotic which can be left in the shoe (In-Shoe SMO) and only requires an ankle strap. This takes less time because it’s two less things to do when getting the orthotics on and off. Making this easier can be the difference between a child doing their orthotics and shoes independently or not. Which is an especially important consideration for kids in school, as teachers and education assistants well know.

In-Shoe SMO

In-Shoe SMO

Regular SMO

Regular SMO

 

For children who wear orthotics which go from the foot to the knee (AFO’s) most designs require them to put the orthotic on before putting it into a shoe. Recently, I have designed a new style of AFO which allows the client to keep their orthotic in their shoe for ease of sliding in and out. This AFO has the joint at the back of the brace instead of the sides, and I call it the PJO (Posterior Joint Orthotic). Along with increased independence this can definitely reduce the time it takes to get out the door and helps to make transitions quicker in school so your child can get more play time with their friends. Please contact me if you would like more info about the PJO.

PJO (back view)

PJO (back view)

PJO

PJO

Regular Hinged AFO

Regular Hinged AFO

For some kids it is very important to prevent them from getting their orthotics off. In these cases there are a few options which can help. The easiest is to roll a sock over the top strap of the orthotic, and if it’s long enough, roll it down over the heel so the sock is locked in place by the shoe. If this doesn’t work the other thing I have done is add a leather buckle closure to the end of the Velcro strap. This is very effective but it makes the process of getting the orthotics on and off significantly longer.

 

Fitting orthotics into footwear is the biggest challenge I face as an orthotist. It would make my job very easy if I could just give my clients a big clunky shoe to fit their big clunky orthotic. The problem is nobody wants to wear a big clunky shoe. Kids with special needs are still kids, and kids usually want the same things as other kids. So getting to have a shoe like their friends can mean a lot. That’s why I do whatever I can to help fit an orthotic into “cool” or “pretty” shoes. The most common alterations include grinding the plastic and making sure the strap placement is high and out of the shoe. These sound like simple solutions but it sometimes takes hours to get orthotics to fit properly into nice shoes.

 

The second most common issue regarding footwear is getting boots to fit over orthotics. In the past I have recommended to not spend too much time looking for boots because most will not fit over orthotics. I am always on the hunt for good quality boots at affordable prices. Please let me know if you find some!

Orthotic in Croc Sandal

Orthotic in Croc Sandal

Keeping Pace Sandal

Keeping Pace Sandal

The final footwear issue is using sandals with orthotics. For some kids having footwear which is light and breathable is very important. In most cases Crocs can work well to fit over orthotics. They are not the most durable but will usually last a summer. I have seen kids wearing other styles of sandals but no brand has had a consistent style which works. If you want a sandal which is made specifically for orthotics you can check out the Keeping Pace website and ask your orthotist to order them for you, as they will not ship to Canada. Unfortunately, the styles are limited and not really “cool” or “pretty”, and they are quite expensive, but they are very durable. Otherwise, for most kids I recommend just wearing a sandal that fits the foot for limited use (as long as they are safe to do this) and don’t worry about using the orthotic, sometimes it’s nice to have a break.

 

Orthotics have come along way since the days when all orthotics were made of metal and leather. These were very heavy and cumbersome. Now orthotics are most commonly made form different types of plastics which have reduced the bulk and weight significantly. However, in certain situations even these relatively lightweight orthotics can be too heavy for the kids to move with so we need to be able to offer options. At this time there are two main ways to reduce the weight of an orthotic. The first is to remove unnecessary plastic from the orthotic. The second is to use materials which are lighter than plastic. Lightweight materials which orthotics can be made from are carbon fiber and fabrics. These lightweight orthotics are not typically custom made and they may not provide the strength or stability of a custom made plastic orthotic. Therefore it is very important to consult with your orthotist, therapist, and/or physician when considering these options.

Carbon Fibre AFO

Carbon Fibre AFO

DMO wrist hand orthotic

DMO wrist hand orthotic

 

The comfort of an orthotic is something that obviously needs to be right for anyone wearing these devices. I make sure to include padding or flexibility at potential problem areas. Two things I commonly do in these situations is to add foam or gel, and remove plastic or hard material from the affected area. The benefits of anticipating problem areas by incorporating these extra comfort options in the original design of the orthotic is to reduce the number of extra appointments the family would have to make for adjustments due to skin issues, and to help ensure that the initial fitting is relatively quick (20-30 minutes).

 

Another way to reduce the number of extra appointments is to ensure that the orthotic is durable. If your child is very active or if the orthotic needs to be extra strong for any number of reasons, it is usually a good idea to mention this to your orthotist so we can include the extra reinforcements into the manufacturing process. In situations where extra reinforcements are required I will typically increase the thickness of the plastic and/or use a stronger foam, fabric or leather for strapping or liners.

 

It may come as a surprise to you, but orthotics can also be multifunctional. As well as for use during walking, the same orthotic can be used as a stretching aid, a trial for a different style of orthotic, or they can have removable sections for specific activities. The most common multifunctional components I have used are ankle stretching straps, removable knee and foot sections, and when appropriate we will sometimes cut down the orthotics to a lower level of support for the client to try before deciding to make a new device.

AFO with ankle stretch straps

AFO with ankle stretch straps

AFO's with removable SMO's

AFO's with removable SMO's

AFO with removable Knee Orthotic

AFO with removable Knee Orthotic

The next item on the checklist is the option to have a custom image printed on the plastic. For many years orthotists have been able to offer standard designs that everyone could choose from. While this made the orthotics more kid friendly it didn’t always match what the child was really interested in. Now it’s possible to make an image that matches anyone’s interests, and the client and their family can even design it themselves! Sometimes our clients like to get help from their parents, siblings and even grandparents when making their choice, which really makes the orthotic experience feel like a family affair. Toronto Orthopedic has been offering this service for a number of years now and it has really helped the kids and their families take a more active interest in the orthotics. Everyone is excited to see the finished product at the delivery day “reveal” and the kids look forward to showing off their new orthotics to their family and friends.

 
 

Finally the moment you’ve been waiting for and probably the most important item on the checklist  . . . cost. There are many expenses for families of children with special needs and orthotics can be expensive. The good news is that the Government of Ontario covers 75% of the cost of the custom orthotics (as long as they go above the ankle) and if your family is receiving assistance from other government programs (such as Ontario Works, Ontario Disability Support Program, Assistance for Children with Severe Disabilities, etc.) then 100% of the cost is covered. Other third party payers such as health insurance, or other charitable organizations (such as Easter Seals, Jennifer Ashleigh Foundation, Lions Clubs, Rotary Clubs, etc.) may cover the remaining 25%. Getting in touch with these charities can feel like an overwhelming task, especially if you don’t have a social worker. I understand how difficult this can be so the friendly and knowledgeable office staff at Toronto Orthopedic can help your family figure out their way through these systems so you can get the funding you need. I will caution you to be patient, because dealing with these organizations can take time, but hopefully it will be worth the wait.

 

I hope you have found this information valuable. Please leave a comment, or contact me if you have any questions. Thanks! 

Download the short version of the checklist now!