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.