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AFOs

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early steroid treatment has beeen shown to extend mobility, thereby averting contractures 
for DMD
Night Splints 


So...   Do we need to wear night splints? 

 Night Splints for DMD by Deborah Robins is licensed  under Creative Commons 
Attribution-NonCommercial4.0 International License NB Not to be construed as medical advice
 

Problem
Inevitable contractures will affect  
walking, seating and dressing
Later, contractures can hinder sleeping, wearing shoes, medical tests and more.  

Any deformity will have psycho-social impacts for yourself and others.

Solution
Take the longer view
Have a growth mindset
Preventative habits almost always benefit a progressive condition.

Consider your own sustainability by thinking mindfully to regularly review: diet, exercise, medicines, stretching and positioning.
Remember:

AFOS are worn at night to keep feet in the maximum COMFORTABLE   range — NOT stretch the muscles.
  
Without them, the feet automatically point down.

This pointing allows the build-up 
of scar tissue that hardens 
 in a shortened, inelastic
position and results in
       debilitating contractures.
Seek the best Advice
General therapists may confuse  contracture development in DMD with  other conditions 
like cerebral palsy and acquired brain injury
In DMD, the build-up in fibrotic scar tissue is part of the wound repair cycle. Muscle cells are replaced with fat and inelastic scar tissue. 

Regular stretching prevents ‘firming up’ in a shortened position. 

Range is maintained as tissue settles in the longest position gained by active stretching e.g. walking (on flat feet) or standing or passive stretching.
Types of Splints
Night AFOs (Ankle Foot Othoses) are not suitable in daytime as they disturb needed sensorimotor input and hinder your precarious balance. ·

Knee splints shouldn’t be worn at night. It is paramount that a young person gets a good night's sleep. Knee splints prevent position changes and cause restlessness. 

In order to stretch calf muscle (Gastrocnemius) properly you do need a straight knee. However your well-being is the most important thing and Gastrocnemius stretches can be done in the stretch program or by standing etc.
Lined polypropylene Ankle Foot Orthoses set 
at maximum range of dorsiflexion are most common
Adjustable Angle Orthotic provides a stretch into dorsiflexion. It is tailored to your existing range of movements - adjust as needed.
 
To provide the optimum stretch to calf muscles knees should  be straight.

Walking splints are no longer recommended. 
UCBL 
(an "in shoe" orthotic)
to counteract pronation
Useful Tips

Drill cooling ventilation holes in polypropylene splints

Wear 100% cotton socks underneath splints to keep cool

Allow yourself a special night off occasionally

Alternating the splinted leg is 50% less effective but is an option

Celebrate milestones to reward your commitment to long term goals

Be Safe:   Use urinal under bed or a non-slip sole rather than risk nocturnal falls
Be Smart:   Scaffold your body effortlessly. eg. wear hightop basketball shoes 
Be sustainable:   Correct your posture often and adjust wheelchair to align your body 

Sources: Posselt, H. (2011) Duchenne muscular dystrophy: a team approach to management. Brisbane: MontroseAccess.

David J Birnkrant et al (2018) Diagnosis and management of Duchenne musculardystrophy, part 2: respiratory, cardiac, bone health, and orthopaedic management. Lancet Neurology Online: http://dx.doi.org/10.1016/S1474-4422(18)30025-5