Surestep SMO helps baby walk

Development of a muscle group around the ankle may determine whether your baby will be able to walk on his/her own. A Surestep SMO is one of many external devices that gently wrap around your baby’s lower leg. It is an orthosis that helps your baby take those first steps.

Babies usually stand on their own and walk between 12 and 18 months. If baby is too unstable to do either, a good pediatrician suggests a pediatric neurologist. An SMO may help your baby take first steps. An SMO stands for Supra Malleolar Orthosis. It is designed to help support weak dorsal muscles and associated areas so your baby can walk.

The basic SMO is similar in design to an Ankle Foot Orthosis (AFO) that adults wear. It is a reinforced plastic sleeve that attaches to the ankle and is fastened with Velcro.It does not cure a possible condition but adds support to help make walking possible for those who can not support themselves/ The Surestep SMO is usually the most recommended device for babies.

I use an AFO called ToeOff BlueRocker to help me walk with mt muscular dystrophy impairment. I can’t walk without it.

David Zwicker, a certified orthodist, at Prothotic Laboratory in New York. He suggested the ToeOff AFO as an alternative to the one my physiatrist prescribed. He was right. Upon trying one of these ultralight carbon graphite devices, I was able to walk smoother than I had in previous years.

An SMO and AFO are particularly helpful with foot drop when your foot moves abnormally due to weak dorsal muscles at the juncture of your leg and foot.

Consequently, an SMO and an AFO have certain inabilities based on a wearer’s condition. Walking stairs and doing simple to complex maneuvers are difficylt. Falling in these may cause considerable damage to the supported area that is “caged” in the brace support. SMO and AFO are braces, albeit products using modern technology.

Controlling consequences, Surestep SMO suggests seeking out a competent orthodist (such as David Zwicker) who can help adjust the Surestep SMO for maximum comfort, usability, and performance. Many pediatric neurologists aren’t aware of the nuances of these devices.

A pediatric neurologist focuses on development delay of your baby. The practitioner also considers hypotonia or poor muscle tone.

Many pediatric neurologists connect with rehabilitation specialists. The key specialist is a physiatrist, a medical doctor that deals with helping muscle and limb structure and movement.

Unlike an AFO, the basic Surestep SMO is designed to be least invasive for your baby, as an integral part of the shoe. As such, muscle tone may improve as the baby walks more.

A Surestep SMO targets babies with muscle and angular improprieties as a device that helps move development along. At 18 months, most babies overcome the need by age 3.

After age 3, your pediatric neurologist may advise exploration of advanced and genetic testing that may point to dystrophies of muscles or some neural conditions. At any rate,

Basically, the Surestep SMO is an ideal way to aid walking movement and improved muscle tone with gait for most babies that may require it. It is a rather common neuromuscular problem with a variety of solutions.

Braces have evolved in leaps and jumps since those bulky ones that Forest Gump wore as a child. Can it be a challenge? Among those children who have walking diffriculties, an SMO or AFO is a major boost for healthy walking and social development.

DARPA Airlegs for military mobility

It is often debatable whether all is fair or unfair in love and war. When it comes to the latter, the costs of war often require technology developers like DARPA to help the military and those we love. DARPA was created nearly 60 years ago under President Eisenhower’s administration as a part of the USA Department of Defense. Many of the technologies you use today, from smartphones to GPS and voice-to-text capabilities probably came from ideas from DARPA.

Few might recall that many of the basic principles of the internet were founded by a government agency for sharing information. Defense Advanced Research Projects Agency or DARPA created the first computer-based web network to collect and share research from various centers under DARPA grants. One of their recent projects is Airlegs, that helps energize walking power for soldiers climbing extreme levels of terrain.

Many of the prosthetics and walking devices used by those with muscular dystrophy or multiple sclerosis, that are generally available today, may have been results of earlier DARPA research.

Ankle Foot Orthoses or AFO that are dynamic braces that assist those with weak ankle muscles may have originally been designed for use by veterans. Today, these are mechanical devices that help make walking easier for those that normally can’t. Without the use of AFO devices, many would only be using wheelchairs or mobility scooters. Those patients and health care professionals who are aware of AFO technologies may help some patients with ankle and lower leg muscular problems choose the option of walking at close-to-normal levels.

Of course DARPA primary focuses are catering to military excellence in the field and those that are casualties of war. Engagements in Iraq and Afghanistan have motivated the need to revolutionize upper-limb prosthetics for use by wounded veterans. The program, launched in 2006, has been designed to allow those with upper-leg and upper-arm problems to enjoy nearly normal mobilities and lives.

Mechanical lower extremity prosthetics have been available since World War II as shown in the movie Best Years of Our Lives. A Navy soldier was one of the actors and demonstrated his adroit capabilities with mechanical hands. Of course, those were bulky and heavy and required quite a bit of strength to wear. The dilemma with upper-limb prosthetics is facilitating weight balance and lower extremity control with a lightweight product.

The DEKA-3 is a result of DARPA development. This and other next step technologies are being commercially produced for use by patients in need.

DARPA pushes the leading edged of the sciences and often are society’s first encounter with the legal or ethical dilemmas that can be raised by new biological and engineering technologies. When considering these, the Department of Defense does need to integrate the necessities of USA interests along military usefulness.

Airlegs uses an exoskeletal backpack that generate air impulses that help normal soldiers walk faster, and better in rough conditions. As superheroes go, Harvard University (under a DARPA grant) developed an Exosuit that conforms to the body, allowing for natural joint movement while augmenting effectiveness in combat. Both these technologies may one day be beneficial to those suffering with incurable muscular-skeletal problems.

Somewhat lower in scale to Airlegs, there are numerous commercial devices available for neuromuscular disorders that use air to enhance mobility. People with foot injuries may benefit from AirCast that is a post-surgical cast that can be customized with air pockets for comfort and greater walk ability.

The WalkAide system uses electro-stimulation of nerves to help patients with nerve diseases like multiple sclerosis walk more naturally. It’s a fair and less cumbersome device to most AFO braces but does not influence those with muscular exclusive diseases.

Electrical stimulation therapy has been co-sponsored by Christopher Reeve and DARPA funding to help treat paralyzed patients as an aid for possible recovery or some mobility.

DARPA is not exclusive in setting these trickle-down technologies from military to public use. The National University of Singapore has been studying robotics as an aid to improve gait and walking abilities of patients under care of physiotherapists.

While many of these independent research projects and DARPA projects offer exciting reads, some succeed and some fail.

DARPA is intended primarily for defense technologies and the resulting products are intended for use by skilled soldiers. Some products derived from DARPA research grants do manage to trickle down for use by medical professionals and the general public. The internet was one of those DARPA projects! The efficacy of applying some of those technologies on wider samples may be difficult, while many promising projects fail in production.

Some limitations may stem from health insurance coverage restrictions or professionals with no education of newer methods at handling certain problems. It becomes more economic than practical.

Physiatrists, Orthotists and Prosthetists often work jointly in accessing and finding ways to help mobilize immobile medical patients. Some of the hardware come from archival DARPA studies. Because conditions vary from one patient to another, experimentation and therapy are necessary for adaptation to different individuals. “The evolution of orthosis and prosthetics is very promising,” says David Zwicker, a New York specialist. He adds, “Customizing these for each patients use is a must for performance.” As advanced as these appliances are, they aren’t always 100% perfect. Benefits and consequences partner in each design.

Of course, there are exceptions. There are wounded soldiers and athletes using DARPA-sponsored prosthetics that are so exceptional that they manage to compete in Paralympic games. The Paralympic Games are organized in parallel with the Olympic Games, while the IOC-recognized Special Olympics World Games include athletes with physical, sensory, and intellectual disabilities.

Perhaps the most famous (or infamous) of these is Oscar Pistorius. Although both of Pistorius’ legs were amputated below the knee when he was 11 months old, he has competed in events for single below-knee amputees and for able-bodied athletes. He competed in the 2012 Olympics. At his unfortunate criminal trial in 2013, he discussed how prosthesis evolved at such great levels that he was able to compete and win many Paralympic awards.

Zwicker concedes, “These are more exceptions than the average patients.” As a Myotonic dystrophy patient, using the Toe-Off AFO braces Zwicker recommended, my dynamic brace is indispensable as a walking tool. Sometimes they are like a balancing act and they stretch walking shoes beyond limits. Nonetheless, these braces allow a smooth (if slow) walk for someone with my degree of uncurable muscular ailment. The basic mechanics of the dynamic orthosis may have been introduced in earlier DARPA-funded experiments for wounded veterans.

More people resort to more orthodox, less challenging methods like wheelchairs, scooters, and walkers. I notice very few that recommended or prescribe dynamic braces. Thankfully, more children with neuromuscular development diseases find new technological tools that help them through their lives. Some have been adopted from DARPA products targeted for military use. Unfortunately, at this point, they are exceptions. They are the few fortunate ones.

Mobility devices make up only a small portion of DARPA sponsored research. Most go to weaponry, targeting, and reconnaissance. People are fortunate to inherit the by-products of some of these as available apps in smartphones and tablets.

According to the US Department of Labor, training and employment of Orthotists and Prosthetists is projected to grow 36 percent from 2012 to 2022, much faster than the average for all occupations. The large, aging baby-boom population will create a need for orthotists and Prosthetists, since both diabetes and cardiovascular disease, which are the two leading causes of limb loss, are more common among older people. In addition, new methods are likely to challenge this growing field as more people suffer from incurable immobilizing diseases.

When you see what may seem as inordinate government spending toward the military, realize that some of that money fuels DARPA research. You inherit some of the DARPA outcomes indirectly. Any transaction requires weighing benefits and consequences, DARPA funding sponsors at-the-edge research at many universities and labs that work toward advances of all kinds. There may be consequences. Yet, the next time you use GPS, the Internet, or a form of prosthesis, remember benefits often outweigh the consequences that may result through personal needs and interactive abuse.

Perhaps nothing is fair in war but being triumphant may be a necessary good or evil. Reaping other benefits from war-based research may indirectly help many. DARPA helps balance the scale.

ToeOFF Walk Aide is for New Balance

Imagine, if you will, that a child or adult is stricken by an event that leaves muscles inactive. There is loss of movement and, with it, losses of freedom. New technologies and research are helping mobility challenged to meet those extra challenges that bring more than the sense of normal movement. We are talking 21st-century ways to help you move much better than you’ve dreamed.

Muscular Dystrophies, ALS and Multiple Sclerosis are leading diseases that immobilize patients. There are also conditions due to compressed or damaged nerves as results of development, accidents, and war. When nerves and muscles can’t evoke action potentials to stimulate movement, you are unable to move. There are many levels of research to infer causes and effects. Biochemistry has thus far been leading symptom control. Over the past 20 years, giant strides have developed technological devices that can help promote movement, albeit better movement than none. There are perhaps only a few million people in the USA where chronic immobilization is a symptom. New tech research is helping those walk forward.

Immobilization may often occur in the mind but many suffer immobility from muscle weakness to severe paralysis. Those with spinal cord injuries may become permanently paraplegic with the inability to move their legs at all but new studies with electrical impulses can help carve ways to mobilize the immobile of body. For those with weak leg muscles, pushing walkers or using wheelchairs and scooters are the common ways of finding mobility. Precious few seek out trying to walk with braces. Braces are changing. They are no longer clunky and heavy. ToeOFF is a leading orthosis that you fit in your shoe. For those who have a form of ankle weakness, ToeOFF offers dynamic mechanical devices that help people walk more naturally. In recent years, alternate technologies, such as Functional Electric Stimulation of nerves have been emerging (FES). Is there attractive hope toward mobilizing the immobile?

Until FES experiments began in the late 1990’s, if you couldn’t walk you used a cane or crutch for support. In more severe cases, you might have used a wheelchair or would have been bedridden and constantly dependent on others.

In the mid twentieth century during the polio epidemics, leather and steel leg-braces were quite a common sight. A Persian, in the 15th century, first described the coating of plaster for fractures and other bony injuries of the limb. By the 17th century, there were braces for those who could not walk but they were heavy and cumbersome. President Franklin Delano Roosevelt was stricken with polio and used braces to stand when making speeches. They were those heavy leather and steel contraptions that were difficult to put-on and take-off. His braces were extremely difficult to use. In recent years, uses of aluminum and carbon fibers make braces lighter. Adjustable rubber and/or Velcro straps make them easier to adjust. AA Swedish designed brace, sold in USA as ToeOFF, is a prescription brace that helps certain people walk better and more comfortably.

Allard ToeOFF is known as a dynamic Ankle Foot Orthosis, often referred as an AFO that aid those people that have muscular weakness from the muscle groups that disable ankles to move up and down. The result is foot drag. ToeOFF using a lightweight, mechanical carbon-fiber device that helps restore a more normal walking gait. It’s a great device and helps many people with muscular dystrophy, multiple sclerosis, neuropathies, and myopathies that are aware of ToeOFF and the availability of the ToeOFF line and the use of other dynamic AFO devices.

ToeOFF is an appliance that allows people to easily put on and fit into different types of shoes. It is a lightweight, supportive brace specifically designed to correctly position feet for walking without foot drop. It covers the symptoms attributed to weaknesses in dorsiflexion of the ankle. Dorsiflexion problems may come from acute or chronic conditions. ToeOFF is a non-electric device that acts as a dynamic brace that normalizes the way you walk when a group of muscles don’t allow that seemingly simple action. Foot Drop is a relatively common problem among people of all ages but is also a symptom of nerve and muscle diseases. It can disable walking. ToeOFF is a prescription brace that helps facilitate “normal” walking (within degrees and limits) in those people with dorsiflexion from weak muscles.

ToeOFF has become a great aid for people with diseases where dorsiflexion is a symptom. Where other muscles are not as weak, ToeOFF is a fantasy device that helps people with muscle diseases walk. For overcoming the challenges of biped walking, ToeOFF really offers an alternative to some from being confined to a wheelchair or scooter.

Science fiction sometimes becomes reality and neurokinetic and neuromuscular researchers have more avenues and tools with which to explore how to stimulate movement and mobility for many muscle group problems. Of course, many studies are too small to deliver impact. Through various independent resources, including injured veterans from recent and ongoing Asian wars, there has been a drive to test electrical impulses as means of preventing pain and restoring movement. It seems like fantasy but small steps are being realized every day. For some, small steps bring large results.

Stimulating muscle movement to enable the motion-challenged to find motion is now being experimented with as a means to help people walk. The principle isn’t a new one. About 300 years ago, Luigi Galvani at the University of Bologna in Italy. He realized that if he sent an electric impulse at the lower spine of a frog, the frog’s legs would twitch. Similar experiments helped Galvani create neurophysiology as a study of how nerves can activate muscles in the body.

Galvani’s studies transitioned to studies of stress. In law enforcement, a Galvanic Skin Response in the hand helps determine whether a person may be telling the truth or not. The skin conductance response, also known as the electrodermal response (and in older terminology as “galvanic skin response”), is the phenomenon that the skin momentarily becomes a better conductor of electricity when either external or internal stimuli occur that are physiologically arousing. It occurs in the fight or flight response at the root of placing the body on stress alert.

A Superman on screen, actor Christopher Reeve suffered virtually total paralysis after a spinal injury. The Christopher Reeve Foundation offered grants (in the last decade) to study Functional Electrical Stimulation of nerve tissue to help induce movement. Functional Electrical Stimulation applies small electrical pulses to paralyzed muscles to restore or improve their function. FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There’s evidence that FES helps reduce the frequency of pressure sores.

For research, FES is extremely valid when FES is used with a functional task such as walking, cycling, or grasping objects for a number of rehabilitative purposes and across differing diagnoses. FES has demonstrated the capacity for strengthening muscles enhancing circulation and blood flow, reducing pain, and retarding muscular atrophy.

In 2001, Case Western Reserve University, Department of Veterans Affairs, developed an intramuscular implanted system that activates the hip, knee, and trunk muscles to facilitate ambulation. At the time, the problems of electrode integrity in addition to adjusting the wavelength and amplitude signal measurements demonstrated promise.

Over the years, Federal Drug Administration worked at approving several devices that could provide enhanced results. Bioness L300 Plus adds a thigh component that facilitates knee extension and adds stability during walking as well. Other similar peroneal nerve (associated with the muscles that cause foot drop) stimulators commercially available are the WalkAide System and the Odstock devices. These systems have demonstrated long-term improvement in walking skills for persons with stroke as well as persons with multiple sclerosis and, possibly, other (thus far) incurable muscular diseases.

Alas, the rub is that virtually all these disabling diseases and conditions have no cure. Devices like ToeOFF and FES help the immobilized meet the challenges of moving. When you’re immobile or paralyzed, the facility of movement is like a light from the sky, even if only a short one.

The AFO and FES devices available for public use have been approved by medical agencies and federal groups like the FDA. This doesn’t mean that there are no side effects and contraindications as patients use them. While ToeOFF and WalkAide (and similar devices) are approved for certain conditions, each individual may be affected uniquely. Improvements may be individual specific and may not likely be generalized to work equally for a general population.

FES seems to be laying the groundwork toward the future of orthosis and. thankfully, there are products that offer advanced alternatives to the AFO. As relatively new, and somewhat unknown through the medical profession, FES is still somewhat expensive and most insurances do not cover use of a device like WalkAide. In addition, a pair of AFO (generally covered by insurance) may cost in the $1,000 to $2,000+ range. The WalkAide System may cost around $5,000 for a single and, a bit more, for a pair. Often these conditions may affect both left and right legs. Poverty and lack of adequate health insurance for those disabled by chronic nerve and muscle diseases. The merits of these prosthetics, however, could be life-changing to those afflicted by conditions.

In cases like multiple sclerosis and muscular dystrophy, understanding the etiology (causes) of the disease dynamics and causes is extremely important. Dorsiflexion is only one of possibly hundreds of symptoms. ToeOFF and WalkAide are examples of special devices that assist at making immobilization levels more mobile. While FES is promising for some, others may not benefit from neural electric therapies and devices.

ToeOFF and other AFO may work better with patients of muscular dystrophy and diseases of weakening muscles that are not necessarily associated with nerve damage. WalkAide may have little or no effect in those cases and, ominously, dystrophies have not been indicated to be (possibly) effective using an FES product. FES has been shown to be effective by generating electrical signals along nerve pathways and the nerves that are primarily associated at controlling muscles in certain areas. Some cases of dystrophy patients may not gain positive effects from an FES device because weakness is due to a genetic disruption of a neurotransmitter called Dystrophin and those signals may not change the efficacy of those muscles that affect foot drop and some other gait issues. That is why ToeOFF may still be the most advanced form of orthosis for muscular dystrophy patients.

Understanding those subtleties requires an integrated approach between physiatrists and rehabilitation specialists familiar with the problems behind neuromuscular conditions of different severity and sources. This is one of many reasons why ToeOFF and WalkAide are prescription products. For the most part, the etiologies of many of these conditions still require further research as well. In limited studies, however, products like ToeOFF and WalkAide remain to offer considerable help for those that can benefit by them.

ToeOFF is a partial solution and professional orthotists like David Zwicker, in conjunction with your prescribing doctor, can help patients optimize mobile functions. An AFO is an appliance and the appliance fits in a shoe, primarily a New Balance sneaker is recommended. As shoes are designed for feet and not necessarily a foot and an orthosis, the material of the shoe needs to be strong and stable enough to support it. Otherwise your balance may be compromised. You may require a wider size and may find that shoes last months instead of years. It’s a consequence that can be annoying. It’s fortunate that New Balance makes shoes with several width selections. That helps. Afflicted with moderate to severe dorsiflexion, ToeOFF helps you walk more normally than if you did not wear it. As an alternative to one of those electric wheelchairs, ToeOFF is a good device.

WalkAide does not require to be placed in a shoe. The battery powered unit may be placed anywhere on the calf around the peritoneal nerve fiber that is beneath your knee. That makes WalkAide an attractive alternative but only where nerve fibers and muscles interact with functional electrical stimulation. It may not work with patients suffering from muscular dystrophies or certain myopathies.

An orthosis, like a dynamic AFO (such as the Allard ToeOFF device) is a form of prosthetic. You might have your physical leg but the muscles related to dorsiflexion (and walking) don’t work. For the past 100 years, these prosthetics were heavy and large. While wealthy victims of Polio (i.e. President Franklin Delano Roosevelt) had to learn how to use them, ToeOFF is part of a group of AFO that are light and easy to use. Neuro-prosthetics is the study and development of medical devices that replace or improve the function of damaged neuromuscular organ systems and restore normal body processes, create or improve function, and/or reduce pain.

There is no 100% solution as of yet. It is promising that technological strides are being researched to offer immobile, afflicted people some more choices at the ease of getting around. Ranges might be limited. I guess it’s better to have some mobile range than none. There is promise in better AFO and FES development as the future unfolds. At least, there is hope.