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Using The Bamboo Brace for the First Time
We generally recommend starting with the #3 support stay and using the brace a few times to see how your child’s functional abilities are affected. With practice you can easily make the brace more flexible or more rigid depending on what you would like the brace to help your child accomplish.
For example, if you’re battling against spasticity such as with cerebral palsy, then you might want the brace a little more rigid and if you’re working with a child that has lower muscle tone such as with Down syndrome you might want the brace a little more flexible.
In cases such as with Rett Syndrome or after oral facial surgery where the braces are used as a deterrent to interaction with the head, mouth and face, we generally start with the middle supports stays and move up or down as indicated.
Suggested Wearing Schedule For The Bamboo Brace
Like any other brace or orthotic
you should begin using The Bamboo Brace for 20-30 minutes once or twice/day and
then begin to use it for longer periods of time depending on your child’s
diagnosis and presentation.
Typically children with cerebral
palsy benefit from longer wearing periods (i.e. 2-3 hours at a time twice/day)
as they require much repetition in order to establish and implement more
functional motor control patterns not only at the elbow, but the shoulder and
Children with lower muscle toned
diagnoses and genetic conditions (i.e. Down Syndrome, Prader-Willi,) where
weakness is prevalent can often wear The Bamboo Brace for shorter periods of
time to gain extra strengthening repetitions during formal therapy sessions or
at home during your practice programs.
Lastly children who use the brace
as a deterrent from undesired oral/facial interaction (i.e. Rett Syndrome, Severe Autism)
generally work up to wearing The Bamboo Braces throughout the day as they are
an excellent snug-fitting alternative to more bulky and rigid bracing.
Most common oversight is making the brace too rigid into extension.
Many people are looking for extension (straightening) at elbow and that is the reason they’ve chosen The Bamboo Brace. However unyielding extension in many cases is no more functionally beneficial to developing children than excessive flexion (bending) of the elbow.
With this principle in mind we are looking to prevent most of the elbow flexion but still allow a modest amount (15-30 degrees) so that the kids don’t become frustrated and are still able to use their arm(s) for necessary functional skills such as transitions between postures (rolling, sitting, crawling, standing, etc.)
In terms of children with neuromuscular challenges such as Cerebral Palsy as well as children with lower muscle tone such as in Down Syndrome, the "active-assistive" nature of The Bamboo Brace allows for strengthening while the children are actually wearing the brace. That's right, as the support inside the brace rebounds it dynamically and actively assists the children with the repetition helping the appropriate muscle groups to fire. However all of these principles are nullified if we have the brace too rigid. The children may look good at times while in a rigid brace, but the carryover once they are unbraced is much less in my clinical experience.
If you’re using The Bamboo Brace to assist with 4-point weight bearing and crawling, ease into it.
Many people are very excited about using The Bamboo Brace to help their children crawl (creep) in the 4-point position and we agree this is one of its best applications, however you don’t generally make a lot of friends by immediately placing the child in 4-point with big expectations right from the start.
Ease into it by starting in positions such as kneeling at furniture or household objects where there is some weight through the arms/hands but not full body weight. We call these positions "Gravity reduced." As the child feels and tolerates the sensation of their new alignment you can begin to guide more weight through the arms. As an example to help you understand, many of us could easily do 50 wall push-ups without stopping, however 50 traditional push-ups without stopping is very challenging.
This process is very individualized between children and can take from a day or two to some period of weeks. Other positions where you can ease more weight over time are floor sitting and supported standing at household objects like chairs, couches, mantles and beds. I have enjoyed a great deal of clinical success by varying the degree of gravity within the session depending on how the children are responding. This principle alone, when used with creativity, will assist you in having fantastic clinical results
It’s an elbow brace, but pay attention to the strength and control gains at the shoulder and core which have a very positive effect on function.
Through the dynamic realignment of the elbow, The Bamboo Brace actually helps produce excellent functional gains at the shoulder and core muscles . Spastic elbow patterns do not just prevent the elbow from functioning; they also shut down the independent motor control at the shoulder and the trunk as well as the wrist and hand.
Neurodevelopmentally its is more functionally beneficial for all of the joints in our bodies to be able to move either independently or in unison (synergy) with each other depending on what we are trying to accomplish. This is how the functional movement that we often take for granted is so easily achieved such as eating a sandwich or throwing a ball. However in many of our children they cannot move the elbow independently of the shoulder or the shoulder independently of the core.
By choosing to brace and realign at the elbow we help create the ability for the children to begin learning to move the shoulder without as much elbow interference and with this newfound freedom the dissociated movement continues between the shoulder and the trunk and so forth. We simply choose the elbow because it is the easiest joint with which to begin.
Initially when we dynamically brace at the elbow we will unmask a great deal of shoulder weakness because the shoulder is not accustomed to working without the elbow tagging along. With this in mind it is often helpful to support the arms (not overworking the shoulder against gravity) by playing or practicing seated at a table or highchair in smaller children. This horizontal type play (we call abduction and adduction of the shoulder) along the top side of a surface while braced, allows the shoulder to begin to gain strength in a side-to-side fashion before we place the requirements to lift it against gravity and play horizontally at the same time. As the shoulder becomes stronger the children will then be able to use the Bamboo Braces in many different and varied positions and can wear them for longer periods during the day.