The primary purpose of ‘research’ as it is applies to TheraTogs is quite simple. Determine a hypothesis based on a specific indication. Define when to use TheraTogs based on ‘scientific plausibility.’ Ergo: reasonably high probability that the treatment will work based on observed clinical data. Define ‘how’ TheraTogs is applied to treat the indication tested in the hypothesis. Define ‘How’ the application altered (positive or negative) the symptoms or indication treated. Reexamine the original hypothesis and repeat.
Simple and research are seldom listed together in a single sentence. However, simple is critical when considering the strategy and strapping utilized to promote postural control, muscle balance and altered movement strategies. Each component contributes to the overall goal. Watch the Prezi presentation as a quick reminder of the different types of studies that lead to a hierarchy of evidence. HINT: Case Studies
Engineered From Clinical Experience and Academic Literature
Clinical Research and Clinical References
NEW! Ehab Mohamed Abd El-Kafy (2014) The clinical impact of orthotic correction of lower limb rotational deformities in children with cerebral palsy: a randomized controlled trial. Clinical Rehabilitation 2014, Vol. 28(10) 1004-1014.
Fenneman, P, Ries, JD. (2010) Effects of TheraTogs on the Postural Stability and Motor Control of a 7-year-old Girl with Down Syndrome and Severe Motor Delays. Poster presented at APTA Combined Sections meeting, February 2010.
Maguire et al. (2012) How to Improve walking, balance and social participation following stroke: a comparison of the long term effects of two walking aids- canes and an orthosis TheraTogs- on the recovery of gait following acute stroke. A study protocol for a multi-centre, single blind, randomized control trial. BMC Neurology 2012, 12:18.
Maguire C, Sieben JM, Frank M, Romkes J. (2010) Hip abductor control in walking following stroke — the immediate effect of canes, taping and TheraTogs on gait. Clinical Rehabilitation 2010 Jan;24(1):37-45. Switzerland.
Flanagan A, Krzalz J, Peer M, Johnson P, Urban M. (2009) Evaluation of Short-Term Intensive Orthotic Garment Use in Children Who Have Cerebral Palsy. Pediatric Physical Therapy 2009;21:201-204.
Sefecka, A. (2009) Case Report: The AtaxiTog System As An Adjunct To Traditional Physical Therapy Intervention For A 13-Year-Old With Postural Instability Post Non-Traumatic Cerebellar Injury;A Five-Week Program. Poster presented at APTA Combined Sections meeting, February 2009.
Rojas A., Weiss M., Elbaum L. (2008) The Effect of TheraTogs on the Gait of a Child with Cerebral Palsy: A Case Study. Florida International University Department of Physical Therapy, Miami FL. Poster presented at FIU Honors College Annual Research Conference, April 2008.
Engelmeyer, Kelly SPT, et al. (2007) The Effect of TheraTogs on Gait in a 5-Year-Old with Spastic Hemiplegia. School of Physical Therapy, Maryville University, St. Louis, MO. Poster presented at APTA Combined Sections meeting, February 2007.
Siracusa C, Taynor M, Geletka B, Overby A. (2005) Effectiveness of a biomechanical intervention in children with spastic diplegia. Pediatric Physical Therapy 17(1): 83-84. Detailed Abstract, Pediatric Physical Therapy (PDF) Poster Presentation.
Starting a literature search? Use the document TheraTogs Science Origin to focus on the areas of neuro-development techniques, muscle balance theory, cortical adaptability and motor learning, physiological adaptation, skeletal modeling and postural control, and somatosensory issues.
Developmental perspective of sensory organization on postural control -S Hirabayashi, Y Iwasaki. Brain and development, 1995. Elsevier
Stance posture control in select groups of children with cerebral palsy: deficits in sensory organization and muscular coordination. – LM Nashner, A Shumway-Cook, O Marin. Experimental Brain Research, 1983. Springer
The development of sensory organization on postural control was studied using computerized dynamic posturography. Generalized postural stability increased with age but had not reached the adult level at the age of 15 years. The significance of each…
This study has focused upon the automatic components of posture and movement in a group of ten cerebral palsy children carefully selected to represent a spectrum of
abnormalities relatively pure by clinical standards and ten age-matched normals. Each…
Woollacott MH, Shumway-Cook A. 2005. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast. 12(2-3): 211-219; discussion 263-72. Review.
Abstract (edited by Beverly Cusick): The efficiency of balance recovery can be improved in children with CP, indicated by both a reduction in the total center of pressure path used during balance recovery and in the time to restabilize balance after training. Changes in muscle response characteristics contributing to improved recovery include reductions in time of contraction onset, improved muscle response organization, and reduced co-contraction of agonists/antagonists. Clinical implications include the suggestion that improvement in the ability to recover balance is possible in school age children with CP.
EW Bushnell, JP Boudreau – Child development, 1993 – Wiley Online Library
… has already been recognized in the case of two key motor “milestones” achieved during infancy. … vastly in- creases the likelihood and salience of certain experiences for the infant; these experiences …
IC Van Haastert, LS De Vries, PJM Helders… The Journal of Pediatrics, 2006, Elsevier.
… as many infants with low AIMS scores in early infancy subsequently present with …Alberta Infant Motor Scale: reliability and validity when used on preterm infants in Taiwan. …of 15-month motor and 18-month neurological outcomes of term infants with and…
Sahrmann, S. A. and Norton, B. J. (1977), The relationship of voluntary movement of spasticity in the upper motor neuron syndrome. Ann Neurol., 2: 460–465. doi: 10.1002/ana.410020604
Gossman, Shirley A Sahrmann and Steven J Rose. (1982), Review of Length-Associated Changes in Muscle: Experimental Evidence and Clinical Implications. Phys Ther., 62:1799-1808.
Vicki Stemmons Mercer, Shirley A. Sahrmann, Virginia Diggles-buckles, Richard A. Abrams, Barbara J. Norton. Age Group Differences in Postural Adjustments Associated With a Stepping Task. (1997), Journal of Motor Behavior, Vol. 29, Iss. 3.
1977: Passive movement elicited tonic reflexes, which predominated during muscle stretch in patients and during muscle shortening in the volunteers. Ratios of the EMG activity elicited during stretch, shortening, and isometric activity were used as measures of spasticity and were compared with the time for RRM. A positive correlation between elbow flexor spasticity and the time for RRM was shown. Qualitative analysis of the EMG activity during voluntary isotonic movement, however, showed that primary impairment of movement is not due to antagonist stretch reflexes, but rather to limited and prolonged recruitment of agonist contraction and delayed cessation of agonist contraction at the termination of movement.
1982: Movement dysfunction that may be caused by length-associated changes in muscle is a problem of people treated by physical therapists. The purpose of this article is to review the literature related to length-associated changes in muscle. An analysis of length-associated changes in animal and human studies is presented. The methods used to produce the changes in animals are dis cussed, and the clinical implications of the length-associated changes in muscle are suggested.
1997: In this study, differences among age groups in the postural adjustments associated with a stepping task were identified. Twenty subjects from each of 3 age groups, children (8–12 years), young adults (25–35 years), and older adults (65–73 years), performed the task in 2 movement contexts: place and step. Inplace, the subject simply lifted the foot and placed it on the step. In step, the subject lifted the foot, placed it on the step, and stepped up onto the step. Latencies of postural and focal muscle activation were determined by using surface electromyography and pressure switches. Center of pressure (CP) data were obtained by using a force platform. Subjects in all 3 age groups consistently demonstrated postural adjustments before movement initiation. Children displayed longer postural latencies than young adults as well as disproportionately large values for CP path length. Older adults showed prolonged postural-focal latencies and decreased CP excursions…
Aubin CE, Labelle H, Ruszkowski A, et al. 1999. Variability of strap tension in brace treatment for adolescent idiopathic scoliosis. Spine. 24(4): 349-354.
[Abstract: A mechanical evaluation of brace strap tensions to document their variability in different patient positions and to assess their biomechanical effectiveness.
OBJECTIVES: To measure the strap tensions at which adolescents with scoliosis are wearing their braces and to determine the variations in strap tension in different patient positions.
SUMMARY OF BACKGROUND DATA:
The biomechanical action of thoracolumbosacral orthoses is still not well understood, and there is no standardized strap tension at which the brace should be fastened to obtain optimal results. METHODS: This study was conducted in 34 adolescents with idiopathic scoliosis wearing thoracolumbosacral orthoses. Brace straps were instrumented with load cells and tightened at four tensions (the ones prescribed by their treating physician and three standardized values: 20, 40, and 60 N). In each case, the tension was recorded while the patients assumed nine positions corresponding to normal daily tasks. The variability of strap tension was evaluated by comparing the changes from the original standing position. RESULTS: The prescribed tensions measured in thoracic and pelvic straps were markedly variable. The greatest changes in tension occurred when the patients were lying down. Relaxation of strap tension was found when the patients returned to the standing position after having completed the tasks. CONCLUSIONS: If strap tension affects the biomechanical actions of the brace, these results indicate that regular brace strap tension adjustments are needed and raise questions about the efficacy of nighttime bracing to correct spinal deformities.
Beynnon BD, Good L, Risberg MA. (2002) The effect of bracing on proprioception of knees with anterior cruciate ligament injury . J Orthop Sports Phys Ther 32(1):11-15.
[Abstract: After ACL injury, application of an elastic bandage or neoprene sleeve improved joint position sense and showed no effect on recovery of position sense after 2 years of wear.]
Blair, E., J. Ballantyne, S. Horsman, P. Chauvel (1995) A study of a dynamic proximal stability splint in the management of children with cerebral palsy. Dev Med Child Neurol 37:544-554.
[The Upsuit is a custom-made, Lycra trunk suit. Significant effect on postural stability and UE movement, and carry-over noted. Advocated particularly for athetoid and dystonic subjects. Limit wear to 6 hours/day to avoid dependence on it.]
Bravard S, Diehl D, Hogan A, Moeding J, Wallace M. (1997) The effectiveness of inhibitory taping of the upper trapezius muscle during a functional reach as determined by electromyography . Phys Ther 77(5): s-29.
[Abstract: Authors found reduced EMG output for both shoulder shrug and shoulder forward flexion in all 37 PT student subjects.]
Hylton N, Allen C. (1997) The development and use of SPIO Lycra compression bracing in children with neuromotor deficits. Pediatr Rehabil. 1(2): 109-116.
[Stabilizing Pressure Input Orthosis, developed by a parent, Cheryl Allen and Nancy Hylton,PT, is a development off the BENIK trunk supports, using lighter and cooler layers of Lycra. Spio reportedly evolved in parallel with the Australian, Ballantyne’s Upsuit. Review article with photos of cases and suggested protocols, in combination with “DAFOs”. ]
Johnson MP, McClure PW, Karduna AR. (2001) New method to assess scapular upward rotation in subjects with shoulder pathology. J Orthop SportsPhys Ther 31(2):81-89 .
[Authors used a modified digital inclinometer, and found good to excellent validity.]
Marcus RL, Sands WA, Nicholson DE. (2001) The effects of compression garments on movement function in motor impaired children. Poster presentation – Gait and Clinical Movement Analysis Society – Annual Meeting, Sacramento, CA. April.
[Abstract: Author investigated claims made by Blair et al (1995) and Hylton et al (1997) by using gait analysis to detect effects of wearing compression garments on kinematics and kinetics of gait and of single limb stance phase. No significant effect was reported. So I invited Robin to consider repeating the study using elasticized strapping in addition to compression garments to alter gait kinematics.]
Morin L, Bravo G. (1997) Strapping the hemiplegic shoulder: a radiographic evaluation of its efficacy to reduce subluxation. Physiotherapy Canada Spring: 103-112.
[Authors compared typical sling with elastic adhesive taping for 15 patients with shoulder subluxation, 5 days each, and then combined them. The two supports combined were most effective.]
Nicholson JH, Morton RE, Attfield S, Rennie D. (2001) Assessment of upper limb function and movement in children with cerebral palsy wearing lycra garments. Dev Med Child Neurol. 43: 384-391.
[Abstract: Functional gains from increased proximal stability were often outweighed by inconvenience of donning and doffing and loss of independence.]
Paleg G. (1997) Improving function with dynamic trunk splints. Advance for Phys Ther 8(48):34. December 1 issue.
[Author describes Second Skin’s “Upsuit” and BENIK’s neoprene splint.]
Snijders CJ, Hermans PF, Niesing R, Spoor CW, Stoeckart R. 2004. The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clin Biomech (Bristol, Avon). 19(4): 323-329.
[CONCLUSIONS: Backward rotation of the pelvis combined with flexion of the spine, i.e. slouching, results in backward rotation of the sacrum with respect to the ilium, dorsal widening of the intervertebral disc L5-S1 and strain on the iliolumbar ligaments when protection from back muscles against lumbar flexion is absent. Lumbar backrest support almost eliminates lumbosacral and sacroiliac movement.
RELEVANCE: Understanding why the iliolumbar ligaments are loaded in slouching contributes to the understanding of the biomechanics of low back pain in everyday situations with small or negligible compressive spinal load. The results recommend lumbar support: backrests with free shoulder space.]
Wang S, Hughes K, Olsen S, Hanten W. (1997) The effect of the McConnell shoulder taping technique in normal subjects: an electromyographic study. Phys Ther. 77(5): S-41 .
[Abstract: 29 subjects with no pathology, mean age 28. Taping was used to reposition the humeral head (?). Authors detected no changes in EMG output with and without taping, and considered that the lack of pathology might be a factor. Perhaps the taping technique is another factor?]
Abel MF, Damiano DL, Blanco JS, et al. 2003. Relationships among musculoskeletal impairments and functional health status in ambulatory cerebral palsy. J Pediatr Orthop. 23(4): 535-541.
129 ambulatory children and adolescents participated in a prospective evaluation that consisted of LE passive motion and spasticity examination, 3-D gait temporal-spatial and kinematic analysis, and acquisition of GMFM and PODCI data.
Conclusion: caution should be exercised when anticipating functional change through the treatment of isolated impairment and that addressing multiple impairments may be needed to produce appreciable effects.
Bedotto RA. 2006. Biomechanical assessment and treatment in lower extremity prosthetics and orthotics: a clinical perspective. Phys Med Rehabil Clin N Am. 17(1): 203-243.
[Abstract: Biomechanical treatment is like a jigsaw puzzle with two complex counterparts having many pieces. The physical and mechanical components are equally important and cannot be separated from each other. The patient with a prosthesis or an orthosis represents a biomechanical system; total treatment is essential. All of the pieces to the puzzle must be used to complete the picture. Given the present structure of the educational system, there is a separation of disciplines necessary to provide one truly biomechanical treatment. Physical therapists are educated in the bio aspect of treatment, whereas prosthetists/orthotists are educated in the mechanical aspect. Biomechanical treatment requires the direct interaction and integration of the two disciplines. Physical therapists and prosthetists/orthotists need each other. One without the other can provide only half of the treatment necessary for optimal outcomes. The patient needs both.
Physical therapists need to become more familiar with mechanical treatment and learn how to integrate this into their physical treatment program. Prosthetists/orthotists must become more familiar with the importance of physical treatment and the internal corrective forces necessary for efficient ambulation. The traditional label of orthotics and prosthetics and related technology as products must be replaced with biomechanical treatment that includes orthotics and prosthetics services.
Professionals working with each other is a positive step, but they need to be working together as a team toward a common goal. They need to be in the same place at the same time and work together consistently to provide total treatment. This is more than a multidisciplinary approach. It is one treatment. In this way, each benefits the other as they teach and learn simultaneously. At present, this teaching and learning can be done only on an individual basis. It is the author’s hope that experienced prosthetists/orthotists and physical therapists reading this article will see the need to combine their efforts to provide truly biomechanical treatment. By working together, they can expand their present knowledge and skills.
In this way, treatment and outcomes can improve and serve as the guiding force for a new generation of rehabilitation specialists. This process can be expedited through the educational system by offering advanced clinical degrees specializing in biomechanical treatment specifically designed for clinical practice rather than research, administrative, or academic positions. For this idea to become reality, educational institutions representing the physical and mechanical aspects of biomechanical treatment also must work together; this would expedite the learning curve so that it would not take so long to put the pieces of the puzzle together.]
Edin BB, Vallbo AB. 1988. Stretch sensitization of human muscle spindles. J Physiol. 400: 101-111. [67
Afferents from the finger extensor muscles were consecutively recorded by microneurography. The units were classified as primary (I) or secondary (II) muscle spindle afferents or Golgi tendon organ (GTO) afferents on the basis of their responses to ramp-and-hold stretches, sinusoidals superimposed on ramp-and-hold stretches, maximal twitch contractions and isometric contractions and relaxations. The muscle was repeatedlystretched and then either kept short or long for a few seconds followed by a slow ramp stretch. The responses of the muscle afferents to the slow stretch were compared under the two conditions. 30 of 38 I spindle afferents, 4 of 11 of the II afferents, and none of the 18 GTOs showed an enhanced response to the slow ramp when the muscle had been kept short compared to the response when the muscle had been kept long.
Conclusion: Stretch sensitization does occur in human muscle spindles and, when present, constitutes firm evidence of the afferent originating from a muscle spindle rather than a GTO.
Ge W, Long CR, Pickar JG. 2005. Vertebral position alters paraspinal muscle spindle responsiveness in the feline spine: effect of positioning duration. J Physiol. 569(Pt 2): 655-665.
[Proprioceptive information from paraspinal tissues including muscle contributes to neuromuscular control of the vertebral column. We investigated whether the history of a vertebra’s position can affect signalling from paraspinal muscle spindles.
Single unit recordings were obtained from muscle spindle afferents in the L6 dorsal roots of 30 anaesthetized cats. The L6 vertebra was controlled using a displacement-controlled feedback motor and was held in each of three different conditioning positions for durations of 0, 2, 4, 6 and 8 s. Conditioning positions (1.0-2.2 mm dorsal and ventral relative to an intermediate position) were based upon the displacement that loaded the L6 vertebra to 50-60% of the cat’s body weight. Following conditioning positions that stretched (hold-long) and shortened (hold-short) the spindle, the vertebra was repositioned identically and muscle spindle discharge at rest and to movement was compared with conditioning at the intermediate position. Hold-short conditioning augmented mean resting spindle discharge; however, the duration of hold-short did not significantly affect this increase. The increase was maintained at the beginning of vertebral movement but quickly returned to
baseline. Conversely, hold-long conditioning significantly diminished mean resting spindle discharge. The relationship between conditioning duration and the diminished resting discharge could be described by a quadratic revealing that the effects of positioning history were fully developed within 2 s of conditioning. In addition, 2 s or greater of hold-long conditioning significantly diminished spindle discharge to vertebral movement. These effects of vertebral positioning history may be a mechanism whereby spinal biomechanics interacts with the spine’s proprioceptive system to produce acute effects on neuromuscular control of the vertebral column.
Kolban M. (1999)
[Variability of the femoral head and neck antetorsion angle in ultrasonographic measurements of healthy children and in selected diseases with hip disorders treated surgically] Ann Acad Med Stetin. Suppl 51: 1-99. [Article in Polish]
[Abstract: An increase in antetorsion was observed in 56 joints (77%) in a group of38 children with spastic CP subjected to surgery. Mean angle of antetorsion was 37o (SD +/- 11). The angle returned to its preoperative values within 2-3 years from surgery. In the group of 25 children with Perthes disease, increased antetorsion was found in 11 (44%) joints subjected to surgery and in 8 (32%) normal joints. The angle changed during the observation period, confirming the opinion that the increase is a secondary event in this disease. The angle was much greater than normal for age in the group of 21 children with congenital hip dysplasia. Basing on the results of surgery it is concluded that corrective osteotomy of femoral proximal end in cases of increased antetorsion and valgity of femoral neck is not a sufficient procedure to prevent the angle from reverting to pre-operative values and should be supplemented by osteotomy of the pelvis.
Furthermore, ultrasonography has emerged as the best method currently available for measurement of femoral head and neck antetorsion. The correlation coefficient for USG vs. direct (intraoperative) measurement was 0.9 in all groups, reaching 0.93 in the spastic CP group, in which contractures and limited mobility are responsible for very low coefficients in the case of other methods.
The use of USG for assessment of femoral antetorsion has revealed, particularly afterlonger observation periods, that the angle in the apparently normal contralateral extremity exceeded values normal for age.]
Pincivero DM, Bachmeier B, Coelho AJ. (2001) The effects of joint angle and reliability on knee proprioception. Med Sci Sports Exerc 33(10):1708-1712.
The detection of passive knee movement, and the subsequent voluntary response, may be dependent on joint angle. Authors suggest a PPC assessment method that should enhance test-retest reliability.
Sahrmann SA. (2002) Diagnosis and treatment of movement impairment syndromes. St. Louis, MO: Mosby.
[NOTE: Billi Cusick says this is an essential resource. Tough reading at times, but certainly worth it.]
Sanders JE, Goldstein BS, Leotta DF. (1995) Skin breakdown in response to mechanical stress: adaptation rather than breakdown – a review of the literature. J Rehabil Res Dev. 32(3): 214-226.
[Note: Billi Cusick says this is a good review of skin tissue adaptability and physiology under loads. Applies to orthotic (compression and shear) more than taping (tensile loading) interventions. Excellent list of references.]
Thomas SS, Moore C, Kelp-Lelane C, Norris C (1996) Simulated gait patterns: the resulting effects on gait parameters, dynamic electromyography, joint moments, and physiological cost index. Gait Posture 4: 100-107.
[Abstract: Authors altered gait function and all other variables by taping the ankle into equinus and setting the knee in flexion on nondisabled subjects. EMG patterns were similar to those reported for children with CP.]
van der Heide JC, Hadders-Algra M. 2005. Postural muscle dyscoordination in children with cerebral palsy. Neural Plast. 12(2-3): 197-203; discussion 263-72.
[Abstract: Until now, 3 children with CP functioning at GMFCS level V have been documented. The children totally or partially lacked direction specificity in their postural adjustments and could not sit independently for >3 seconds. Some children functioning at GMFCS level IV have intact direction-specific adjustments, whereas others have problems in generating consistently direction-specific adjustments. Children at GMFCS levels I to III have an intact basic level of control but have difficulties in fine-tuning the degree of postural muscle contraction to the task-specific conditions, a dysfunction more prominently present in children with bilateral spastic CP than in children with spastic hemiplegia. The problems in the adaptation of the degree of muscle contraction might be the reason that children with CP, more often than typically developing children, show an excess of antagonistic coactivation during difficult balancing tasks and a preference for cranial-caudal recruitment during reaching.]
Woollacott MH, Shumway-Cook A. 2005. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast. 12(2-3): 211-219; discussion 263-72. Review.
[Abstract: The efficiency of balance recovery can be improved in children with CP, indicated by both a reduction in the total center of pressure path used during balance recovery and in the time to restabilize balance after training. Changes in muscle response characteristics contributing to improved recovery include reductions in time of contraction onset, improved muscle response organization, and reduced co-contraction of agonists/antagonists. Clinical implications include the suggestion that improvement in the ability to recover balance is possible in school age children with CP.]
Jee WS, Tian XY. 2005.
The benefit of combining non-mechanical agents with mechanical loading: a perspective based on the Utah Paradigm of Skeletal Physiology. J Musculoskelet Neuronal Interact. 5(2): 110-11
Skeletal Modeling during growth.
Step 1: Read about the Skeletal Modeling Process NDTA Modeling Process
Step 2: Read about the Soft Tissue Modeling Process NDTA Soft Tissue Modeling
Step 3: Read about Musculoskeletal Changes in the Sagittal Plane NDTA Musculoskeletal Sagittal
Step 4: Read about Musculoskeletal Changes in the Frontal Plane NDTA Musculoskeletal Frontal
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