Optimizing TheraTogs Outcomes
To optimize TheraTogs effects on postural alignment and control, begin by improving the sitting and standing base of support.There are different recommendations for these issues based upon the diagnosis. Diplegic CP has different orthotic requirements from those for Quad CP and hemiplegic CP and stroke.
Sitting – begin with the pelvis. If the child sits with the pelvis rotated backward and the spine rounded, “shim” under the pelvis by inserting a wedge that is higher in back than in front. Add slip-resistant material to the upper surface of the wedge if needed.
Standing – begin with the feet. 
A primary goal for the child with diplegia, hemiplegic CP is to help the child to learn to carry his or her body weight more effectively on the heels than the forefeet. The base of support must be optimized before addressing other concerns above the feet. This is true of any functioning position.
Most ankle-foot orthoses (AFOs) are made to prohibit the ankle from plantarflexing. However, if the calf muscles are too stiff to allow the heel to settle on the ground without pronating the feet, the typical AFO interferes with delivering sound sensory input to the loaded heel and force the foot to pronate. Address this problem by removing the AFOs and inserting lifts under the heels to make loading them in good foot alignment easer. This process is called “tuning”. Making the toe end of the AFO stiff, and reducing the flexibility of the forefoot off the shoe will improve the effect on training to keep body weight back on t he heels. If upright standing balance improves with these modifications, present them to the attending physician who prescribes AFOs.[1]
After lifting the heel, consider evaluating the potential effectiveness of a type of AFO that allows the ankle to plantarflex and helps it to dorsiflex, TogRite[2] elastic strapping can be used to mimic the operation of this type of AFO:
Anchors: Wrap a piece of 3”-wide TogRite strapping around the upper calf, snugly and tab it closed. Wrap another piece of TogRite around the forefoot of the shoe.
Motion-assist split strap: Cut a piece of 3” TogRite strapping that equals the length of the front of the leg from lower knee to the top of the midfoot. Divide both ends of this piece of TogRite with very sharp shears, cutting carefully down the middle of the strap. Cut in ¼ of the length at one end and ½ the length at the other end. Attach small tabs to all 4 ends of this split strap.
Approach from the front and attach the long straps to the back side of the calf anchor.
With the knee and ankle flexed, draw the short ends down to attach to the foot anchor.
Pull on the middle of the split strap to check the tension. It should be strong.
Evaluate standing and walking with the preview strapping. If they improve and the child likes the system, present it to the attending physician who prescribes AFOs.
[1] Owen E. 2010. The importance of being earnest about shank and thigh kinematics especially when using ankle-foot orthoses. Prosthet Orthot Int. 2010 Sep;34(3):254-69. Review [2] TogRite Strapping is available for purchase as a bulk supply item from TheraTogs directly, or via one of our distributors.