Dear O&P list:
I have two separate questions: 1. Has anyone heard of and _had
experience with a COPES type TLSO. I believe this was developed at the
Children’s Hospital(Cinn., Ohio). My Patient is a 10 yo girl with
severe NM scoliosis. Goal is to postpone surgury for 2 or more years.
Very involved child, significant curve with lots of rotation. Other
experiences with orthotic management of severe scoliosis and welcome.
Child does not ambulate. Also has a feeding tube.
2. 70+post polio man has worn a KAFO with bail lock KJ(conventional) for
many years. He has become progressively weaker and getting up from
chairs is more and more difficult for him. He is extremely fearful of
the KJ not locking before he stands up completely. He is asking for an
extension assist for the KJ. His opposite side is much weaker now and
once in an upright position he can lock the joint but its a very
laborious fight against gravity until he is safe. He is unable to
manage standing with the orthosis pre-locked. He likes his older KAFO
the best(of course) and would like something done with this. He has
tried the elastic holding the bail in the locked position but this
causes a flexion moment when he unlocks it that is too dangerous for
him. Has anyone come up with a retrofitted extension assist for a
KAFO. Thank you for any suggestions or info regarding either of these
cases.Molly PitcherCPO
My apologies for not responding sooner. Below are the answers to my
inquiry. For the scoliosis problem, I casted the child on a Risser
frame and had a bivalved flex-foam TLSO made by Spinal Tech. She has
done well with the orthosis tolerating it throughout the day.
I am still considering what to do with my polio patient. I am concerned
he doesn’t have enough strength to lock the step-lock KJ through the
rachet mechanism easily. At this time he extends the bail-lock type KJ
by trying to quickly flex his hip then catching the heel on the ground.
This is the strategy he has used forever and he is not able to do it
consistently this old way because of becoming gradually weaker. He
cannot rise with the KJ locked. Am open to other suggestions . Thank
you for all the responses.
The only exposure I’ve had with the COPES TLSO is what I’ve seen on
the internet, and on a few patients in clinic (Copes is based in
Louisianna). It’s developed by an individual who used to be
certified by ABC, but is no longer. Do a
“scoliosis” search on the internet and you’ll find his
homepage….without difficulty, as he clearly is using the internet
as a strong marketing tool. After reading his claims of the
orthosis, and his voluminous “resume,” see if you’re still
interested.
My preference in bracing children with severe NM curves is a
soft type (polyethylene based foam such as aliplast) TLSO with a
rigid frame. The edges are very forgiving, with the ability to
provide structural support only in the critical areas necessary to
reduce the size of the curve in-brace.
-Don Katz, C.O.
Director, Orthotics Department
Texas Scottish Rite Hospital for Children
The only exposure I’ve had with the COPES TLSO is what I’ve seen on
the internet, and on a few patients in clinic (Copes is based in
Louisianna). It’s developed by an individual who used to be
certified by ABC, but is no longer. Do a
“scoliosis” search on the internet and you’ll find his
homepage….without difficulty, as he clearly is using the internet
as a strong marketing tool. After reading his claims of the
orthosis, and his voluminous “resume,” see if you’re still
interested.
My preference in bracing children with severe NM curves is a
soft type (polyethylene based foam such as aliplast) TLSO with a
rigid frame. The edges are very forgiving, with the ability to
provide structural support only in the critical areas necessary to
reduce the size of the curve in-brace.
-Don Katz, C.O.
Director, Orthotics Department
Texas Scottish Rite Hospital for Children
I have had good results with a limited use of the Soft TLSO with Frame
that
Spinal Tech custom makes. I have used it 5 or 6 patient like you
discribed. I cast the patient lying down with the knees and hips flexed
and as much correction as possible. Keep the foam as long as possible
but
trim the frame at the level that you would normally for that curve. I
will
put straps outside the foam, attached to the frame.
No help on the polio patient, but I would like to know what works.
Good luck, and let me know what works for you.
Terry Supan, CPO
Associate Professor
Director, Orthotic Prosthetic Services
SIU School of Medicine, Springfield, IL.
I don´t know about the size and weight of your polio patient, but I´d
like to give you a hint; I have tried using a joint which I believe is
manufactured in the US and called Step-Lok or something similar. It
can be used in free-swing or locked position, and when in “lock” mode
it allows the user to extend the limb to the first step of locking,
then the next and… well, you get the picture.
I have used it mainly on children, but I think that the joint also
comes in adult size. So, I wish you good lock (sorry ´bout that…:-)
If you would like to try the joint but can´t find it, don´t hesitate
to e-mail me and I´ll make an inquiry with the Swedish supplier.
Kjell-Ake Nilsson, CPO at Linkoping University Hospital, Sweden.
Search the Internet with the search engine Alta Vista for Copes and you
will
find a number of references about his work, Arthur L. Copes, Ph.D.,
Orthotist.
A suggestion for your KAFO would be to use a step-lock hinge available
from
OTS.
This is a ratchet type setup that would allow him to reach full
extension
without worrying about the knee collapsing. The release is the same as a
bail
lock
I can’t help much on #1 but have you tried a spring loaded bale lock?
I
believe it is make by Becker. I ‘m not in the office to check but if
it’s not
there, call me at 714 738-4769. We’ve had good success with them.
Good luck!]
Dear Molly Pitcher, CPO,
We are in receipt of your Janaury 24 correspondence.
After reviewing your letter with Dr. Copes, our director, here is a
synopsis
of his reply:
“Thank you, Molly, for your informative letter. Based on what you have
written, it would be impossible for me to comment definitively about
your
patient’s particular case, however, if you wish to telephone me at my
offices in Baton Rouge, I would be happy to speak with you about her
specific condition and attendant problems. During our conversation, for
which there is no charge, I will also answer any questions you may have
about our dynamic brace and treatment regimen for idiopathic scoliosis.
The
telephone number to call is 504-292-4333 Monday-Friday 8:30am-5:00pm
CST. I
will instruct my staff to keep your e-mail in my active file in
anticipation
of your call.”
Thank you for your inquiry. Should you need anything further at this
time,
please recontact us by phone or e-mail at your earliest convenience.
Sincerely,
Angie Poche
COPES FOUNDATION
Molly, I have fairly extensive experience with nm
scoliosis but none
with the Copes Orthosis. I have used co-polymers, polypro, soft
Bostons,
bivalved, ant. & post. openings, but have settled on an anterior
opening
one eighth inch low density polyethylene with 3/16 th alimed 4E
foam
lining
(same liner as Boston Orthosis). With a feeding tube I prefer an
ant. open-
ing without a lash and typically cut a small 1 1/2 – 2 inch tear
drop like opening
running laterally from the left edge of the ant. opening. The
ant.
opening can be 1 – 2 inches without problems. With the typical
long
C-curve I would stay reasonably close to both axillas and the
sternal notch, as trunkal flexion or extension is quite often
a
related concern, and this with reduce the need for extensive seating
straps.
I hope this might be helpful, please feel free to
contact in
future,
