The Battle of Compliance: How to Keep Kids in Their Braces

At least dental braces are securely attached. Orthotic braces are another story. Given the chance, many children would prefer to toss their orthosis-along with all the time and effort spent diagnosing the situation and fitting the brace-in the hallway closet and forget about it. Compliance for kids of all ages, therefore, is an ongoing struggle. "First of all, you have to get the parents on board, and you have to be frank with them and let them know that it's going to be a battle," says Scott Hosie, CPO, Shriners Hospitals for Children, Salt Lake City, Utah. "In this case, parents have to be parents and be a little tough." Photograph courtesy of Cascade Dafo. Hosie said that the orthotic system being used must provide enough of an increase in function so that the child and parents are willing to put up with inevitable downsides such as cosmetic issues and overall comfort. If it is apparent the bracing system is beneficial, those gains must be explained to the child. "You have to teach the kids about the benefits in a way they can understand; i.e., falling less often, able to walk further, keep up with peers," says Don Buethorn, CPO, founder and owner of Cascade Prosthetics & Orthotics and Cascade Dafo Inc., manufacturer of the Dynamic Ankle Foot Orthotic, both located in Ferndale, Washington. Buethorn also recommends making orthoses fun and colorful and to allow the child to help with color choices. For school-aged children, it can be essential to make the braces look cool. Any number of transfer-paper designs-from lightning bolts and snakes to raindrops and butterflies-can be laminated onto the orthosis. Almost every shade in the color spectrum is available, making it easy to match school colors. Other practitioners say a bit of inspirational humor helps ( Podiatry Today, February 2005), but the best way to ensure a happy and compliant user is comfort and a proper fit. "The reason [compliance] is a struggle is because you have people jamming [patients] into braces that don't fit," says Beverly Cusick, PT, MS, COF. Proper fit, of course, is always the goal, and that can be a battle in its own right when comfort is considered. "Softer materials and padding can cause more problems than if you have a nice, slick surface," Hosie says. "There is going to be friction with foam, and if there is any movement in the brace, then you are applying even more friction to the skin.... It all comes down to fit." Lightweight materials such as carbon fiber are not only strong and light, but also responsive and energy efficient in some lower-extremity systems. However, in some cases a carbon fiber composite provides only a little added benefit. A typical plastic ankle-foot orthosis (AFO) "for a six-year old only weighs a few ounces anyway, so there's not much difference," Hosie says. Adaptability of the bracing system also plays a role in continued and constant use. One example, the Dobbs Brace, a dynamically hinged leg brace for the treatment of clubfoot designed by Matthew B. Dobbs, MD, a pediatric orthopedic surgeon at St. Louis Children's Hospital, Missouri, employs an articulated bar. "With a solid bar, kids were forced to kick both legs simultaneously, and there was a lot of discomfort as they tried to adjust the brace," Dobbs says. "This design lets them move their feet independently, and that tends to allow children to sleep through the night without waking up. If kids sleep through the night, so do the parents, and that tends to make parents more compliant with use as well." And never forget a first impression. The initial experience especially should have at least some element of fun. In their paper titled "Treating Pediatric Foot and Leg Deformities," Eric M. Feit, DPM, and Alona Kashanian, DPM, recommend listening to the parents' concerns and then breaking the ice by watching the child walk or run in the hall. A little play will help loosen the child up, which is a good step toward understanding and compliance.

The Battle of Compliance: How to Keep Kids in Their Braces

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