Bracing and CMT

Helios Leg Brace for CMT Patients

Braces are orthotic devices used to hold a part of the body in the correct position to allow function and healing. Bracing is used in the management CMT to support and hold a part of the body compromised by of muscle weakness, muscular atrophy, and sensory impairment. Many CMT patients consequently need to wear special footwear, foot orthoses and ankle-foot orthoses (AFOs) to maintain independent ambulation. But there are a variety of braces available for ankles, knees, feet, hands, and other areas weakend by CMT. Even your neck and spine can be braced. For many with CMT, brings newfound ability to walk quickly and smoothly and greater independence in everyday activities.

CMT FACTS: Bracing and CMT

What bracing options are available for child with CMT who are still growing?

Bracing for children with CMT should consist of all the same clinical evaluations and goals as for adults. The only difference is consideration for growth. As growth rates cannot be controlled or clinically predicted, it is to the discretion of the practitioner on whether or not they could build in extra length to the device for potential growth without compromising fit, stability, and function.Here are the factors used to determine and prescribe an orthosis. As you can see, age is a relevant part in the person overall condition: Strength of various musclesAgeOverall strengthHand involvementExtent of damage to muscles, tendons, ligaments, bones, joints, and balance

What is the difference between orthoses and braces? What are the different types of braces recommended for someone with CMT?

An ORTHOSIS is an orthopedic appliance or apparatus used to support, align, prevent, or correct deformities or to improve function of movable parts of the body. It is both a clinical service and a product. However, the clinical portion comes first and must be of sound biomechanical correction for the orthosis to work. Bracing is a type of orthosis. A brace is an orthotic device that is used to support and hold any part of the body in the correct position to allow function and healing, such as a leg brace that permits walking and standingTypically, people with CMT use braces in their lower extremities but there are also bracing options available for deformities on the spine and hands and arms. Ankle-foot orthoses (AFOs) are any orthotic device for the lower limb that enclose the ankle and foot and do not extend above the knee. These are intended to prevent footdrop by stabilizing the foot and ankle. Knee-ankle-foot orthoses, are orthotics that also accommodate for knee stabilization problems and stem from above the knee to the foot. Knee-ankle-foot orthoses are used when muscle weakening and wasting has spread to the thigh muscles and exacerbate knee-stabilization problems during gait and causing sudden knee bending. Here is a list of specific types of orthoses. Consult your doctor to see what kinds of options are available for you:Posterior leaf spring Ankle-foot orthosis (AFO)Solid ankle AFOFloor reaction AFOJointed AFORange-of-motion adjustable jointed AFOEnergy storing carbon fiber AFOKnee-ankle-foot orthosis (KAFO)Energy storing KAFOOff-the-shelf AFOs (not recommended for CMT patients with moderate deformity and above)

What outcomes can I expect from braces?

Corrective bracing for people with CMT aim to correct alignment of joints, restore balance, prevent further deformity, and promote more functional gait for increased mobility. What about bracing? People find themselves much more capable when wearing their AFOs. Custom-made ones are best, and expect alterations until they feel right for you and don't hurt. Some people don't even need AFOs but manage very well with sensible flat shoes, probably lace-ups, and some only need in-shoe orthotics that can't even be seen. A lot of people with CMT wear athletic walking shoes all the time, and high-tops can really help stabilize the ankle if you're into sports.Simple wrist braces can help a person work longer, but getting away from the type of work that puts undue stress on any part of your body is the smartest way to go when something is weakened. Figure out why it's weak, and then don't do it. That's fine advice if the activity isn't one you must do, like walking, breathing or eating. If you stand on your feet all day, or your job demands that you walk many miles a day, and your legs, ankles and feet are suffering, try to find another job somewhere with the same company that doesn't demand you do this. For instance, if you keypunch all day long and your fingers are getting so weak you are making mistakes, try to develop further skills so you'll be eligible for another job where keypunching isn't the main activity. Your fingers won't get stronger keypunching but will continue to weaken, and that weakness will carry over into your personal life and include everything from preparing meals to making beds and wiping your behind. This is serious stuff; you have to be aware of what is happening to you and beware of occupational hazards. Even a hobby can weaken you if it is repetitive and you are continuously working muscles that are served by CMT nerves.

Why does CMT cause mobility impairments and how do braces help?

CMT is characterized by the atrophy of motor and sensory neurons with consequent muscle weakening and sensory reduction in the limbs. The main problems in the lower extremities are impaired stance and gait, which stem from footdrop, foot rotation, and planerflexion failure (think, inability to flex feet). Most people need to wear special footwear, foot orthoses, and ankle-foot orthoses (AFOs) in order to walk independently. Footdrop and balance loss are the most common complaints CMT patients have when evaluating for AFOs. Balance loss can cause pathological gait to be more exaggerated. With standing balance loss, CMT patients will need to rely on leaning on objects while standing, and touching objects such as walls while walking. The effects of foot drop and balance loss can overtax existing musculature that is working, early fatigue, and heightened risk of tripping and falling which means increased risk of injury. Aside from the physical implications, falling and fatigue weigh on people with CMT psychologically. One study (Vinci, Paoloni, etc. 2010) found that, with every trip or fall, people with CMT felt more insecure aware of their disability. It also found increased fatigue limits peoples ability to go places and do things they want to do, which also can be isolating.