CONSTRAIN TO GAIN! SUCCESSFUL USE OF LOWER EXTREMITY CONSTRAINT IN A CASE OF UNILATERAL EQUINUS GAIT

Background & Purpose: While CIMT is widely used to address UE asymmetries, it is not often used on the LEs. Research on LE CIMT is emerging but limited. This case study will highlight the applicability of solid AFOs for LE CIMT in the pediatric population, demonstrate effectiveness of conservative management (PT/orthotics) for asymmetrical gait and functional LE contractures, and demonstrate the need for resourcefulness when providing clinical care.

Case Description: A 21 month old female with unilateral equinus gait of unknown origin was evaluated by orthopedics and referred to PT. Details related to her PT plan of care will be shared including therapeutic interventions and collaboration with orthotics to receive bilateral, custom, solid AFOs. The process of transitioning from bilateral to unilateral CIMT wear will be discussed.

Outcomes: Functional ankle ROM and gait changes were assessed using the Observational Gait Scale. Significant improvements in symmetry, gait mechanics and functional ankle ROM were documented over a year, including carry over to barefoot mobility.

Discussion: The successful outcome in this case demonstrates the feasibility and effectiveness of translating the emerging research on LE CIMT to the pediatric population and calls for reflection on the common clinical practice of brace/cast application unilaterally on the involved LE, rather than bilaterally or on the uninvolved LE, when addressing unilateral LE impairments. Further research is encouraged to compare the efficacy of different treatment approaches and determine the best method of LE CIMT application.