Thank you John for your thoughtful review. I look forward to trying one of these.
Over the past two months I’ve delivered two “Dynamic Response AFOs”, designed and fabricated by Biomechanical Composites. The two patients I recently fit with the Dynamic Response AFOs both had very typical presentations. One was an incomplete SCI (secondary to a rare form of spinal fluid cancer) and the other was several years s/p CVA with hemi-paresis. In both cases they presented with a polypro AFO, designed and fabricated according to acceptable orthotic principles. Both patients wore their orthosis out of necessity, but reported significant frustrations with poor function, general discomfort, and associated joint pain.
Both patients reported immediate benefits from the Dynamic Response design. The Dynamic Response AFOs fit very well, with only minimal adjusting required. The flexible, total contact foot design was less bulky and provided improved comfort and control compared to their previous orthoses. But in both cases the greatest benefits were related to the features inherent in the composite materials. I’m still thinking through these cases, and I’ll be following up on each patient, but here are my initial thoughts on the improvements that I observed. The SCI patient had weak quads, and forcibly extended his knee in order to control knee flexion during loading response while wearing the previous orthosis. The hemi-paretic patient hyper-extended his knee in order to achieve knee stability, which caused debilitating pain over time. The dynamic responsiveness allowed by the posterior carbon fiber strut in the new AFOs absorbed the plantarflexion/knee flexion moment at heel strike, essentially providing a stance flexion feature. This allowed a more normal transition to weight acceptance, foot flat, and mid-stance, requiring less control by the patient. The post-CVA patient came in to my office exhibiting toe initial contact while wearing his old orthosis, and achieved heel initial contact and a more normal progression through the rockers of the foot in his first steps while wearing the Dynamic Response AFO.
I’m fairly skeptical of device hype, and I’d like to see some objective gait analysis comparisons on both of these patients. However, my clinical assessment and patient reports in both of these cases revealed a dramatic improvement in almost every way over their previous AFOs. Both patients were thrilled with the new brace, reporting immediate improvements in comfort and function. The SCI patient’s physical therapist reported improvements in his 6 minute walking test, and his daughter told me last week that they are able walk longer distances when shopping. (Functionally a positive outcome, a potential negative economically.) Like most orthotists, I have to make clinical decisions without the advantages of a formal gait lab assessment, and I’ll take these kind of results all day long. This is a great design, and a very well-made product.