Dynamic Lycra® Orthoses

Dynamic Lycra® orthoses or Dynamic Elastomeric Fabric Orthoses (DEFO) have been used in the treatment of children with hemiplegia in the UK since 1997. The benefits of use have been identified in some research studies and from current established practice within the United Kingdom. The orthoses include gloves, socks and shorts all designed specifically for a patient’s specific neurological and functional needs. They come in a variety of colours from superman blue/red for the boys, lilac/pink for the girls and other colour mixes to suit most tastes. The orthoses are tailored to the child’s measurements and include two layers of Lycra based material. The layer next to the skin is made of a polyester/cotton Lycra® with panels of a stronger Lycra® placed according to the child’s prescription.

Gloves

The gloves are designed to straighten the wrist, externally rotate the forearm and to provide stability to the fingers. The gloves can be used for fisted and floppy hands. It is important to use the affected hand to help the brain to relearn the correct movement patterns.

It should be remembered that the gloves will have a negative effect on the fine motor movements like pinching and finger movement. This is because the gloves are designed to change the underlying gross motor movements which result in the typical hemiplegic arm positioning and movement.

By changing the foundations of movement the fine motor skills can be developed after using the glove for a period of time which encourages the movement patterns to be learned. This can take up to 3 years before the glove is no longer required. Clinical experience suggests that if the gloves are used early in childhood, they are not required later even during the adolescent growth spurt.

Socks

The dorsiflex pattern socks are designed to lift the foot up and to provide a sense of foot awareness to the child. They are a relatively new treatment option for children with hemiplegia and allow range of movement. The socks are best used on children who have a range of ankle movement when they are sitting down and a little active upward toe/foot movement. The socks take some getting used to as they encourage the leg to come forward when walking forward. The socks are unable to control flat feet as they are designed to lift the foot up, however medium density foam moulded insoles can assist to control this if needed. Socks, like ankle foot orthoses are just one of the treatment options that can be used to improve walking.

Shorts

The shorts resemble long cycling shorts and are designed to provide a compressive force to the hip joint which provides stabilisation around the pelvis. They encourage more stability and improved balance as the shorts improve the core stability required to allow walking to occur. They are known to improve standing and single leg balance. There are de-rotation panels down the leg to reduce the in turning often seen in the child with hemiplegia. If one leg only turns in it is possible to turn the leg further inward whilst putting the shorts on resulting in a greater outward rotation making the shorts very useful for accommodating this problem.

Suits

There are occasions when the child with hemiplegia needs support to the trunk due to asymmetry. The suit provides more stability than the shorts and enables the trunk to be held in a more central position.

Due to the specialist nature of these orthoses your orthotist/physiotherapist/occupational therapist will need to carry out a detailed assessment and identify specific goals, against which outcomes, using the orthosis can be measured. This provides further evidence to assist in analysis of outcomes for ongoing research.

Frequently Asked Questions

How long does my child have to wear the orthosis each day?

Over the first week wearing time is started at:

- 1 hour for the 1st day
- 2 hours for the 2nd day
- 4 hours for the 3rd day
- 8 hours for the 4th day
- All day from the 5th day

The orthoses should be worn 7 days a week

DO NOT WEAR the orthosis AT NIGHT as clinical evidence suggests that this will adversely affect the way the orthosis will work and the changes seen will be reduced. The client should remain active to gain full benefit.

Do the suit/leggings/shorts affect toileting?

The orthosis is designed to accommodate nappy changing requirements but also offers options to allow normal toileting whilst still wearing the orthosis. Zips and larger toileting hole arrangements are designed into the orthosis depending on requirements. Please note that females should lean forward when toileting to prevent “splash back”.

Are there any time when the client should not wear the orthosis?

Occasionally due to growth the orthosis can be come tight. This is normally identified by cold hands,
fingers and limbs becoming cold to touch, or blue. If this occurs please notify your clinical team immediately as re-assessment is required. If the client becomes unwell the orthosis should be left off until they have recovered. In the hot summer there has been reports of over-heating- this is normally due to over clothing and lack of fluids. Research has shown that the rise in body temperature is only equivalent to applying an extra layer of clothing- so to resolve this problem leave a shirt or vest off. Lycra® Orthoses are suppied to the Far East where the humidity is much higher than in the UK, with no problems.

What are the washing instructions?

The orthosis should be washed at least once every 2/3 days.
The washing instructions indicate a hand wash, with the orthosis being wrapped up briefly in a dry towel to remove the excess moisture. The orthosis should be hung either on a hanger or by a clip so that the air can move around the orthosis-possibly in an airing cupboard, so that the orthosis is ready for use the following day. Regular washing will prevent the orthosis becoming unduly soiled and will prevent the fabric from becoming stiff due to impregnation of dust etc. If your orthosis is silver treated this will need to be re-applied after 100 washes as the silver ions start to disperse after 50 washes.

As a parent/carer, what are my responsibilities?

You may be required to keep a daily diary of how long the orthosis is worn and what you noticed whilst the suit was on. You may also be asked to provide details of the reasons why the suit was not worn if there are any days when this was the case. This is to assist in recording for the long term evaluation of Dynamic Movement Orthoses (DMO) provision. If you find the orthosis is becoming tight or excessively worn you should notify your local clinical team for a review. It is possible that the client has outgrown the orthosis and it may require replacement.

What evidence is there for the use of Dynamic Movement Orthoses(DMO)?

In the first instance you should discuss this with your local clinical team. If you require further evidence you can visit the SCOPE website or log into www.dmorthotics.com and navigate to the related literature file where all available scientific papers are listed.

Martin. Matthews, MPhil.
Orthotic Clinical Specialist
D.M.Orthotics Ltd

See also HemiHelp’s information sheet on Ankle & Foot Splints or Orthoses (AFOs)