Security issues are concerns about safety. They involve activities or movements
that elicit fear. We don't want to get hurt.
In the case of physically challenged individuals, the fear
is usually of falling. Security Issues are
based on actual events and justifiable concerns. An example
of a security issue for anyone is walking on ice. One
discovers quickly that they must alter their walking
strategy. It may be based on a previous experience or the
mere fact of losing control without actually falling. One
soon learns to alter their walking strategies. Most people
will crouch down a little and spread their feet out. This
lowers the center of gravity and increases the foundation.
The concentration required for movement is intense and
becomes the primary focus of attention. Shorter steps or
even shuffling the feet without lifting them is safer. Arms
are spread out to help with balance. All these compensations
are made to reduce the security risk. If these strategies
don't work, it may be necessary to get down on all fours and
crawl to safety.
It is human nature to make compensations for security reasons. Security issues in CMT can become a routine part of daily life. This may happen gradually over time. Each falling episode has a cumulative effect. Ultimately ambulation becomes a conscious effort. Normal ambulation is an unconscious activity. Security issues can make ambulation a conscious activity. This creates compensations, balance problems and a lack of efficiency. Until the security issues have been solved, compensations will be made. In the case of a typical individual on ice, the security issues are eliminated upon reaching dry ground. For the individual with CMT, security issues become ingrained in the subconscious mind; in other words, the compensations become normal in spite of the lack of efficiency. Understanding that they exist, recognizing and understanding their purpose and providing a solution will return security and efficiency to near normal levels.
Security issues causing compensations in CMT are learned activities. They ultimately become habits. Each person demonstrates unique characteristics and degree of severity. The most common examples of security issues in gait are decreased standing and walking balance, tripping over the feet, ankles rolling over and for some, knees buckling.
Difficulty with balance is one of the most common security issues in CMT. This is caused by a combination of weak muscles and progressive deformities in the foot and ankle complex; in addition, balance is normally maintained by a complex array of neuro sensors and muscles. This is called proprioception. Proprioception can be defined as the awareness of the body in space or the awareness of the position of a body part without visual cues. As the body leans too far, sensors send messages to activate muscles to oppose that movement and return to the original upright position. In CMT, the sensors and muscles that provide proprioception may not be working properly. Instead of small activation of a few muscles to maintain standing in one place, the individual with CMT often has to take quick steps to catch and right themselves.
Tripping or the loss of balance heightens the awareness of security issues and the fear of falling. The most common compensation is to lift the whole leg high enough to clear the foot that is dropping. As weakness progresses, the leg must be lifted higher. This compensation is called high steppage gait. One must lift 15% of one's body weight straight up against gravity on each step. This involves increased energy expenditure and creates balance problems.
The ankle rolling over also affects balance and the fear of falling to one's side unexpectedly. This is caused by deformities from an imbalance of muscles. Certain nerves are affected more than others, thus affecting the precious balance of muscle strength. 70% of people with CMT tend to have more of a discrepancy that causes excessively high arches called pes cavus. As the deformity increases, the ankle is very susceptible to rolling over to the outside. Falls, ankle sprains, and even fractures are all quite possible and common. The compensations are spreading the feet, slowing down, shorter steps, quicker steps and no longer shifting one's body weight over the feet. Ultimately, balance becomes impossible.
The buckling of the knees is less common than the previous issues; however, the resulting security issue dramatically increases the chances of falling. To prevent the likelihood of knees buckling, one will start snapping their knees backwards on each step. This creates hyperextension at the knee. (also called recurvatum) This repetitive compensation in time stretches the structures on the back of the knees. The structures involve ligaments, tendons, joint capsules, nerves and blood vessels. The recurvatum is classified as mild, moderate and severe and will progress if not prevented. Pain can also be associated with recurvatum. To be secure, one rapidly moves 15% of their body weight 180 degrees away from the intended forward direction. A secondary compensation often associated recurvatum is the forward movement of the upper body over the weight bearing leg during stance. Before a step can be taken on the other side, the trunk must move backward and to the opposite side. Since the trunk comprises 70% of the body weight, this constant and repetitive movement increases effort and energy expenditure tremendously! The body is literally moving in opposite directions at the same time! This is extremely inefficient.
In order to be effective, bracing solutions™ must recognize and address all security issues. This includes structural and functional deficits in addition to the compensations and their causes that are unique to the individual with CMT. Deviations and habits caused by security issues must be solved in order to achieve balance and efficiency. Remodeling tight structures will improve security, balance and efficiency as well as improve weight distribution on one's feet. As anatomical positioning improves, security and balance improve. This allows for the restoration of proper movement patterns that ultimately leads to optimal efficiency and a return of a normal gait.
Efficiency is defined as productive with minimal effort or capable. The underlying goal of DynamicBracingSolutions™ is to allow movement in the most efficient manner. Solving all the complex issues in each of the three planes throughout the gait cycle and preventing further deformities, translates into efficiency. Ambulation is fundamental trait of human beings. It is an unconscious activity that is often "taken for granted." Gait can only be an unconscious activity if it is optimally efficient. The desire to ambulate is based upon this notion. Insecurity and fear leading to compensations and balance problems diminish the desire to ambulate.
We believe at DynamicBracingSolutions™, that new possibilities have been recognized and have developed the technology in order to deal with complex pathomechanical profiles. Outcomes once thought unobtainable are now possible.
Do we have solutions for CMT? In most cases, the answer is absolutely yes! We believe there are no other braces that can remotely compare to our dynamic remodeling orthotic support systems. It is our commitment to individualized solutions in CMT that makes us unique in the orthotic profession.