What are Orthotics and Durable Medical Equipment (DME)?
Orthotics are custom or prefabricated external devices designed to support, align, prevent, or correct musculoskeletal deformities or improve functional mobility. Common types in pediatrics include:
- Ankle-Foot Orthoses (AFOs) – for foot/ankle stability and gait correction.
- Supramalleolar Orthoses (SMOs) – for subtalar joint alignment and medial-lateral ankle control.
- Knee-Ankle-Foot Orthoses (KAFOs) – for knee and lower limb support in more involved motor impairments.
- Upper extremity orthoses – for wrist/hand support or positioning.
Durable Medical Equipment (DME) are medically necessary devices that provide mobility, positioning, or support for children with functional impairments. Includes:
- Wheelchairs (manual or power)
- Gait trainers and walkers
- Standers
- Bathing and toileting systems
- Adaptive seating systems
When Do PT’s Address Orthotics Or DME?
- Postural Instability or Deformity Progression
Poor alignment during standing or sitting, increased risk of contractures or scoliosis in non-ambulatory children. - Inefficient or Unsafe Gait
Frequent tripping, fatigue, toe-walking, or knee hyperextension due to lack of support or poor mechanics. - Delayed Functional Mobility
Inability to independently stand, walk, or self-propel due to weakness, tone abnormalities, or joint instability. - Improper Fit or Use of Equipment
Skin breakdown, discomfort, or ineffective device use due to outgrown or poorly adjusted orthotics/DME. - Lack of Access or Training
Family/caregivers unsure how to use equipment appropriately, leading to underuse or dependency.
How Can PT Help With Orthotics And DME?
- Comprehensive Equipment Evaluation and Consultation
Assess posture, ROM, tone, strength, and functional needs to recommend appropriate orthoses and DME. - Collaboration with Orthotists and Vendors
Work closely with device vendor or manufacturer to ensure proper fabrication, fitting, and adjustment of custom equipment. - Gait and Functional Training with Devices
Teach children how to ambulate or perform activities using orthotics/DME to promote independence and safety. - Caregiver and Patient Education
Train families in donning/doffing, pressure relief, maintenance, and optimal positioning. - Monitoring and Reassessment
Regularly re-evaluate fit and function of orthotics and DME to adjust for growth or changing functional status. - Support for Insurance and Documentation
Provide clinical justification and documentation for device funding and acquisition through healthcare providers or insurance.