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How TheraTogs Work - In Depth
Muscles are Dominant in Movement
The muscle groups most often targeted for TheraTogs strapping are underused and overlong. They are the synergists with or the antagonists to the muscles that are dominant in movement. For example, the gluteus medius and minimus muscles are often underused in the presence of a dominant group of hip adductors.
So the hip abductors are shortened with TheraTogs strapping, and then put to work at a more appropriate length in daily function. If the tensor fascia lata (TFL) dominates as a hip flexor because of medial rotation of the knee axis in the swing phase of gait, then a lateral hip rotation strap is applied to move the TFL muscle force vector off the anterior hip joint, and to attempt to allow the iliopsoas to flex the hip more competently.
TheraTogs Strapping Approach
The basis for the TheraTogs strapping approach - that emphasizes shortening the long muscles before lengthening the short muscles, and that provides the user with a more effective movement or muscle activation strategy while working to gradually change the existing, pathological recruitment strategies - lies in the work of Shirley A Sahrmann, PT, PHD, Professor in the Division of physical Therapy at Washington University in St. Louis, Missouri.
Selecting and Applying the Straps
The recommended sequence for selecting and applying strapping applications is the same that occurs in normal development, progressing from the sagittal to the frontal to the transverse-plane, paying close attention to the body-ground interface and how the child uses it as a base for engaging in activities. The work of Lois Bly provides a detailed guide to the building process that occurs in normal infancy. When in doubt, address upper trunk extension deficits first.
Sensory, Motor, Skeletal, Joint and Muscular Factors
Each child or adult with CNS dysfunction presents hundreds of variables that comprise a unique constellation of sensory, motor, skeletal, joint, and muscular factors.
TheraTogs, Inc. strongly recommends that all TheraTogs fitters undertake a full musculoskeletal assessment for each client prior to designing a TheraTogs strapping system, in order to identify problems of skeletal geometry, muscle imbalance, and joint laxity, and to exercise proper caution and safety in seeking correction of certain pathomechanical and pathokinesiological problems.
For example, two children with diplegic cerebral palsy might have achieved the same functional level, but they can demonstrate very different musculoskeletal characteristics. The same strapping application - say for reducing medial knee joint rotation in gait - might be appropriate for one but might risk the health of the hip joint in the other.
Sensory perception might be very different, resulting in starkly different responses to wearing TheraTogs. One child might learn from them and wean out of them within 6 months. The other might only show improved function while wearing them, the way eye glasses improve vision only when worn. Or several years might be warranted to achieve a lasting learning effect. We do not know enough yet to determine who will fall into which group.
Once the Assessment is Complete
Once the assessment is complete, the clinical practitioner can use any combination of tension-generating force vectors and magnitudes to design a system of straps that persistently and gently manipulates the wearer’s musculoskeletal system for as long as he/she wears it – and in some cases, after removing it. (This is what we mean when we say you can “send your hands home” with your patients.) Once the assessment is completed, the clinical practitioner can use any combination of tension-generating force vectors and magnitudes to design a system of straps that persistently and gently manipulates the wearer’s musculoskeletal system for as long as he/she wears it – and in some cases, after removing it. (This is what we mean when we say you can “send your hands home” with your patients.)
Great Results
Generally speaking, a TheraTogs strapping system can replicate any light to moderate manual correction that the clinician can apply to improve a wearer’s posture, balance, or limb motion. The complete system is typically introduced to the wearer in small stages over time, allowing him/her to adjust to the new demands of each strap, and allowing the caretakers to learn to apply the system correctly in stages.
The more severely-involved the child, the less obvious are the effects of TheraTogs wear. If manual correction of posture is heavy and difficult, TheraTogs have to struggle in a similar way. They are, after all, only fabric. The main benefits we've seen for children with severe involvement have been in their preference for wearing them, some relaxation or calming - either immediately or over time - and in easing the work load in carrying and positioning for their caretakers.
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2007-2008 TheraTogs, Inc. All Rights Reserved Telluride, Colorado USA
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