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ADM Orders & Spring Changes

Posted on Friday, February 2, 2018

Please note there may be a slight delay on ADM orders due to the change in our spring configurations - see article.


REVISED ADM SPRING STRENGTHS

 

As of Monday 5th February 2018 C-Pro Direct will introduce changes to the spring strength guides for both Night and Day ADMs.  Also the term Night ADM will be replaced by Non-Ambulatory ADM and the term Day ADM replaced by Ambulatory ADM.

 

Background

C-Pro Direct continues to refine its understanding of the ADM and to study in greater detail the biomechanical properties of both the ADM and Boots and Bar.  In light of recent biomechanical analysis and customer experience we have revised our standard recommended spring strengths for both Non-Ambulatory and Ambulatory ADMs.  The revised spring strength guide will deliver a more consistent progression of net forces and net force direction throughout the full size range.  The changes introduce a new 510 Nmm spring option.

 

Non-Ambulatory (Night) ADM Changes

The changes to Non-Ambulatory ADM standard spring strengths are summarised below.  Please note that the spring strengths shown are the Standard STJ and Standard TTJ options.  Each ADM may be ordered in nine combinations of Standard, Strong and Soft STJ spring and Standard, Strong and Soft TTJ spring.  Our aim is that the Standard STJ, Standard TTJ option works best for the majority of patients.  Ultimately, clinical judgement is necessary to decide what spring combination best delivers the desired clinical outcome on a patient.  Factors, such as body mass, inherent resistance, range of motion and muscle tone vary between patients and will impact on the ADM effect on a patient.

 

 

Sandal Size

ADM Size

New STJ / TTJ

Previous STJ / TTJ

Comment

0

XXS

90 / 90

90 / 110

Slightly less Dorsiflexion

1

XXS

120 / 120

110 / 120

Slightly greater Abduction

2

XS

170 / 170

170 / 170

No change

3

XS

170 / 240

170 / 240

No change

4

S

240 /310

240 / 420

Less Dorsiflexion

5

S

310 / 420

240 / 490

Greater Abduction Less Dorsiflexion

6

SM

400 / 510

320 / 600

Greater Abduction Less Dorsiflexion

7

M

510 / 600

320 / 780

Greater Abduction Less Dorsiflexion

8

M

600 / 780

400 / 780

Greater Abduction

9

ML

780 / 960

400 / 960

Greater Abduction

10

L

960 / 960

600 / 960

Greater Abduction

11

L

960 / 1330

600 / 960

Greater Abduction and Dorsiflexion

12

L

960 / 1330

780 / 1330

Greater Abduction

 

 

Ambulatory (Day) ADM Changes

The Ambulatory ADM spring guide has been brought into alignment with the Non-Ambulatory ADM.  This means that the Ambulatory ADM selection is now based on foot length and not shoe size.

 

The revised Ambulatory ADM guide now includes an XL size ADM.  This is designed for Teen / Adult patients and is currently in a test phase (ie., not yet for sale).  Please contact us if you have patients who may benefit from the XL ADM.  We have a briefing document and application form to join the test group.

 

Questions and Answers

Q:  Why have you dropped the terms DAY and NIGHT?

A:  Because the terms Non-Ambulatory and Ambulatory better describe what you can do with the ADMs.  The terms Day and Night resulted in some confusion.  The Non-Ambulatory ADM may be used during the day, but is not for walking (other than a few gentle steps around the house).  The Ambulatory ADM may be used for walking regardless of the time of day.

Q:  I have an ADM already and I am not sure if I need different springs?

A:  The ADM spring guides are just guidelines. Factors, such as body mass, inherent resistance, range of motion and muscle tone vary between patients and will impact on the ADM effect on a patient.  Please contact C-Pro Direct in cases where the foot position achieved is not satisfactory and we will provide help and assistance.  An appreciation of the patient history and clinical judgement are important and where there are concerns we may need to hear from the clinician with patient responsibility.

Q.  What foot position is best?

A.  Clinical judgement is necessary and no absolute statements are possible as there can be any number of factors to be taken into consideration for a specific patient.  As a general guideline for clubfoot patients with good correction and range, the ADM should ideally be delivering between 15 and 20 degrees of rotation at both the STJ and TTJ mechanisms when the patient is fully relaxed.  Our analysis shows that this will result in foot positions (foot position relative to the tibia) that compare favourably with the Boots and Bar.

Q: What spring combinations are best for Ambulatory ADMs?

A:  The combination that delivers the best gait and can be worn comfortably by the patient.  The Standard STJ, Standard TTJ options are intended to suit most Ambulatory ADM users who have relapsing clubfoot and possibly associated tight joints and reduced range.  Patients with hypermobility, low muscle tone (as often the case with neurologically related conditions) may require soft STJ springs and soft TTJ springs.  Please contact C-Pro Direct for advice and support.

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