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Orthologix Clinical Update

Orthologix brings you quarterly information to keep you current on industry news, trends and insights. Orthologix is an orthotics and prosthetics practice delivering evidence-based care throughout the Delaware Valley.



SWASH® from Allard USA

SWASH® - sitting, walking and standing hip orthosis - is unique to other hip orthoses as it offers controlled variable abduction. It is engineered with a complex series of angles to maintain good hip alignment as the uprights follow the pathways of motion of the femurs.

While standing or walking, SWASH provides just enough abduction to prevent scissoring and media femoral rotation.

As the hips are flexed to assume the sitting position, it automatically further abducts the hips to create a tripod base for enhanced sitting stability and more upright posture.

The most visible benefits of the SWASH are readily apparent by improvements in sitting and standing posture and stability, and for the ambulatory user, improvement in gait. However, one of the most important benefits of the SWASH is guidance for hip alignment.

Primary development goals of the SWASH:

  1. Increase abduction and stretch hip adductors to improve hip alignment.
  2. Prevent excessive adduction during sitting, standing, and walking.
  3. Optimize sitting and standing posture.
  4. Achieve the above goals with an automatic transition from neutral to abduction.

The SWASH is available in sizes that fit infants to small adults and does not interfere with a child's ability to play and does not interfere with most walkers, wheelchairs, or even standing frames.


  • Limits or controls adduction when sitting, standing and walking to prevent scissoring.
  • Provides additional abduction for muscle lengthening and sitting stability.
  • Provides support throughout the day.
  • Limits adduction during the night.
  • May reduce hip displacement caused by strong adductors.
  • Can prolong effects of other treatment modalities.
  • Maintains muscle length.
  • May delay the progression to surgery.


  • Improved ambulation when wearing the orthosis. "Gait scores showed improved pelvic symmetry, better knee clearance, and progression in functional walking scales in most cases."
  • Longer walking distances using less energy is reported by some parents.
  • Vertical positions and dynamic walking are associated with improved respiratory, bladder and kidney functions.
  • Improved trunk control facilitates upper body function for enhanced stretching and other exercises to improve muscle control and coordination skills.
  • Improved sitting balance means the possibility of using both hands to perform tasks such as eating, playing, manipulating objects, and interacting with others instead of holding the sitting surface for touch balance.
  • Neutralizing the dislocating forces secondary to high adductor tone may arrest or reduce hip displacement.
  • Clinically observable impact on the function of the proprioceptive response. This can be seen in the reduced tone of the adductors; improved posture of the trunk; and enhanced coordination of the upper extremities resulting in better reach targeting.
  • Often helps the wearer overcome pathological movement patterns.
  • Early mobilization may also reduce subluxation and dislocation of the hips.
  • Improved respiratory function as a result of the more upright posture.

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Protecting Hips at Risk

The role of a variable hip abduction orthosis to improve posture and function
By Jan F.A. Smits, C.P.O.

In the U.S., there are over a half million adults and children with symptoms of cerebral palsy. The overall prevalence of cerebral palsy was 3.6 per 1,000 in 1996 and 3.1 per 1,000 in 2000 (Bhasin et al). Cerebral palsy is a challenging condition in which patients have to fight “high muscle tone” most of the time and in which coordinated movement is difficult to achieve. This large group of patients is in constant need for our devoted attention. It is common sense to bring these children to an upright position as early as possible, not only to improve kidney and bladder function, but also to prevent damage at the hip joints.

Click here for more:

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Peter Rosenbaum, MD, FRCP(C).

Professor of Paediatrics, Canada Research Chair in Childhood Disability
Co-Founder, CanChild Centre for Childhood Disability Research

Peter Rosenbaum, MD, FRCP(C), Professor of Paediatrics at McMaster University, has held a Tier 1 Canada Research Chair since 2001. He is among the most experienced developmental paediatric researchers in the world. With his colleague, Dr. Mary Law, Dr. Rosenbaum was the co-founder of CanChild Centre for Childhood Disability Research at McMaster, an award-winning multidisciplinary health system-linked research center. In October 2007, Dr. Rosenbaum became the inaugural Director of McMaster's Child Health Research Institute, addressing 'Children with complicated lives and their families within a life-course perspective'. During 2009, he was the Acting Chair of the Department of Paediatrics at the Michael DeGroote School of Medicine at McMaster.

Dr. Rosenbaum has held more than 80 peer-reviewed research grants and is a contributing author to over 300 peer-reviewed journal articles and book chapters. He has been an invited lecturer and keynote speaker in 25 countries. He co-authored 'Cerebral Palsy: From Diagnosis to Adult Life' (2012), and co-edited 'Life Quality Outcomes of Children and Young Adults with Neurological and Developmental Conditions' (2013) with Dr. Gabriel Ronen. In 2015 he and colleagues are working on a book on ethical dilemmas in developmental medicine.

In the role of teacher and mentor Dr. Rosenbaum has been a supervisor or committee member with 45 master's and doctoral level students, including students at the Universities of Oxford, Utrecht, Witwatersrand, Ljubljana (Slovenia) and Toronto in addition to McMaster. Since 2012, he has been a consultant to UNICEF's Expert Consultation on the Collection of Data on Children with Disabilities.

Dr. Rosenbaum's accomplishments have been recognized nationally and internationally. In 1995 he was the first Canadian to be invited to hold the Folke Bernadotte Stipendiate (lectureship) of the Swedish Neuropediatric Society. He has received the Ross Award from the Canadian Paediatric Society (2000); the Weinstein-Goldenson Scientific Award from the United Cerebral Palsy Research and Educational Foundation in Washington, DC (2002); an Honorary Doctor of Science, Université Laval (2005); and the first American Academy for Cerebral Palsy and Developmental Medicine Mentorship Award (2007). In April 2009, he received the Emil Becker Award from the “Gesellschaft Neuropädiatrie” (German Neuropaediatric Society), Graz Austria, where he delivered the Emil Becker lecture to the Society's annual meeting. In October 2011, he received the Academic Leadership Clinical Investigator Award from the Paediatric Chairs of Canada.


Cunningham BJ, Rosenbaum PL Measure of Processes of Care: a review of 20 years of research. Dev Med Child Neurol, 56(5): 445-452.

Rosenbaum PL, Eliasson A-C, Hidecker MJC, Palisano RJ (2014). Classification in Childhood Disability: Focusing on Function in the 21st Century. J Ped Neurol Volume 29(8):1036-1045 (published online 7 May 2014 DOI: 10.1177/0883073814533008)

Rosenbaum PL, Gorter JW. (2012) The 'F-Words' in Childhood Disability: I Swear This is How We Should Think! Child: Care, Health and Development. Jul;38(4):457-63. DOI:10.1111/j.1365-2214.2011.01338.x

DiRezze B, Rosenbaum P, Zwaigenbaum L. What Attributes Determine Severity of Function in Autism? A Web-based Survey of Stakeholders Focus on Autism & Other Developmental Disabilities Volume 27 Issue 1 March 2012 pp. 37-39. DOI 10.1177/1088357611424906

Brehaut JC, Garner RE, Miller AR, Lach LM, Klassen AF, Rosenbaum PL, Kohen DE. Changes over time in the health of caregivers of children with health problems: Growth curve findings from a 10-year Canadian population-based study. Am J Public Health published October 20, 2011. DOI: 10.2105/AJPH.2011.300298

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Congress Approves Medicare Access and Chip Reauthorization Act

In a significant victory for physician group practices and MGMA (Medical Group Management Association), the Senate voted to approve the Medicare Access and CHIP Reauthorization Act on April 14, 2015. This legislation, which passed the House of Representatives on March 26, permanently repeals the Medicare Sustainable Growth Rate (SGR) formula. President Obama publicly stated that he will sign the bill into law.

This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule. In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended. CMS will immediately begin work to implement these provisions.

In an effort to minimize financial effects on providers, CMS previously instituted a 10-business day processing hold for all impacted claims with dates of service April 1, 2015, and later. While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate.

No action is necessary from providers who have already submitted claims for the impacted dates of service. The legislation includes a two-year extension of the Children's Health Insurance Program (CHIP) for low-income children and a two-year extension of funding for community health centers.

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NEXT 2015, June 3-6, National Harbor, Maryland

NEXT is the leading-edge event for physical therapy professionals with trend-setting programming, innovative content, and exclusive access to the profession's forward thinkers.

PT Day on Capitol Hill, June 3-4

This year, APTA's annual Federal Advocacy Forum is replaced by PT Day on Capitol Hill, June 3-4, 2015. Meet with your elected representative in Congress, network with other PTs, and have an opportunity to train to be an effective advocate. Registration required by May 14. Visit

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Q & A

Please feel free to submit your questions on the SWASH® from Allard USA as well as any other issue you would like addressed.

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Educational Workshops and Inservices

Orthologix is available to present educational workshops and inservices for your group or your facility. Email us at to schedule.


We hope you have found this issue of the Orthologix E-news informative.

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Orthologix Clinical Update