Michelle L. Lange, OTR/L, ABDA, ATP/SMS
Dynamic Footrests provide up to three types of movement – a telescoping downward movement, knee extension, and plantar/dorsi flexion. By providing component movement in response to client movement, forces are absorbed, protecting both the client as well as the wheelchair frame and seating system from harm. Broken footrest hangers and footplates are an all too common occurrence! Extensor tone is absorbed and diffused by this dynamic component, reducing overall tone and posturing. Movement is provided, which can increase sitting tolerance, decrease agitation, and increase alertness. Finally, by providing movement within a limited range, the lower extremities may even experience strengthening.
Some clients may benefit from using only the telescoping feature which moves downward toward the floor. The telescoping feature can still absorb and diffuse force on its own. This feature is standard on the Seating Dynamics Dynamic Footrests and is appropriate for a client who has very tight hamstrings which limit active knee extension. The hamstrings cross both the pelvis and the knee and when the knee is extended, the pelvis can be pulled into a posterior pelvic tilt. Use of dynamic footrests that lengthen only is appropriate for clients who may lose the position of the pelvis if the knee also extends.
Knee Extension Feature:
Knee extension, in combination with the telescoping feature, follows the natural arc of movement which occurs when the knee is straightened. This feature can be added to the Dynamic Footrests and is the most common configuration. If the position of the pelvis can be maintained, lengthening and knee extension together provide more movement and active range at the knee. If knee elevation does not pull the pelvis into a posterior pelvic tilt, this movement is recommended.
In general, the feet will need to be secured to the footplates to move the Dynamic Footrests into extension without the feet moving forward and off of the footplate surface.
Plantar / Dorsi Flexion Feature:
When the lower extremity is extended, extension may be seen at the hip, knee, and even ankle (plantar flexion). The plantar/dorsi flexion dynamic movement absorbs this force at the ankle. Most clients with increased tone will push into plantar flexion (toes toward the floor). This dynamic component will facilitate a return to a neutral amount of ankle flexion by moving in the opposite direction, dorsiflexion (toes toward the ceiling). If the client wears static AFOs, this movement will not be possible and so this option is not recommended. If the client has active ankle dorsi and plantar flexion, providing this option allows movement and active range at the ankle. Typically, the feet will need to be secured to the footplate in order to activate this movement.
Dynamic Footrests are appropriate for many clients using wheeled seating and mobility. Keep this option in mind when making equipment recommendations.