
Guide

Sitting Walking And Standing Hip orthosis.
Primary development goals of the SWASH®:
The most visible benefits of the SWASH® are improvementsin sitting and standing posture and stability, and for theambulatory user, improvement in gait. The benefits can beimmediate and are often dramatic. Continued improvementsmay be seen after the wearer has become acclimatized tothe orthosis.Given the visible benefits, perhaps the most importantbenefit the SWASH® offers is its influence on hip stability.The very nature of high adductor tone places dislocatingforces on the hips. The internal rotation and adductionforces leave hips at risk. Data shows that ambulatory childrenwith CP have a 30% incidence, and non-ambulatorychildren have a 60% incidence of hip subluxation requiringmedical intervention.
Indications:
Contraindications:
Precautions:
Limitations:
What makes SWASH unique to other hip orthoses is that it offers controlled variable abduction.
Although it looks like a simple device, 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 medial 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.
without SWASH with SWASH
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, perhaps the most important benefit the SWASH offers is the improvement in hip alignment.
S.W.A.S.H.® Original features:
Less abduction:
Reduced abduction better accommodates wheelchairs with narrow seat structures and is better tolerated by children with tight adductor muscles. With a more upright posture and increased sitting stability, often the hands will now be free for activities instead of balance.
More abduction:
Increased abduction offers maximum opportunity for muscle lengthening in the sitting position, and is also recommended when there is need to influence the trunk toward more spinal extension. With a more upright postureand increased sitting stability, often the hands will now be free for activities instead of balance.
115 or 123 Degree Uprights?
SWASH® is available with either 115° or 123° uprights. This refers only to the fixed angle of the most proximalvisible curve in the uprights – it does NOT refer to theexact degree of abduction obtained while wearing theorthosis.Standing and walking functions of both uprights are verysimilar. Generally the differences between the two arerelated to sitting function, with the 123° uprights creatinggreater amounts of abduction and the 115° uprights creatingrelatively smaller amounts of abduction.
NOTE: In sitting, the 123o uprights will have a greater influence towards posterior pelvic rotation, thereby increasing the flexion influence on the trunk.The selection of the 115 or 123-degree uprights does have an affect on the postural out come of the fitting.
Size chart:
Pelvic section circumference: At level of the anterior superior iliac spine (ASIS).
Thigh circumference: Distal thigh, just proximal to the condyles. When fitted, theends of the thigh cuffs should almost meet (to allow forgrowth).
Upright length: Distance from waist to mid-patella with knees extended.
Upright diameter: For SWASH® Classic only, size 1 uses 6mm diameter uprights and sizes 2, 3, and 4 use 7 mm uprights. All sizes SWASH® LP II use 8 mm diameter uprights.
Level of function and tone (not just the size chart) should be evaluated when selecting the proper diameter upright.
Sizing guide.
Use the table below to select the largest size that will fit the child, based on the measurements, to allow optimum room for growth.
Keep the following in mind:
Interchange ability of Components:
Guidelines for Product Selection The following are offered as general guidelines only.
When possible, it is recommended to try each style on the patient to best assess which offers optimum function.
Swash Classic | Swash Low profile |
When maximum trunk control is requires, for the candidate who lacks muscle strength or upper body control to sit upright. |
When the primamry goal is to control scissoring gait and the posterior joints on the SWASH Classic interfere with posterior walker and new walker is not an option. |
When patient is primarily non-ambulatory ( GMFCS IV-V) |
When wearer has limited space between the iliac crest and the rib cage. |
When a smaller diameter ( 6mm) uprights on the size I are desired to perit less restriction of movement. |
When maximum upright strength is required to manage adductor zone. |
When the greater pelvic coverage area triggers more desirable neuro-sensory motor response. |
When candidate and/ or caregiver acceptance of "bracing" is an issue, the Low profile II is more cometically acceptable to some. |
Size | Pelvic section | Thigh cuffs | Upright Diameter | Upright Length |
---|---|---|---|---|
1 | 400-465mm /14 3/4-18 1/4in | 210-250mm / 8 1/4-9 3/4in | 6mm | 310mm / 12 1/4in |
1A | 400-465mm / 14 3/4-18 1/4in | 210-250mm / 8 1/4-9 3/4in | 7mm | 310mm / 12 1/4in |
2 | 460-550mm / 18-21 3/4in | 250-290mm / 9 3/4-11 1/2in | 7mm | 375mm / 14 3/4in |
3 | 540-630mm / 21 1/4-24 3/4in | 290-330mm / 11 1/2-13in | 7mm | 440mm / 17 1/4in |
4 | 620-720mm / 24 1/2-28 1/4in | 330-380mm / 13-15in | 7mm | 480mm / 19in |
PELVIC SECTION
Measure:
SWASH CLASSIC - At level of the (ASIS).
SWASH LOW PROFILE - At level between crest of ilium and ASIS. Ideal is to fit the orthosis at midpelvic girdle to obtain firm grasp and control of the pelvis. Depending on anatomy, final fitting location may vary from just below the waist (navel) to mid pelvic girdle.
THIGH CUFFS:
Measure at distal thigh, just proximal to the condyles. Ideal is to fit the cuffs as distal as possible without creating pressure or interference in the popliteal area. However, pressure on the thorax, excessive spinal flexion, or discomfort due to hamstring tightness, may be relieved by moving the cuffs up 1 - 3 inches.
UPRIGHTS
Measure waist to mid-patella. At final fitting, should be shortened to level of distal thigh cuff padding.
115 = narrow sitting base
123 = wide sitting base