YAAD ORTHOPEDICS provides services to hospitals, medical institutions, kindergardens, schools for children with special needs etc. YAAD ORTHOPEDICS is recognised by the Ministry of Health, the Ministry of Defense, Social Security services, the various health funds and insurance companies as a supplier of orthotics.

YAAD ORTHOPEDICS is an orthopedic clinic under the management of Ronny Shelly and Avi Yardeni. It has a staff of 12 trained workers, each specifically trained in his/her field. YAAD ORTHOPEDICS decided to concentrate on the field of orthotics in order to provide the widest possible and most advanced range of devices

An orthopedic clinic is where orthopedic devices are casted, fabricated and supplied, according to the referral of the treating staff.

In the world at large, an orthopedic technician requires at least a bachelors degree. In addition, Masters degrees are available (M Sc). In Israel there is no professional school dedicated to the training of orthopedic technicians. However, sometimes courses are held for the training of professional technicians who work in the field. This training does not result in an academic degree.

Services include casting, fitting and supplying of orthotic devices. In addition the technicians provide backup services and technical consultation by their presence in the rehabilitation and orthopedic clinics in the hospitals.

In order to reap maximum benefit from the braces the first and foremost requirement is the correct donning of the brace. This technique has been demonstrated and explained by the technician. The heel of the foot should be held well in place in the brace. You should  be pedantic about gradual donning of a new brace and you should pay attention to any red areas that indicate pressure from the brace. Importance is placed on the correct type of shoe to be worn with the brace. You should understand that this brace is a medical device and as such, requires follow up by the medical staff, together with the parents. Anything that seems unusual or out of order should be attended to immediately by the medical staff. The parents are responsible for this.

In general we recommend wearing the brace for 6-8 hours a day. In some instances this recommendation is not realistic because of the specific treatment that your child receives. Because of this, on receipt of the brace, you should begin the use of the brace gradually with the aim of reaching the recommended time and thereafter follow the instructions of the treating staff.

The brace is a rigid device and it resists the movement of the ankle, one of the reasons that the brace causes pressure on the soft tissue of the leg. This pressure is uncomfortable and sometimes even painful. Adjustment to the brace is a gradual and exhausting process. However if it is done correctly it is totally possible. We recommend that you incorporate the use of the brace “intelligently” paying special attention to the behavior of the child and making adaptations according to his ability. For example, if you have reached wearing the brace for 2 hours and you should increase the time increment by 15 minutes, you can maintain wearing the brace for 2 hours for a few days and only thereafter increase the donning time on a daily basis. Note that we do not recommend decreasing the time with the brace as this does not serve the purpose of adaptation to the brace. On the contrary,  this could result in a relapse and an even longer process for full integration with the brace.

After removing the brace you should wait for 20 minutes and only thereafter check the leg for signs of pressure. If there are still red marks at this stage this may be a problem and you should come to the clinic for a check up. We should stress that the areas that are particularly problematic for us are the bony areas. These areas are at particular risk for pressure sores. If there is skin breakdown the brace cannot be worn until the skin has healed completely.

We recommend a follow up visit once every three to four months in the event that there are no problems that arise from wearing the splint. If an unusual problem has arisen, you should come immediately to the clinic. These visits to our clinic do not replace the follow up visits that the medical staff recommend.

We recommend sports shoes. The brace will result in the need for shoes that are larger in size than that which the child ordinarily uses, usually 2 sizes larger. Even so, there is a wide range of shoes that is appropriate and that does not make walking more difficult even though the shoes are large. To this end our recommendations are:
• The shoe should have the widest possible opening at the toes. The tongue of the shoe should be right at the end.
• The regular insert of the shoe that is not stuck down should be removed to make more room for the brace.
• The toe end of the shoe should be rounded to point upwards (like running shoes). This facilitates bringing the leg forward when walking
• We see no advantage of ankle high shoes. In fact the opposite is true. Lower cut shoes are easier to wear.
• The shoes should have laces.
• You should look for the smallest shoes that you can find, obviously with the brace on the leg of the child. The shoe should be as tight a fit, as the brace will in any event stretch the shoe out quickly and then it will not be so difficult to put the shoe on over the brace.

Yes. A deteriotion in the quality of your child’s walking may be as a result of pain or a change in the functional status of the child. You should visit our clinic with your child and you might even need to see the treating staff.

We do not know of any special socks for wearing with braces. However we recommend socks that are 100% cotton. They should be tight enough that they do not make folds under the brace. They should not have any patterns which could leave marks on the soft tissue of the child because of the pressure that the brace puts on the leg.

We recommend changing the socks at least twice a day during the hot months. In this way the socks will continue to absorb the sweat.

Yes. With wet wipes.

The clinic that supplied the brace also guarantees the brace as regards repairs. In the event that the straps or the padding show wear you should come to the clinic to have them replaced.

The guarantee includes all repairs of padding, straps, connections, breakages and a re-evaluation of the fitting of the brace over time with use. The guarantee is valid for as long as the brace is suitable for the child’s limb.

We recommend gradual accomodation, in other words beginning on the first day with 15 minutes and increasing it incrementally by 15 minutes until the child is wearing the orthosis for 6-8 hours.

Visits to the treating physician are scheduled according to the wishes of that treating physician and are not dependant on the orthopedic clinic. However it is worthwhile raising the question of orthotics. It happens quite often that the parents remember that the braces are too small after they have left the doctor’s office and then the whole issue of ordering new braces is delayed because of the need to schedule a new visit to the doctor in order to get a written referral for new braces.

We recommend total cooperation between the physiotherapist and the orthopedic clinic, including the stage before ordering the device and checking the results after the brace has been supplied. The physiotherapist is usually an integral part of the rehabilitation team and knows the child better than anyone else.

The othotics are usually suitable for a year (12 months). However, because growth is not a linear process, it frequently happens that the brace is too small long before the end of the year or the opposite – that at the end of the 12 month period the brace is still good. The best time to check the brace is during a check up visit. In addition, the line of the end of the toes is over the end of the brace and this is a good indication that the child has grown.

First you have to call the clinic in order to make an appointment to renew the brace. At the same time you have to check with the physiotherapist whether the new brace is to be the same as the one your child is already using or whether the model should be changed. In order to change the model you need to refer to the doctor.

We recommend that you come to the clinic for a check-up. It sometimes happens that when you are at the clinic we are unable to discover the reason for the pain. This is usually because the patient does not arrive wearing the brace and therefore we cannot see if there are any areas of pressure. To prevent this from happening, we suggest that the child wears the brace 1-2 hours before the visit to the clinic in order to save the time it would take to find the pressure areas at the clinic.

There are many reasons for wearing a brace. Some of the more common ones are:
• Maintaining the correct alignment of the foot
• Preserving range of motion
• Decreasing degrees of freedom of movement in order to give more support
In order to benefit the most from the brace, you must ensure that the brace is put on properly as has been explained to you by the technician. You should also stick to the schedule of wearing the brace. You  should ensure that there are no long breaks during the year when the brace is not worn. Finally we strongly recommend coming for regular check-ups.

Dysfunctional walking is a general problem that is usually a symptom of a more central problem. Orthotics provide a single and localised treatment that is part of an overall multi-disciplinary treatment plan.  The orthotics cannot change the overall situation significantly. Their task is to maintain and improve the present problem. However, we believe that the all encompassing treatment will allow the child to achieve far-reaching improvements.

The brace cannot directly make the problem worse. However, if the model of the brace that was ordered is not appropriate for the child’s needs, or if the child does not use the brace correctly, the brace cannot fulfill its task and will therefore prevent the patient’s progress. It is important to note that some of the braces are meant to maintain the length of the muscles and prevent contractures. Contractures can limit movement. Incorrect treatment of the brace can cause the problem to deteriorate over time due to growth of the child or not maintaining the correct muscle length.

The available options are determined by the source of impairment or injury. 

The Ministry of Health (Misrad HaBriut) participates in the costs of orthopedic devices according to 2 criteria:
a. a list of diagnoses which is published such as MS, CVA, CP, polio, OI, SMA etc
b. the patient must be defined as having a rehabilitative-functional level of ambulation. In other the patient must have the ability to walk at least 20 steps independently or with an assistive device (crutches, a walker or others)
Patients who fulfill these criteria will receive financing of 75-100% of the cost of the orthotic which has been predetermined by the Ministry of Health.

Health Funds (Kupat Holim) are supposed to fund those patients who do not meet the rehabilitation criteria, in other words patients whose walking is only therapeutic and not functional. This is dependant to the agreement between the patient and the health fund. The level of participation fluctuates between 30 and 80 percent of the cost of the orthotic,varies from health fund to health fund and is a function of the relationship between the patient and the specific health fund.

Ministry of Defense (Misrad HaBitachon) pays the entire cost of the orthotic for patients who are accorded the status of disabled veteran needing an orthotic device and who provide a referral from the rehabilitation clinic of the Ministry of Defense.

Insurance companies provide funding for orthopedic devices for patients who have been injured in car accidents dependent of the policy between the client and the insurance company. Usually the process is handled by the lawyer for the client and the agreement of the insurance company is based on price quotes for the device.

Social Security (Bituach Leumi) Social security provides 100% reimbursement for orthopedic devices for those who have been injured in terrorist attacks

In addition one can apply for assistance from voluntary organisations such as Variety and Ilan.

The criteria for Misrad HaBriut are:
• Israeli citizenship
• A recognised diagnosis as stated by a physician from the financing committee
• Definition of the patient as one who has a rehabilitative level of mobility – an independent ambulator for 20 steps, with or without an assistive device.

There are no clear criteria. The patient will need to inquire at his/her own health fund their willingness to cover part of the cost of the brace.

The cost of the brace varies from one funding source to the other and is determined by each individual institution.
Each institution has published a price list which obligates the supplier. In the event that you want to verify the cost of the brace for private purchase, this is not fixed and varies from clinic to clinic.

Taking into consideration the fact that you already have the right kind of shoes and that you have received a personal explanation regarding wearing the brace, the right way to get used to the device is by wearing it gradually. This means increasing the time with the brace incrementally and gradually overcoming obstacles that come your way. If, after two or three weeks, there are continuing constant problems such as pressure, pain, dragging of the toe of the shoe, difficulty in overcoming stairs or inclines, we recommend returning to the clinic and allowing the technician to overcome these problems.

We recommend wide shoes with no heel that can accommodate the volume of the brace without increasing the size of the shoe drastically (sports shoe or flat walking shoes). It is important to remember that orthotics do not require the wearing of orthopedic shoes. In most cases patients find suitable shoes that are also aesthetically pleasing, this is an advantage over orthopedic shoes.

First of all you should keep in touch with the orthopedic technician so that any problem that arises from accomodating to walking with a brace can be dealt with as soon as possible.
In addition it is recommended that you schedule a few sessions with your physiotherapist. In this way you can work together on specific aspects for improving you walking pattern.

If this is your feeling, you should contact the technician, the physiotherapist or the doctor.

Generally, the technician will take care of supplying a foot orthotic for the left leg in order to even out the leg length difference. Sometimes, the injured leg is significantly shorter than the healthy leg and in this case a foot orthotic will be needed to equalise the height. If you feel this difference in leg length you should draw the attention of the technician to this fact so that he can check this out in detail.

Yes! This problem can be dealt with by changing the direction of the closing straps, the placement of these straps and/or widening of the narrow areas which might be making it difficult to get the leg into the brace. Once again it is recommended to notify the technician of this problem.

If the brace helps to solve problems such as wheelchair transfers, toilet and shower transfers, then of course there is a purpose to using it.
If the only purpose of the brace is to help when training walking, and this is only done once a day, then there is no purpose to wearing the brace when sitting in the wheelchair.

If this is the case you should consult with the technician, the physiotherapist or your doctor.

Yes. Usually the numbness caused in the leg is a result of the brace compressing the soft tissue of the lower part of the leg.  This can be prevented by resting the leg on a raised support when sitting.

The most common reason for this is that the joint of the brace is not aligned correctly with the anatomical knee joint. From the initial bending of the knee until 90 degrees the movement of the two joints are not synchronous. This is felt by movement of the support areas of the brace against the soft tissue of the thigh and calf and gives the feeling of “squeezing”. You should have this checked out at the technician’s clinic.

There are two main reasons for this:
a) the leg with the brace has not been elevated enough by the healthy leg. This can be solved by a foot orthotic on the healthy side.
b) there is too much downward movement at the ankle joint and this can be corrected by adding an assistance spring around the ankle joint.

In all probability, yes. When you walk with a long leg brace that has a locked knee you should feel safe and secure. If not, it could be that the angle at the knee joint is not optimal to provide you with a feeling of security.

We recommend that you wear a long hose made out of natural material such as cotton in order to absorb the persperation. In addition, you should aerate the brace after wearing it so that the next time you don the brace it is dry and not damp. If this does not solve your problem you should consult with a dermatologist.

One needs to identify the exact part of the brace that is tearing the clothing and this point should be sanded and smoothed to prevent the damage. Besides this recommendation it should be noted that this is a common problem and cannot be solved completely because the sides of the brace are rigid and cause shearing when there is friction between the brace and the chair etc.

In and of itself this is worrying. If the opening has only happened recently then in all probability there is a mechanical failure of the joint. This can be fixed by visiting the technician’s facility.
If this problem has existed since the beginning, it could be that the Swiss joint is not appropriate for your level of functioning. In this case you need a closer evaluation, both by the technician and by the medical personal.
In any event, this situation of lack of safety of the joint is unacceptable and needs urgent attention.

If you feel this way you should be evaluated by the staff person who is teaching you or who taught you to walk, in other words, the physiotherapist.

Nothing.

There are two possible reasons for this:
a) the brace is malfunctioning, and this should be checked out by the technician.
b) The available range of movement at the hip joint. If this is limited then your son will not be able to reach the required range in order to lock the brace. This problem does not have an absolute solution because of the difficulty in maintaining range of motion in these joints over time. Because of this, the problem needs to be addressed by the whole team involved, the doctor, the physiotherapist and the technician.

Come immediately to the technician’s clinic!

This varies depending on the level of injury, kind of diagnosis, age, weight, height, physical strength and leve of endurance. You should ask your doctor this question to get an answer that is specific for you.

The functional ability of the child will depend on the level of injury and the age of the child. In our experience, children with spina bifida function well with an RGO and are defined from our point of view as having the potential to function on a day to day with the brace.

We see no limitation on the level of functioning due to the wearing of a corset. It is clear that there is more difficulty in doing some tasks because of the decreased freedom of movement of the trunk. However, this can be compensated for, and all tasks can be accomplished, if somewhat slower or with more difficulty.

The correction is in direct relation to the growth of the child. Therefore, the more the child grows, the more the brace is able to affect the deformation. This can only be achieved if the brace is worn correctly and all day long.

24 hours a day, except for showering.

The brace should be worn until growth ends. This varies from teenager to teenager and between girls and boys. In general growth ceases between the ages of 15-16. The cessation of growth can be verified by x-raying the wrist joint