TheraTogs ULTRA PTA (Posture and Torso Alignment System) is a set of two garments and a small set of straps, which are an expandable and wearable therapy system that is used by clinicians for flexible kyphosis and lordosis.
What do TheraTogs do, exactly?
A properly fitted TheraTogs system gives the wearer a comfortable, breathable, Latex-free “second skin” on his/her torso and selected limb segments, providing vertical stiffness to reinforce the wearer’s stability, and horizontal stretch for mild compression and a comfortable fit. TheraTogs are designed to be worn as undergarments, with garment components worn next to the skin.
- For clients with neuromotor, balance, and posture issues: TheraTogs garments serve as a Velcro-sensitive field for attaching elastic strapping that assists underlying muscles - in virtually any configuration - to provide LIVE-IN postural improvement, better balance, or more precise movements.
- For clients with sensory processing issues: TheraTogs garments provide a “wearable hug” of gentle compression across the upper and lower trunk – giving significant and consistent proprioceptive and deep pressure input that calms behaviors, improves focus, and enables increased function.
One of the key benefits of TheraTogs is carry-over between therapy sessions. The clinical practitioner can send his or her clients home from a successful therapy session with a TheraTogs system that continues to deliver gains made in postural alignment, muscle function, or sensory processing. A TheraTogs strapping system can replicate almost any successful, gentle, manual correction that the clinician can attain in a wearer’s posture, balance, or limb motion.
NOTE: Rather than receive only 1 to 3 hours of therapy per week, the typical TheraTogs client receives up to 16 hours of wearable therapy every day.
How do TheraTogs work?
TheraTogs embody several principles inherent in the sciences of kinesiology, biomechanics, skeletal modeling, and motor learning. They work by:
- Increasing sensory input to the skin and underlying muscles and joints to facilitate the functional activation of those muscles.
- Training the wearer to use more efficient and kinesiologically appropriate muscle recruitment strategies for balance and function – and solidifying those gains with live-in practice and day-long functional repetitions.
- Applying prolonged, gentle forces with full-time TheraTogs use to change the physiology of muscle and connective tissue – and bone and joint geometry for infants and young children – in favor of more efficient function.
- Applying consistent, gentle compression and proprioceptive input.
Using any combination of tension-generating force vectors and magnitudes, TheraTogs straps shorten and assist weak, underused muscles, reducing postural convexities and realigning functioning limbs and joints.
The complete system is typically introduced in small stages over time, allowing the wearer to adjust to the new demands of each strap, and allowing caregivers to learn to apply the system correctly in stages.
The wearer gains the experience – and the training potential – of prolonged therapeutic “handling” throughout the day, every day, as she or he undertakes routine activities using TheraTogs-induced improvements in posture and joint alignment, and while recruiting muscles at more normal lengths. (This is what we mean when we say you can “send your hands home” with your patients.)
NOTE: Clinicians applying TheraTogs for neuromotor issues should undertake a full musculoskeletal assessment of the potential wearer – ages 3 years and older - prior to designing a TheraTogs strapping system, in order to identify problems of skeletal geometry versus muscle imbalance or joint laxity, and to exercise proper caution and restraint in seeking correction of pathomechanical function – particularly in the transverse plane (i.e. rotation).
How do I know if TheraTogs can help my client?
TheraTogs are so adaptable – it would be challenging to list all their potential applications and uses, but here are a few guidelines:
If your client presents any of these indications, TheraTogs has been shown to be effective in addressing their related stability, alignment, and movement control issues:
| Ataxia |
Attention deficit disorders |
Hemiplegia |
| Hypotonia |
Intoed gait |
Muscle recruitment problems |
| Postural mal-alignment |
Out-toed gait |
Sensory integration/processing issues |
| Athetosis |
Flexible joint deviations |
Pain due to muscle imbalances |
| Mild weakness |
Diplegia in childhood |
Joint laxity |
- In general, if the therapist/practitioner can effect a change in the client's stability, alignment, mobility, sensory processing or motor control through unforced handling during a therapy session, it's likely that this change can be replicated and supported outside the session by a properly configured TheraTogs strapping system.
- If you feel you’re “running out of hands” and could use a few more to effectively manage your client’s problems related to positioning (in a wheelchair or on other devices), or to improve client handling during therapeutic exercise sessions, you’ll generally find them in TheraTogs.
- If you have a client who benefits from deep pressure or proprioceptive input, the TheraTogs TankTop and Hipster (available as the SPD/SI system) can provide this input in a comfortable, non-intrusive way, under the client’s clothes.
NOTE: We recommend that clinicians obtain a Clinical Sizing Kit so that they can explore potential TheraTogs solutions for their clients by trying them on over clothing, and experimenting with donning and strapping applications. This is also an excellent way to improve compliance at home.
What kinds of benefits can TheraTogs provide?
The possibilities of using TheraTogs are virtually limitless. Here are a few examples of common applications:
Ataxia
TheraTogs garments — alone or with straps — use vertical compression through the trunk and lateral compression through the hip joints to improve balance and reduce staggering gait by increasing proprioceptive input and reducing load-bearing joint deviations.
Sensory Processing Disorder / Autism Spectrum
TheraTogs garments — alone or with straps — extend consistent external compression through the trunk and hips to provide calming proprioceptive input and/or deep pressure to help the client regain body awareness/control, attention, coordination, breath volume and control, and/or balance.
Kyphosis / Lordosis
Upper Extremity (UE) strapping applications can straighten the upper spine and bring the shoulders back to address flexible kyphosis. This application often requires counter support with crossed straps over the abdominals.
(UE) strapping applications can also help the abdominals to flex the lower spine, and to extend the hips to address flexible lumbar lordosis.
Shoulder / Upper Extremity Mal-Alignment
-
UE strapping applications can realign the shoulder on the trunk, correct rotation of the arm at the shoulder, or supinate a pronated forearm to address upper extremity “posturing."
-
TheraTogs can provide functional alignment for clients with scapular, shoulder girdle, and humeral mal-alignments (e.g. subluxation); for clients with brachial plexus injury and hemiplegia; and for clients with scapula-humeral ROM deficits, shoulder pain, and post-fracture or post-surgical weakness or discomfort.
-
UE strapping applications can address elbow flexion/extension deviations or forearm pronation/supination deviations.
-
Wrist and thumb systems can realign functional thumb/wrist deviations; reduce MCP joint hyperextensions; reduce wrist instability – all with adjustable dynamic splinting that supports continual movement and strengthening.
Gait Deviations
-
Lower Extremity (LE) strapping applications can gently rotate the thigh as needed to improve knee joint alignment and function, and to improve the recruitment of muscles that cross the hip joint in swing phase.
-
LE strapping applications can gently rotate the leg unit as needed to improve foot alignment and function.
-
LE strapping applications can reduce hip adduction and keep the legs apart to correct scissoring gait.
-
LE strapping applications can reduce trunk, hip, and knee flexion – while appropriate ankle-foot orthoses (AFO’s) resist forward tilt of the legs at the ankles.
Foot / Ankle Mal-Alignment and Malfunction
TheraTogs Dorsiflexion Assist (DFA) systems can provide functional positioning to correct functional ankle equines, plantar fasciitis, drop foot, flexible foot supination or pronation in the swing phase of gait.
How do I know what size to order?
TheraTogs are sized to fit most wearers within a specific weight range (they're also gender-specific in the larger sizes). Unless your wearer is extremely tall or short for his/her weight, you should be able to order a TheraTogs system chosen by weight, and trim it into a comfortable fit. The client’s shoulder-to-ASIS and ASIS-to-knee measurement will also help ensure a proper fit.
For additional information on sizing please view the TheraTogs Product selection guide.
How do I learn how to use TheraTogs? What information do I get?
Currently, the Full Body, Lower Extremity, and BPI systems include a TheraTogs Donning & Strapping Applications DVD, which details the various parts and pieces of your TheraTogs set, demonstrates the initial fitting process, and shows you several common strapping applications for specific wearer needs.
All TheraTogs systems include a comprehensive, illustrated booklet detailing appropriate indications for use and step-by-step donning and fitting instructions.
How do I know if the TheraTogs are fitted correctly?
Your wearer should be comfortable without feeling constriction, itching, or circulatory impairment. The garments should be snug against the skin, with no significant gaps, folds, or loose material. We advocate marking and trimming off excess fabric. Well-fit garments are snug enough that they effectively grip the wearer’s skin, without slipping, and so that any applied strapping moves the underlying body segments.
My client is at the low end of the weight range for their size. How do I trim the TheraTogs to fit snugly?
Mark and trim the garments to fit as described above. Leave approximately 3” of overlap on the shoulders and roughly 4” of overlap on the waist, ribs, and thigh closure flaps, to allow for growth in girth. By the way, we have found that almost all wearers fit effectively into one of the standard sizes; we can also package mixed sizes upon request. It’s very unusual for a client to truly need a custom TheraTogs system.
Is a medical prescription required for purchasing TheraTogs?
TheraTogs and related strapping systems are intended to be designed and fitted by a licensed and appropriately-trained healthcare practitioner – in most cases, a physical or occupational therapist. However, no formal prescription is required unless the client expects to submit a reimbursement claim to any private, federal or state reimbursement program – which typically require such prescriptions.
Are there reimbursement codes for TheraTogs?
Many state Medicaid programs, and an increasing number of private payors, are accepting reimbursement claims for TheraTogs based on either miscellaneous or product-specific orthotics codes (the “L” code series of the HCPCS system). TheraTogs systems do not (as yet) have specific codes assigned by the appropriate federal agency, although our applications and qualifying efforts are ongoing.
We have created several resources to help clinicians and patients prepare and support reimbursement claims:
Can TheraTogs be worn all day, or is there a time limit for wearing?
There is no generic or standard wearing schedule. We advise that you begin with a week of just wearing the garments, which can ultimately be worn all day – i.e. gradually up 12 to 16 hours - in most cases. Infants and children younger than age 3 years seem to adjust readily. If the wearer is particularly weak, it can take up to 2 weeks of gradually increasing wear time to get up to comfortable all-day wear.
At signs of discomfort, check for:
- Constriction – loosen the fit if necessary
- Excess perspiration – remove the TheraTogs to cool the client down, cut small holes in the garments to add ventilation, or add a CoolMax® Torso Body Sock or an UnderArmour® garment under the TheraTogs
- Client fatigue – loosen the shoulder closures.
When you start to use the training straps, you'll be tempted to correct everything at once, but be careful -- you can overload your client with changes and fatigue. Remember that a client using TheraTogs garments and a strapping system immediately starts using new groups of muscles in new ways, which is likely to tire him/her out more quickly at first – until he/she gets stronger in the new alignment.
The longer the client’s pathokinesiologic patterns have persisted, the more likely that fatigue will be a factor. We suggest that you start applying 1 or 2 TheraTogs straps at home on evenings and weekends; release one end of the strap(s) to remove the tension when he/she is tired, and double the wear time every 2 days or so. Remember that the wearer's comfort comes first. Be patient with incremental gains, and build on them.
Is there any research available on TheraTogs use?
Yes – in addition to the research published on the various biomechanical and sensory integration principles that form the foundation of TheraTogs applications, there have been several small studies published on TheraTogs themselves – with several more projects in the works.
Three independent studies demonstrating preliminary data for gait changes and improvements in children with CP have been completed and presented as posters by three facilities; Ohio University, Shriners Hospital in Chicago and Maryville University. Currently, there are multiple projects studying the effectiveness of TheraTogs in children with CP, children with Ataxia, and adults with Parkinson’s and adults post-stroke in progress.
- Fenneman, P, Ries, JD. (2010) Effects of TheraTogs on the Postural Stability and Motor Control of a 7-year-old Girl with Down Syndrome and Severe Motor Delays. Poster presented at APTA Combined Sections meeting, February 2010.
- Maguire C, Sieben J, Frank M, Romkes J. (2009) Hip abductor control in walking following stroke – the effect of canes, taping and TheraTogs on recovery of muscle activity. Clinical Rehabilitation, Online First edition; 10.1177/0269215509342335 (Nov 2009).
- Flanagan A, Krzalz J, Peer M, Johnson P, Urban M. (2009) Evaluation of Short-Term Intensive Orthotic Garment Use in Children Who Have Cerebral Palsy. Pediatric Physical Therapy 2009;21:201-204.
- Rojas A., Weiss M., Elbaum L. (2008) The Effect of TheraTogs on the Gait of a Child with Cerebral Palsy: A Case Study. Florida International University Department of Physical Therapy, Miami FL. Poster presented at FIU Honors College Annual Research Conference, April 2008.
- Engelmeyer, Kelly SPT, et al. (2007) The Effect of TheraTogs on Gait in a 5-Year-Old with Spastic Hemiplegia. School of Physical Therapy, Maryville University, St. Louis, MO. Poster presented at APTA Combined Sections meeting, February 2007.
- Siracusa C, Taynor M, Geletka B, Overby A. (2005) Effectiveness of a biomechanical intervention in children with spastic diplegia. Pediatric Physical Therapy 17(1): 83-84.
Detailed Abstract, Pediatric Physical Therapy (PDF) Poster Presentation.
Are TheraTogs functionally similar to the “suit therapy” systems?
In the principle of applying vertical compression and some resistance or assistance to selected movements, they resemble each other. However, the implementation regimen, the design, and the cost differ markedly comparing the Europeds and the Adeli suits to TheraTogs. TheraTogs are commonly prescribed for use following a course of Suit Therapy. To draw your own comparisons, go to
www.europeds.org.
How should I care for my TheraTogs?
Detailed care instructions are provided with all TheraTogs systems and should be reviewed with the client/caregiver before initiating product use. Overall, garment pieces and foam lined straps should be rinsed or hand washed with a mild, fragrance-free detergent. Rinsing is critical to eliminate any detergent that might cause skin irritation or decomposing of the foam backing. DO NOT MACHINE WASH OR DRY ANY FOAM-LINED COMPONENTS!
Our TogRite strapping – with the wiggly grip lines on the back – is machine washable. Air-dry this also.
How long will TheraTogs last?
Garment wearing and washing patterns will vary dramatically among users. Daily wear against the skin can be hard on any fabric. While the foam is rather delicate, the outer fabric is very durable. If blemishes like scrapes and cuts into the foam occur, garments will continue to perform. When the fabric starts to lose its grip on the skin, you may consider replacing specific garment pieces. If you notice any signs of decomposition or believe your garment has a manufacturing defect (foam peeling off down to the outer fabric, for example) within 6 months of daily use and careful laundering, please contact a TheraTogs product specialist right away for a replacement: 800-261-4919 or
customerservice@theradapt.com.
Can I order replacement or additional parts?
You certainly can! After purchasing a System, you may replace any of the components as needed without buying another system. Contact us at
customerservice@theradapt.com or by phone at 800-261-4919 for a price quote.