Normal ambulation involves the coordinated effort of the entire body. This involves the head, trunk and arms as well as the legs. Ambulation has been described as a series of falls following a period of recovery. This is a learned activity and requires confidence. It is efficient and appears to be one continuous motion. In actuality, it is a complex series of movement patterns. Under routine circumstances, ambulation is automatic and does not require conscious thought.

In the presence of special conditions, it may be necessary to actively think about the act of walking. A person on the high wire uses compensations involving the whole body in order to maintain balance and security. The arms may be extended out to the side as a counterbalance to the decreased base of support. Walking on ice is another activity that requires compensations to ensure balance and security. The toddler learning to walk has a very wide base of support and uses gross body movements or compensations to avoid falling down. There is a learning curve that must be mastered before ambulation can become an unconscious activity. These counterbalances and gross body movements ultimately give way to effortless and efficient gait as the individual matures. Compensations are normal responses to activities that affect balance and security.

Individuals with physical limitations must use compensations on a routine basis. These compensations are evident in movement patterns that can identify an individual from a distance. Muscle weakness with associated muscle imbalance, joint deformities and limited range of motion or surgical fusions are common causes resulting in a loss of balance. Compensations become an unconscious habit over time. The repetitive nature of these movement patterns decreases efficiency and places a tremendous burden on the body.

Compensations vary in complexity according to the degree of deficiency and loss of balance. They range from a single arm movement in one plane to many movement patterns involving multiple planes of motion. Instead of all the body parts working in harmony, they move contrary to the intended direction. The symmetry of gait is lost. Efficient gait requires the body to continuously move forward with minimal deviation. Compensations involving the trunk, pelvis and arms and legs cause gait deviations. The deviation of these body segments can be forward or backward, up or down, side to side, rotational or any combination thereof. The analysis of the complexities of compensations, their underlying causes and how to eliminate them is a demanding task.

It is important to understand these compensations from the point of view of the client as well as the clinician. Humans are very adaptable. When compensations become habit, security is achieved at the expense of efficiency. The patterns of movement utilized in this effort become as unconscious as "normal ambulation". All compensations detract from the net force of moving the body forward. Inertia (momentum) is lost and rhythm and symmetry is disrupted. It is like driving while alternately hitting the gas pedal and the brakes. Smooth acceleration to a "cruising speed" is replaced by a series of starts and stops. In ambulation, the most energy is expended in acceleration and deceleration. The pre set cadence that each individual is endowed with is altered which decreases the efficiency of the gait cycle even more.

Approximately 70% of the body mass is concentrated in the upper body consisting of the head and trunk. The remaining 30% is distributed between the lower extremities. In single leg support, 15% of the body mass is supporting the remaining 85%! In normal ambulation, this can only be efficient through balance and inertia as the body moves forward. Compensations that deviate from this forward progression of the body increase effort and energy expenditure to extraordinary levels. As the trunk leans to the side and back while the pelvis rotates in the process, 70% of the body mass is going in the wrong direction! The supporting limb may also be supporting the body mass for longer periods of time as asymmetry increases. In cases of one-sided involvement, it is no wonder that the "good leg" presents more problems in terms of pain and orthopedic problems. If both legs are involved, the effort will ultimately lead to a sedentary lifestyle.

With the proper assessment and appropriate orthotic support system, balance can be reestablished and eliminate the need for compensations. The elimination of the habit resulting from these compensations will require conscious effort on the part of the individual to benefit from the orthosis. Fixed deformities, contractures or weakness of the hip musculature will require continued compensations but these can be minimized.

Solutions for compensations that affect balance and ambulation are now available. Recognition of the deficits that ultimately lead to compensations due to the loss of balance is the critical first step. Knowing that there are alternatives to traditional methods of treatment is the next step. Education and understanding can lead to the goal of improved function rather than accommodating existing deficiencies. Early detection can avoid the deformities and possible surgeries that can result from unresolved deficits and compensations. The sooner treatment is initiated, the better the outcomes. Dynamic Bracing Solutions offers solutions in an innovative approach that treats the deficits directly as opposed to treating the symptoms caused by compensations. A truly functional orthotic support system must address the structural needs of each individual and their related security issues. It must be dynamic in order to reestablish balance and eliminate the need for compensations. This approach offers new hope for the physically challenged individual in dealing with functional deficiencies.