Wheel Chat - Your Go-To Mobility Podcast

Wheel Chat: Episode 17 – Cerebral Palsy, Posture & Function: Rethinking Dynamic Splints with Second Skin’s Cathy Harries & Andrea Hinckley

• Wheel Chat • Season 1 • Episode 17

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In this follow-up to their popular appearance on Episode 16, Cathy Harries and Andrea Hinckley from Second Skin return to Wheel Chat for a deep dive into cerebral palsy—covering early intervention, postural care across the lifespan, and how dynamic splinting can change the game for function, comfort, and quality of life.

From toddlers learning to sit, to teenagers building independence, to adults managing pain and postural changes—this episode is packed with clinical insights, practical strategies, and honest conversations about what’s possible with the right goals, tools, and timing.

What’s in this episode:

  • When to consider dynamic splints for children with CP (and what to look for)
  • Why “low function” never means “no function”
  • The truth about splints: soft, dynamic, and made for real-life wear
  • Real-world case stories: from walking trails in Cairns to managing pain at work
  • Managing transitions to adulthood: posture, pain, and long-term planning
  • Setting goals, managing expectations, and getting buy-in from teens
  • How to fund and fit Second Skin into a client’s broader care plan

Whether you're new to cerebral palsy care or supporting long-term clients, this episode offers a realistic, hopeful, and clinically grounded look at supporting posture and participation at every stage of life.

Connect with Andrea:

👉 LinkedIn: https://www.linkedin.com/in/andrea-hinckley-891677223/

Find out more about Second Skin: https://www.secondskin.com.au/

Email us :
We’d love to hear from you. If you have any questions about this podcast, please email us at wheelchatpod@gmail.com

Follow us : TikTok : https://www.tiktok.com/@wheelchat_podcast

Instagram : https://www.instagram.com/wheelchat_podcast/

Disclaimer: The views and opinions expressed in this podcast are solely those of Anthony and Justin.

Anton: [00:00:00] Welcome to the next episode of Wheel Chat. I'm Anton Mitchell and I am very much delighted to have Justin Boulos again with me. Justin, how you doing pal? You all right? 

Justin: Fantastic. Thank you. It's... again still great weather over here and life is as good as always. 

Anton: Well, I'm actually delighted to say that we are having much better weather also, so nah, nah, nah, nah.

Justin: Finally. 

Anton: So no life is good. Life is good here in the uk. But listen, let's get straight into it today because we are absolutely delighted to have back on for our second episode Cathy Harries and Andrea Hinckley from Second Skin. Guys, if you haven't heard the first one, you've got to check it out, but Second Skin are a leader in the design and manufacture and service delivery of custom made medical compression garments and dynamic splints.

Wow. There's a tongue twister. But I'll tell you there is a fantastic product [00:01:00] but more importantly, what's even more fantastic is the guys that work there. Cathy, Andrea, how are you today? 

Andrea & Cathy : Good, thank you. Very good. Thanks for having us again, guys. 

Anton: Oh, no, it's an absolute pleasure. We, we had a great, great time last 

Justin: We survive round one and we got so excited we thought we've got to do a round two. And more specifically with, with cerebral palsy. I suppose in the last conversation, we tried to do all of it in one go, but we just thought, ah, too many questions. Too many questions from Anton and I, and too many great answers! And rather than try to rush it and fit too much in, why not just have these two lovely ladies back on for round two to talk about cerebral palsy. Anton, how you feeling about this one? 

Anton: Yeah, I'm really buzzed about it because I don't know about you Justin, but certainly on my day to day, I'm dealing with a huge amount of clients, with all physical and neurological disabilities. But one of the main ones is cerebral palsy. So, and I reckon a lot of the [00:02:00] listeners, are also the same, especially within the pediatrics. But I think what we really want to chat about as well is not just peds, we want to talk about, you know, meeting somebody at that stage and then, you know, going into adulthood. Currently what we would love to chat about guys, if it's all right with you, is just when you're meeting somebody for the first time from a cerebral palsy point of view, talk us through that process and maybe what the things you would be considering straightaway are. 

Andrea & Cathy : Oh my goodness. That's a very big question, Anton! That's a very big question. I think for us about working out where you are at as a person with cerebral palsy and what you want out of your, the next part of your life and as a family, what is it that you may want for your child to be able to achieve as far as possible? And how do we fit [00:03:00] into that global sort of picture of all of the interventions that you might be doing?

Because most people that we meet with cerebral palsy have got therapists and medical practitioners. They might have a pediatrician, a rehab specialist, a neurologist, lots of the orthopedic specialist type team that they see as well. And so they've got a whole wealth of knowledge from all different people, but it's about how do we fit into the overall plan so that everybody is on the same page and we are all heading in the same direction with the family and the person with cerebral palsy, clearly on board and in charge of that process. And so for us it's about helping to identify what we might be able to achieve and what we could assist you to achieve and how we then fit into your lifestyle, your goals as a family, your big picture medically as well as socially, as school work; all of the environments that you may go to, assist you to [00:04:00] participate, in whatever way suits you. 

Justin: And so for just everyone who doesn't understand, what does need to happen when you meet clients who have cerebral palsy, like what is the issue that we're essentially trying to resolve? 

Andrea & Cathy : With CP it presents very differently for everyone, and I think that's the first thing to really understand. There's a spectrum of presentations from people who are very functionally impaired to those that are not, so you need to kind of see where people fit on that spectrum in relation to their goals and their life and environment and what, what, you know, they need to achieve. It's a group of disorders. It affects motor function, it affects posture, it affects movement; so we need to make sure that we're looking at someone physically and how they're presenting physically in the context of what they do in their everyday life, you know. Whether they're walking from the [00:05:00] bus to school, whether they're getting in and out of the car, whether they're going to the movies, whatever it is, look at them in the context of what they're doing. CP effects coordination, it affects sensory systems, it affects range of motion. So you need to kind of really do a bit of a physical assessment, which these people probably have been through multiples of before they get to you. So if you can obviously gather all that information so you don't have to repeat, they don't have to repeat themselves a million times that's obviously a really helpful thing to do. And in the context of assistive technology and Second Skin dynamic garments, we're obviously looking at, as Cathy's already said, what are their goals? What are they trying to achieve, and how can that device, that assistive technology or the Second Skin splint, how can that help them to achieve that in amongst all the other things? Because these clients come to us with a humongous group of people already working [00:06:00] with them and that's pretty overwhelming. 

Justin: So cerebral palsy, just to summarise what you said is a, can be a range of different, it can mean, it can mean a range of different, I guess impacts in someone's function but essentially the signals from the brain to the muscles aren't firing correctly and multiple things can happen whether someone has high tone or so, like a spasticity rigidity, they could have low tone. I believe you call it hypotonia. So it could be a low tone, could be an impact with the movement. So what is it that you guys are trying to do with Second Skin to help with them? And when should they start that process, you know? They're... CP being a congenital condition, something that they're born with, you know, from... are you in the labor room with them?! Are you waiting a few weeks? Are you waiting a few years? At what point should we start to look at Second Skin?

Andrea & Cathy : We had started prescribing splints for much younger children over the years than when we first started, you know, 35 odd years ago. We were mostly looking at [00:07:00] sort of early primary school and above. Early interventions, definitely all about early intervention these days. And so we do provide splints for small children. The youngest we've got in a body splint at the moment would be about 12 months of age and that's because early intervention is about what difference we can make in those early parts of your brain development and your skin and your skill development, that will assist you to develop those skills going forward as you grow. And that's the same goals that all therapists and all the medical teams are working on because we know a lot more about neuroplasticity these days and how much we can actually impact on change if we impact early, rather than you develop those skills that, in a really challenging way going forward, can we impact on your movement pattern, your control, your ability to sit for longer, your ability to use a switch or drive a wheelchair, your ability to use a walker or even walk [00:08:00] independently. Can we impact on those things early while those skills are developing, as part of your general gross motor development?

Justin: And then how would you identify if I'm a therapist, or even a parent with a child with cerebral palsy, at what point am I even like, you know, you mentioned that there's a wide spectrum and not everyone's the same, and so, you know, I work with a lot of clients, me personally, work with a lot of clients with CP at different ages.

Should they all go into Second Skin? Like what is the, what is the, I don't know, the canary in the coal mine? What's like the, the signal to be like, 'Hey, we should probably look at Second Skin.' Is it more around function? Is it around a test with range of motion? Like is it a functional test? How do I know when to engage in a product like this?

Andrea & Cathy : Developmentally, we are looking for you starting to struggle or already struggling with a skill that you are trying to learn. So if you are trying to learn sitting skills and you can only sit for a very brief period of time with multiple hands on you [00:09:00] holding you up, that doesn't give you a lot of opportunity to practice that skill and learn to sit more independently as you grow. So if we can assist you to develop those sitting skills from a more stable base, with better body awareness, better balance, better ability to be able to practice that for longer than we see that we are the tool that would assist that process. So very much like the therapist with their hands on assisting you to practice and teaching families how to do those things at home, we are giving you another tool that you can wear that asssit the learning of those skills as you develop. So we are looking for little people where those things are already a challenge and where everybody knows because of the extent of their cerebral palsy, that those things will be a challenge as they grow. The earlier we can assist you to practice those skills when you're just starting out, the better outcomes we see further down the track. And that is along the lines of the neuroplasticity stuff that we talked about in the previous podcast and Cathy mentioned [00:10:00] before, is the opportunity to practice and that repetition every day, every week, every month, Second Skin is a tool to help someone to do that outside therapy sessions and outside Mom and Dad, you know, doing handling skills; Second Skin is something to add to the tool belt, yeah. The timing of it though definitely has to be right in terms of everything else that you are doing with your therapy program. So if you don't have your therapist yet and you don't have a bench to practice on, or you haven't got your seating equipment organised yet, then a splint's not to really be of great service to you. So we have to fit what we are prescribing in with all of your equipment, all your therapy program, and have the timing right for that. So if you are a very little person and you are just practicing rolling on the floor, we would not be prescribing a body splint to help you yet with your sitting skills. Because at this stage, you are being carried around a lot, you're held a lot and you're maybe just starting to practice rolling on the floor, where a splint might [00:11:00] actually inhibit some of that rolling practice rather than necessarily be an advantage. But as soon as everybody starts practicing that ability to sit and maintain your head up, then that's a very different conversation.

Justin: I agree. But can you do me a favor? Can you talk to me as if I've no idea what Second Skin is or what it is, like maybe even give some examples for those who are listening. Because again, I know we, we always tend to talk on these things about like, as if everyone knows what we're talking about. But say you're talking to someone who's never even heard of Second Skin or don't even, doesn't even know what we're talking about.

What are some examples or really common ones that you see where you see exactly that, that we implement a splint and now the child can do what or is, you know, allows them to build on what? 

Andrea & Cathy : To build on those skills. Yeah, so commonly we prescribe what we call a lateral stability splint. So it's a little body splint essentially that has short legs that end above your knee, and it has short sleeves that end above your elbow.

And it zips completely open so that it [00:12:00] makes it easy for families to put it on. You don't have to take the whole thing off every time you change your nappy and put it back on again. And it's got, we use layers of fabric to give you some stability, but we can also use a directional line of pull on the fabric that guides you into a better posture. So we can change your hip posture, your pelvic position, what you do with your shoulder position with the fabric.

So it's almost like an active assistant, kind of gently moving you into that posture as you practice. And then we use flexible boning on some people, over the top of that to give you greater stability if you need it. So if you've got involuntary movement and you struggle for control, or if you are really struggling to lift the weight of your head up, it might mean that you need some boning in your splint as well as the fabric to do both of those things; the positioning as well as the structure to give you some support. But we very much focus on something that you practice in, not a splint that does all the work for you.

I describe the [00:13:00] directional line of pull to people like when you apply taping to your body; you can feel the tape doing a pull on you to position your body in a certain way. And I describe the boning as the hands of a therapist on you. But it would be too expensive and too annoying to have us around all the time. So that's kind of how I describe it to clients, yeah. 

Justin: Yeah. That's a, that's a really good way of explaining that. Anton, I feel like I'm going to ask a thousand questions and I feel like I'm dominating the questions. Did you have any questions before I keep going? 

Anton: I'm just really enjoying it. No, no, no. It's all good. It's all good. I think that everyone is listening is going to be taking a lot, and so, you know, feel free to crack on. I think what, what I am certainly taking from it is actually, it's very similar to the approach that we do with wheelchairs, like the, chat that you've been saying... yeah, yeah. So, you know, I don't think anyone needs to be scared of this. I think that's probably because I think a lot of people might be listening to this going, [00:14:00] 'I have no idea. I've never seen this suit before?' There will be lots of people that do know of Second Skin because you're really well known.

But I also think there's a lot of people that are maybe thinking to themselves, 'okay, what is this? W hat does it do?' And I think you're making a really good explanation of that. But I also think, like what Justin's asking is, which you're answering really well is, you know, when do we need this? Why would we need this, and how will it benefit us in the future?

I think that what we see with wheelchairs and offering the correct seating is exactly the same thing. If we get in early enough, then hopefully that early intervention leads to better outcomes, leads to less in the future, et cetera, et cetera. I suppose my question is, what happens if we don't use the suit right? If we don't meet someone early and you're meeting somebody... well, let's actually go into adulthood. So somebody is 20 years old [00:15:00] and they haven't had any intervention. They've had moulded seating in their wheelchair. They've had excellent sleep systems that they've not got on with, but they've tried. But they've got lots of seating options. So they've not, not had intervention. But I know myself, the struggles that that still leads to. Tell me what you do when you meet somebody in that position, please. 

Andrea & Cathy : Oh, I think that's a very different kind of splint because often you've got very established patterns of movement and very established postures in your spine as you've grown.

And so you do see an acceleration in postural asymmetry, scoliosis, difficulties with increasing hip dislocation with age, because growth really impacts on that. And then you get bigger and heavier. You tend to get most people we would see in adults who are less active than the kids that we would see and the teenagers that we would [00:16:00] see.

And that's partly because there's not as much therapy available into adulthood always. There's not always the funding available for therapy in adults. And so if you don't have an ongoing gym program and an ongoing really active lifestyle by that stage, it gets much more difficult to maintain all of those things. So tendons get tighter, muscles get weaker, spines get stiffer. And those positions that you go into, which aren't the most supportive or the best for you, they become the go-tos that you just stay in and then muscles get tighter on one side versus the other, or your hips might rotate or your shoulders might slouch.

Those positions become more so-

Justin: I know as you say this now, I'm like 'my posture!' I did it again. I got to sit up now! But, so what do you do then? So like, again, if people have developed these, these patterns now, is it, are we just trying to, [00:17:00] I guess, reduce the impact, you know, of it getting worse? I guess like, I guess once someone's hit 18 is correction ever a thing? Is that a thing? I know some sleep systems claim that they can do some,like, you know, de rotation and stuff like that through sleep systems, but that's because someone's relaxing into the position for eight hours. Is that a realistic goal of a Second Skin once someone's hit a certain age 

or- 

Andrea & Cathy : We certainly look for how much passive range we've got. So how much actual length when we handle you can we achieve in terms of spinal posture, hip position, knee extension, all of those things. So how much more symmetrical can we make you if we hold you and support you? And whatever we can do with our hands that's where, what we're aiming to do with a splint. And then have you wear that splint for longer periods in your day. So you might do five or six days a week of wearing a splint that might add up to 35, 40 plus hours of being in a better position. But the splints [00:18:00] definitely need to work with great seating, active program, ongoing therapy because there's no question, if you and I sit in our chair at our computer for a long time, we get stiffer, we get tighter and think, 'wow, I need to go for a walk. This is getting more difficult.' We gain weight. We find things more difficult than we used to, and that's the same thing for people with cerebral palsy, except they've got the added difficulties on top of that, of difficulties with their muscle tone, muscle weakness,

sensory changes, all of those things over time and so they're working much harder than you and I do to maintain those skills going forward as you get older. 

Anton: I think that... when I think of a splint, I think, I'm just wondering if people are thinking who are driving along, maybe listening to the podcast, they might be thinking if they haven't had experience with the suit, that it's a piece of wood or something hard, a piece of plastic that's rigid and that so [00:19:00] I think that splint, and I'm not, you might shout me down here, but I think splint might not be the right word that we're, that we want to use here, to describe what you guys do. Because although, because splinting for a lot of people will mean exactly what I've just said, right? So, just for the people listening, this isn't, guys, this isn't rigid. It's not, it's a body suit or an area of the body that can be applied using the material of Lycra or different layers of material, with small boning within it. That's so different guys to what I would've thought myself without knowing this product what a splint was. So if somebody's thinking, 'oh my gosh, a big chest brace that you see occasionally people wearing these big plastic sort of... yeah correct, thank you Justin for showing us. That's not what you guys do, right? 

Andrea & Cathy : No, no. It's a fabric based splint, a material based splint that has stretch to it. And that's what we, when we talked about the [00:20:00] directional line of pull, you are able to stretch and move in the splint because a lot of people need support, but they also need to move. So how do you balance the movement and the support? You do that through something that's dynamic and that's what our splints are; they're dynamic. It's definitely not the hard thermoplastic splints we all learnt back at uni or, you know, back in our support worker days; It's not that hard split. Saying that some people do need that flexible boning. If you think, you know, the old school corsets, but not as dramatic as that, and if you think, you know, those that live in Australia will know, you know, the full kind of neck to knee rashes that all the kids wear to protect them against the sun, but more, more compression and more customisation and support than that. 

The key part is absolute comfort because [00:21:00] none of us will wear anything that is uncomfortable. We don't like shoes that are uncomfortable. We won't wear underwear that's uncomfortable. We can't wait to get it off because we bought the wrong one. So it's the same thing with... there's no way we can encourage any child or adult to put something on five days a week or even six and seven days a week like some of the adults do, if it's not comfortable wear. So comfort's the real key. 

Justin: And this is what I was going, to going to mention, to play devil's advocate for anyone that's listening or any parents that might be listening thinking, 'ugh, a Second Skin in Australia?! My child's not going to, not going to do that.' I guess what would you say to the people who would look at a Second Skin or a parent that might look at it, or therapist that might look at a Second Skin and think'no.' I know you already mentioned nappies, 'you're not going to be able to manage a nappy through there.' It's just another thing to add with dressing and then, you know, maybe I'll get my 5-year-old to do it, but once they get 13, 15, you know, maybe they're going to be like, 'I don't want this mom.' Maybe they're bit more defiant. And that's pretty typical what I see. Like I see quite young [00:22:00] kids in the, you know, with real significant postures in them. I don't really see a lot of 16 to 25 year olds in Second Skin. What happens there? And you know, then they, maybe they come back to it once you know the damage is done and they're like, 'all right, now I've got real pain.' So I suppose my question is... what would you say to someone who would look at it and think it's uncomfortable or someone that is in it and says, "I'm not comfortable with it?" 

Andrea & Cathy : We definitely, as Cathy said, want comfort to be number one. And if that takes us five, six times to get that sorted for someone, we will do that. You know, we use our clinical reasoning and our experience to know what would work with this person, and the fabrics of the splint are anti-microbial. They wick away moisture like you know all the hiking socks and all the hiking, you know, mountain climbing, fancy fabrics; same type of stuff to make it comfortable. We ensure that we support where we need to support [00:23:00] and reduce layers of fabric where we can. And you know, in Australia there's, you know, lots of kids that run around with, you know, just their shorts or, you know, a little singlet on and that we make the splints really cool with different cool fabrics on it, so essentially you just need to put a pair of bike shorts or shorts over the top and you've got a built-in shirt. Really cool fabrics like flames and Lego and rainbows and princesses, so it just looks like a shirt essentially. I just wanted to tell the story of an angsty 16-year-old guy I had, CP with upper limb splinting, and he was reluctantly dragged in by his mother. And the only thing that got him across the line to think about wearing a splint was this cool fabric that we've got, which is called shimmering flames. And it is all shimmering flames. And he went, "Oh, I'll wear that!"

And it got him across the line to wear a splint. So [00:24:00] sometimes it's all about the aesthetics. When you're 16 and you're angsty and you're angry with the world, you just want to be cool.

Justin: I think you need to chat to Marvel and get Spider-Man, Spider-Man fabric license.

Andrea & Cathy : I think the other key issue is that for every person who comes and every family who comes, you want them to have a win. You actually want to say, "That's a great piece of kit. It's made a real difference, and I really like that." So you're not going to suggest to a 16-year-old that you have one of every piece of kit, no matter what it is, because you know that the odds of them putting it on each morning is going to be an argument at home to try and actually get that on. So I've got to find something in my conversation with you that says this will deliver what you are looking for. So it might be the basketball team, it might be 'I want to drive my wheelchair and I can have this wheelchair if I can drive better.' There's got to be something that I can pin it on that you think if I wear this , this is much easier for me and then I will win you over. Not one of everything, not one of every body part that covers, because I'm not going to get a win if that's the case. So [00:25:00] lots of young people are better I think when you go step by step and they get a win and think, 'yep, now I can tell the difference. Now I can see what you're doing. Now I want to talk to you about my left foot' and that happens a lot. So we have people come for a hand splint. They come back and say, "Can you look at my foot while I'm here?" And then we have a look at the next part of that story. But there's no way that you're going to say, "Oh, let's do one of all of these things", because none of us would manage that as part of our daily routine.

Everyone's adding one more thing to their daily routine. So I think you've got to be mindful always that if you want engagement with people, it's got to be something that you think, 'I think I can do it. I think that's doable for us as a family and me as a person.' 

Justin: Perfection is the enemy of good. As much as we probably want to, you know, support everyone everywhere, but exactly what you said: focus on a particular function, whether it be basketball, whether it be your hand on joystick, whether it be a rotation or something.

Start with that, get some proven benefits. And I love what you said about explaining the 'why', [00:26:00] because to a child, it doesn't matter. It's just, it's something to wear like, you know, even wearing a shirt or putting pants on, you know, we're getting pants on for some kids out the door is a, is a chore. But I think if you explained, 'we need this so you can do this', is a great reinforce and I guess an internal motivator for them to want to wear it and hopefully kick that energy throughout their teens, throughout their twenties, and so they're not coming to their thirties falling apart and thinking 'alright, now I really need something.' 

Andrea & Cathy : Yeah, because I think that that's one big thing that Cathy and I see a lot is, a lot of early intervention in CP they transition to adult services, you know, and they go to uni and get jobs and live a great life, but then those secondary effects of the muscle weakness or the spasticity start to create pain. And it's that pain that gets people back because they just can't manage it any longer and it really impacts their life. What can we do to help people to manage that pain and position, you [00:27:00] know, upper limbs or bodies differently to help them to be able to get back to work and get through their workday so that they can get home to their family, for example. So yeah, that's something we see a lot. 

Justin: And just to clarify the goal when you guys are working with clients, is it like a instant win? Like 'wear the splint now you can do this'? Or is it like, 'hey, we're going to do this so over time, then we can get the win.' You know and maybe it's a bit of both, but is it, are you more one or the other?

Andrea & Cathy : Sometimes you know people will be like, 'holy heck, wow!' like straight away. And other people it's a slow burn. And I think we have that conversation with people before we script something to say, "Look, some people see effects quickly and others it takes a little bit of time." And, you know, back to the neuroplasticity thing, you know, it's not, you don't go to therapy once and it's all sorted. It takes time to kind of put away at things. Yeah. Yeah. 

So if you're learning sitting skills, you might put a splint on and say, "Wow, you look so much more upright and I don't need as many hands to [00:28:00] hold you." But now the secret is, how can you practice those sitting skills, consolidate them, get better at it, stronger at it and more efficient at it over time? And that's a learning process. You've got, you have to do the rungs on the board. I tell people it's a little bit like going to the gym and looking in the door as opposed to going in. And you have to go in, if you want to get stronger. You have to actually do the action, do the patterns of movement, do the practice in whatever way that means for you-

And return day after day, after week, day after day to get it. Nothing is instant if you want to get muscle bulk and control and power. You have to do it. If you get a walker and it's parked in the corner and you're not on it more than once a week, what's the odds of you getting very good at that walker? Not great. So practice is the key. And I think the other key is practice being incorporated into your daily routine. So it's not seen as this boring practice routine.

 Is it about the basketball team? Could it be about wheelchair basketball? Could it be about accessing gaming with your switch on the computer? Something that [00:29:00] drives you to do more of it, but you also have fun when you're doing it, is the thing that all of us will do. Not boring. If it's boring, none of us are turning up.

Anton: So, I get it. And I actually really like the, the gym connotation. I'm going to take that. Sorry! I'm going to steal that for sure. But I've got, I'm just wondering because I'm sitting here going, you know, with wheelchairs if we are applying it to how we how we approach, we would provide a, a solution which hopefully is all good, and then maybe we have to go back in six months for a more complex... well we would probably visit in between that initially, but every so often we will have a booked in reevaluation and re-looking at it; reassessment. I presume it's no different with you guys as well, because if success of the suit leads to, you know, a development change, a physical presentation change, I presume you would have to go back and [00:30:00] reevaluate and maybe tweak the suit? Or change the positioning?

Andrea & Cathy : Correct. 

Anton: To then go to the next stage; is that, is that right? And then so for any therapist or parents or individuals who are actually listening that might benefit from a suit, or a splint in this particular instance, what does that look like? What does that journey look like and how, you know, do I have to buy a new one? Does it, can you use the existing one? Like how, how does that work? 

Andrea & Cathy : Look for some families they see improvements and, for example, with a lateral stability splint the improvement might be that their sitting skills are really going forward.

And we might be able to take out some boning, for example, so we can take away some of the support. We have a lot of families with children with CP who get taller and, you know, longer and what that means for them is that that suit doesn't fit them anymore. So how do we, and then, you know, what has that growth meant for their hip joints and their spine and, you know, [00:31:00] their shoulder girdle. You know, it might need some tweaking, but also, you know, in length we need to work on that. We have these amazing things called growth panels in our splints, particularly for, you know, the little's who go and grow on us, where we can unpick certain parts of the splint to allow for expansion across the chest and stomach, and allow for expansion through the crutch when they grow taller and expansion in the inner thighs when they get, when they get muscles in their thighs. So there is capacity for it to grow with them. And you know, some people come back to us, you know, when their orthopedic surgeon has said "You need to have some rods put in your back", for example. You know, how do we then splint around that? So that would take obviously another assessment. So we connect with the local therapists, via phone or email via telehealth and we, you know, chat and see what we need to do and how things have progressed. And we [00:32:00] have these lists of behind the scenes where we check up on people, and make sure that, you know, they're reviewed when they should be reviewed and changes are made when they need to be made.

Yeah, we try and get 12 months out of the vast majority of splints, because it's a big thing for families to do and it's a costly thing obviously because everything we do is custom made for you. And so you want that splint to last and to fit as long as it possibly can. So the vast majority of people would get 12 months out of a splint. We like to check on you at least by six months after you've had it to unpick it if you've grown. We've also started including those expansion panels in some of the adults because they're either gaining weight, gaining muscle changing, their eating habits, whatever it may be, so that we can adjust it along the journey. And we like to see them looking loved and a little bit short at by the end of the year. So we go 'a bit scruffy', I think, I think you might have moved on. We've got paint and stuff all over you. It's time to move on to the next one. [00:33:00] But we try and get 12 months out of them. Some of the very small children will prove us wrong with that if they have a rapid growth spurt or if they suddenly have their feeding program changed and they put on a lot of weight. And an occasional, very tall adolescent will make a difference in terms of height, and you'll think, 'wow, you've grown outta that faster than we thought.' But that's pretty unusual. Most people we would see would get 12 months out of the splint, except for the tiny tots; probably closer to eight, nine months for that group.

Justin: And could I ask, just for the, just for the Australian therapists and parents that are listening, what is, I guess, your success rate on getting these things funded? So for people that do come to you and say, "Hey, I want a Second Skin." In the, in the Australian funding scheme is it pretty well received? Is it, you know, half the people would get them? 80%? 100%? Like what would be your best guess as to the amount of clients that you see for an assessment to actually get an approval?

Andrea & Cathy : Most get approval for their funding, as long as the case [00:34:00] can be made that it's going to assist to achieve the goals that you are aiming for in your overall therapy program. So the therapists have to be able to justify that. And we've got to know when we meet you too, that it's something that would fit into your program, do the right thing, be worn all the time because no one's going to fund anything a second time that has stayed in the cupboard and not actually been on. So some of it is also about our clinical reasoning, making sure that it's the right time, fits in with your program, all of those things, and everyone's ready to do it. So that we can then be able to justify that in terms of funding. But we don't get a lot of rejections of funding because most of the clients we see have a great team around them that actually assists with that process, and we're able to justify that going forward. 

Justin: Okay. Okay. Okay. So talk to me as if like, I am a therapist now and I'm a therapist and I've working with kids between, two years and ten years, and I see a lot of cerebral palsy clients. I'm an Australian; sorry [00:35:00] Anton! Or even if you're international, what I guess, so what, what is the process? So say right now I've listened to this podcast and I am, you know, I've, I've been trying to support my clients through, through postural care and their seating. I've explored sleeping systems, but they're still, you know, I'm still worried they're getting twisted and contorted. What's the next step? Do I contact Second Skin directly? Is this like a skill set that they need to develop? Like what is the process to exploring the idea as to whether or not this is going to be suitable for someone's posture and function. 

Andrea & Cathy : I think you've hit the nail on the head there, in the sense of you've tried this and you've tried that and you've, you know, you've been experimenting with things and it's just not exactly what you need. What else is a tool to help you that you can pull out of your tool, your therapy tool belt, and Second Skin could be it. We know that people don't sit in their wheelchairs every day, all day. People transition into granny's lounge chair, or they go and sit [00:36:00] on the school floor or they have different mechanisms and assistive technology and environments that they're in. So we need to think about what exactly they're going to be doing and we need to make sure, that their team is on board with that as well. 

Yeah, so therapists generally send us videos or families send us videos. We get lots of videos from parents and grandparents, for instance, saying, "This is my child or our young person in action.This is what we want to make a difference to. Can you have a look?" So we love to see movement rather than just photos. I got a gorgeous video today of a little boy who is working on his walking skills and he was bush walking in Cairns. It was the best video I've had. This gorgeous rainforest and he, you know, his mum was taking this video for us of him walking down this beautiful trail sealed, you know, accessible trail [00:37:00] and that really showed us, you know, what his movement was like and what his struggles were. So videos are great. Yeah, videos are great. They really show the movement in action. Photos are also great as well. So we have an online portal on our website,where you can upload clinical information, contact information, and some photos or videos.

We'll look at that and we'll, a therapist will look at that. It's not an admin who will look at that. A therapist will look at that and give you a clinical opinion on what they think could be the tool, splint or bodysuit that could help them. That will go to the local therapist, and this is in an Australian context, that it will go to the therapist who knows that person really well.

And that person will facilitate the funding process from there.

Justin: If you're around the world and you're not sure, just go to Second Skin and check from there. Could I ask one more thing? What about if function's not the thing? Like, so with a lot of clients that I see, it's [00:38:00] maybe they're in a tilt and space chair and they're nonverbal, maybe they're not expressive, but the therapists is just not wanting their 'life box', and for those who don't know, between your ribs and your your pelvis, essentially that little rectangle, we want to keep that rectangle as it is, and we're concerned of that rectangle collapsing and organs compressing. What's justification there? Is it like too bad, like, or is there still, can you still link that to function in some level? 

Andrea & Cathy : I think the word function, and this is probably my little bug bear, that the word 'function' has so many definitions and the people who have low function are assumed to have no function, and that's not the case. For someone to be able to open their life box up and to sit up and to see their loved ones, that is the most basic of function for someone. And I think that's so important to remember that people don't have to move to have function. So that's my little bug bear. Thanks for listening to that! 

[00:39:00] Well sometimes the goal for clients like the ones that you've just described Justin, is that if you can be positioned well, a lot of things are easier in your day. So you are then positioned well in your wheelchair as well as out of your wheelchair. We've got clients sitting in a postal splint who want to go to somewhere like Dreamworld with all the shows and everything they can get on, they can get on those things in their split. We've got others who get on airplanes in this loop because they can travel being more upright and well supported while they do it. And we've got lots of clients where it becomes more and more difficult to seat you often because you are, you've got so much spasticity going on, lots of rotation in your trunk, lots of tone impacting on your day, and comfort's a real issue.

Skin integrity over time and pain is a real issue. So if we can position you comfortably and protect your skin, marry that with a great seat together so that we've got you really well positioned, that impacts on your head position and your head [00:40:00] control, and that makes a difference to everything and how, how people look at you, how people talk to you.

Lots of clients we see will say, "I get sick of people talking to the top of my head." And so it's really nice to talk to people's faces and have you so well positioned that we are talking to your face and your eyes and looking at your expression, looking for your eye blink, looking for your eye gaze technology.

All those things are equally functional and as important, as someone who's able to run. Different, different level of function, but equally important. 

Anton: I think that's a great place, to, to sort of try and wrap the chat up because we can just continue to chat to you guys all day long and I would love to have you back on at some point. I'm sure we will. I'm 100% sure and confident that anybody listening to our, this particular episode and the one previous will have gained a huge amount of knowledge and understanding around the benefits of Second Skin. If they want to get in [00:41:00] touch with you guys, then you know, big shout out to that you're able to go online to... shout me out your website. 

Andrea & Cathy : www.secondskin.com.au. And what's the UK one? Also go a UK website. 

Anton: If, if you're lazy like me, just Google Second Skin. But no, look for, for any of the, everybody listening if you have any questions, you please send those into the link attached. And also please, you know, Justin and I are absolutely loving producing this content for you guys. We're gaining loads of knowledge ourselves, but please do click, like and prescribe.

It is more important than you realise to us. So we really appreciate your support, anyone listening. Justin, anything you want to wrap up with? I have got lots that I'm going to take from today, for sure. I think [00:42:00] takeaway for me, takeaway number one, always make sure that you have a goal at the beginning of the assessment, so that we don't digress or deviate away from that. Next one, any, any other points for your takeaway Justin? Main takeaway of the day? 

Justin: My main takeaway is that you just said like, and prescribe. Prescribe! Which I, I thought was hilarious. 

Anton: Oh, like and prescribe. I, I see what I did there. No, I see what I did there. 

Justin: I thought it was really clever. I think you didn't pause. I was like, 'oh, he's going for it!' 

Anton: Yeah, yeah. No, like and prescribe, but not subscribe. Prescribe, yeah. That's the language we're chatting. Right. That's brilliant. 

Justin: That's it. That's the new slogan. 

Anton: There's the new slogan. Good. I love it. Click like and prescribe. 

Justin: I love it. 

Anton: Yeah. Okay, cool. Not intentional, everyone. Thanks Justin. But yeah, I'm sure everyone's giggling away back there. Is there a main takeaway from you on anything to do with posture? 

Justin: I think you consider, yeah, to consider the idea of like, do, even just to consider Second Skin for, for clients who are really struggling with their seating position. Like I, I'm [00:43:00] always looking at things through the lens of, of a wheelchair. And if someone's this, then we need to do this to the wheelchair, that to the wheelchair. And you know, the past couple years I've started to explore sleep systems and now I'm like, 'Ooh, now we're going to do sleep systems.' And this is just another tool and it sounds like it's, you know, try do this first and do this, you know, do this after. But sometimes it can be before and after. It's not necessarily a segregation of wheelchair sleep system, then Second Skin. It could be a Second Skin even before they even get in a wheelchair, so they can go for walks in Cairns and do all this kind of stuff. And I think, yeah, it's not just, I think I probably saw Second Skin as people who were a bit more functional, that are doing the walking and need a bit of support, but it can very much be people with low function. And Andi, I love what you said. "Low function does not mean no function!" 

Andrea & Cathy : Correct. 

Anton: Yeah! We're going to, we're going to finish. Guys, thank you again for everything. Absolutely wonderful to, to chat again. Everyone who's listening, we will be looking [00:44:00] forward to you coming onto us next time. But please don't forget, what should we do Justin? 

Justin: Like and prescribe! And send in all those questions. I bet there's a bunch of people listening with a thousand questions or therapists in this area. And give us an excuse to bring Cathy and Andi back onto this show. So if you have any questions, send them through and we will ask them live on air.

Anton: Okay, brilliant. Thanks for listening. Cheers guys. Guys. 

Andrea & Cathy : Pleasure. 

Anton: See you guys.