The Dorsi Ramp provides 10, 15 and 20 degree slope angles.
The best advice is to start at the lowest slope angle and work upwards. Always avoid using ramp angles that cause discomfort to the child. Excessive stretching can lead to calf and tendon strains or tears.
A child standing on Dorsi Ramp transfers all their weight through their legs and ankles. Experience has shown that greater dorsiflexion is achievable with Dorsi Ramp than through other methods , such as manipulation by hand with the child lying on a couch. If a neutral, or close to neutral, position can be achieved this way then the child will probably be able to cope well with the 10 degree slope.
Foot Position and Posture
The child should stand on the ramp with their heels close to the lowest corner of the slope. The feet can be pointing directly forward or angled outwards. The compound slope angle will ensure the required level of dorsiflexion in any position with the heel positioned towards the lowest corner of the ramp.
The child should be encouraged to stand on the ramp with a straight and upright posture. If the child needs to push their bottom out, raise their heels or shows signs of discomfort then the angle is too high and a lower slope angle should be selected.
A child will be coping well with the slope angle if they can stand on the Ramp with a good normal looking straight and upright posture for 2 minutes. If the child needs to push their bottom out, raise their heels or shows signs of discomfort then the angle is probably too high.
Dorsiflexion is likely to improve with frequent and regular use. When you are certain the child is coping easily with the 10 degree slope then try the 15 degree slope. When increasing the slope angle monitor the child carefully and start with short duration stretches before building up.
You may find that children have days or periods when dorsiflexion is relatively good and days or periods when tendons and calf muscles are tight and dorsiflexion limited. This is normal. If at anytime your child is showing signs of not coping with the slope angle then reduce it.
Don't despair if you need to regress to a reduced slope angle at any time. Young children often experience growth spurts during which time the tendons take time to catch-up. Just like adults, some days children are less mobile than other. The key to success is regular and frequent use.
Barefoot or Shoes
Children who overpronate or are flatfooted should use Dorsi Ramp with footwear that provides support for the longitudinal foot arch. Ideally such footwear should include custom orthotics. Children who do not overpronate or who tend to supinate (such as children with clubfoot) can use Dorsi Ramp in just socks or bare feet. Shoes, slippers or sandals can always be used if preferred.
A 5 year old boy with Cerebral Palsy and Autism using Dorsi Ramp wearing shoes
with custom orthotics to support his heel arch.