Orthosis and assistive devices are initiated when the child demonstrates the ability to pull to tall kneel or stand. Which option correctly states this initiation condition?

• A. After they begin to walk independently
• B. Once they demonstrate ability to pull to tall kneel or stand
• C. After they start running
• D. When they reach age five

Answer: (B)

Initiation of orthoses and assistive devices is guided by a functional milestone that shows the child can assume an upright posture with some weight-bearing control. When a child with spina bifida can pull to tall kneel or stand, it demonstrates enough lower-extremity strength, hip and knee extension, and trunk balance to benefit from standing-oriented supports. This readiness allows the devices to aid standing and early gait rather than waiting for a later, unrelated milestone. Waiting for independent walking or for running or a specific age doesn’t reflect the child’s actual development stage, whereas pulling to tall kneel or stand directly indicates preparedness for orthotic use.