Moving Forward: Adapting to the Ottobock C-Brace

Yvonne Collery

Both my mother and Linda contracted polio during the 1955 epidemic. Linda and her family lived in the apartment below us, and she and I grew up together. Linda was just 11 weeks old when she contracted polio and was left with paralysis in her right leg. Since learning to walk, she has relied on a rigid KAFO brace for mobility.

Last spring, Linda needed repairs for her KAFO brace, only to discover that her long-time orthotist had closed up shop. Searching online for alternatives, she came across the Ottobock C-Brace and was immediately intrigued. She reached out to the Manhattan branch of Hanger Clinic, listed as a supplier, and was connected with Brian Leone, an orthotist experienced in computerized braces. And so, her long journey began.

What is a C-Brace?

The process of acquiring a computerized brace (in Linda’s case, the Ottobock C-Brace) is long and arduous. Linda had her initial consultation appointment in June 2024, and after several months she received her finished C-Brace and was able to begin using it in physical therapy in November 2024.

Now, you might be asking how the C-Brace differs from an ordinary KAFO. A C-Brace is a computerized brace. It is not a robotic brace—meaning there is no motor in the knee joint, so it won’t do the work for you. Each brace is custom fabricated from carbon fiber by a technician and includes components for the thigh, lower leg, ankle and foot. A computerized component designed by Ottobock is then integrated into the brace by a technician.

What makes the C-Brace revolutionary is its ability to enable walking with knee flexion. This enables users to walk with a centered, upright posture and a more natural gait. The computer system continuously monitors the user’s gait through three sensors, which react thousands of times per second to the user’s movement. Based on this input, the system regulates hydraulic resistance, controlling the flexion and extension of the knee joint with each step.

Another extraordinary function of the C-Brace is its ability to enable users to perform Dynamic Movement Patterns. Simply put, these refer to any movement beyond straight, forward perambulation (forward walking). This includes stepping backward, moving sideways, climbing stairs with alternating steps, even riding a bicycle, among other multidirectional activities.

Ottobock offers an app called The Cockpit, which allows users to switch between different functions. Many C-Brace users may even be able to walk without a cane, freeing both hands for various activities while standing or walking.

Leone pointed out that individuals who used a cane or walker prior to using the C-Brace may still require the assistive device, but the improvements in walking with a more upright, less compensatory gait pattern will reduce stress on other joints and muscles in the rest of the body, which makes pursuing a C-Brace well worth it for those who are good candidates.

Leone also stated that the post-polio population faces the greatest challenges in using the C-Brace’s Dynamic Movement functions. This is due to the severity of weakness in the affected limb, hips and trunk.

Additionally, the vast majority of the post-polio population in the United States is now over the age of 65 and has relied on rigid KAFO braces for many decades. While age-related limitations exist in any population, it is essential to evaluate each potential C-Brace user on an individual basis.

Now for the good news: You have the opportunity to try out the C-Brace and decide for yourself. Your orthotist either has access to or can obtain a generally sized sample C-Brace from Ottobock.

During your appointment, your orthotist will assess you, provide some initial training, and allow you to walk with the C-Brace in a supported and controlled environment. If you are determined to be a good candidate, your journey with the C-Brace can begin.

Next Steps

Now that you and your orthotist have decided to move forward with this process, your next step is to see a physiatrist. Your physiatrist will conduct a thorough physical exam, review your medical history, and determine whether you meet the criteria for successfully using a C-Brace. If approved, you will begin the lengthy acquisition process.

Now comes the paperwork. Your orthotist will need to complete and submit numerous forms to your insurance company. This process requires hours of detailed work on the part of the orthotist.

The Insurance Process

As the majority of the U.S. post-polio population is now of Medicare age, we will focus on Medicare guidelines here. In 2024, Medicare officially approved the Ottobock C-Brace as medically necessary for individuals meeting a specific criteria. To qualify, a person must have a history of prior brace use, and the need for a computerized brace must be medically justified for their specific condition. Trunk stability and sufficient strength to operate the C-Brace must also be demonstrated.

Because Medicare offers a variety of plans, you will need to check with your specific plan to determine coverage. Approval or denial can vary significantly from person to person. Leone emphasized that simply wanting to walk upright, navigate uneven terrain, or wanting to go cycling or dancing are not considered valid justifications for Medicare coverage. The C-Brace is a costly device, ranging from $75,000 to $85,000.

In requesting coverage for Linda, Leone wrote that the C-Brace was deemed necessary because “Linda’s long use of a rigid KAFO brace was causing old/current compensatory gait habits to negatively affect other joints of the body. By having her use a C Brace, we [could] make her a more functional community ambulator.” Additionally, Brian highlighted a broader health benefit, “With an improved gait and reduced pain, Linda will engage in more life-enhancing physical activity, benefiting her cardiovascular health and ultimately prolonging her life.”

Not a Brace for Everyone

Leone emphasized, “The C Brace is not for everyone, but for those who are the right candidate and meet the right criteria, the outcome can be significant, and in some cases, life changing.”

When assessing a candidate, Leone looks for several additional key factors after testing for core and hip strength. He explains, “The person must be accepting of new technology, and if not a fluent tech user, they must be willing to learn. They should not be afraid of significant change, must be highly motivated, and need to be mentally flexible. Most importantly, they must be willing to put in lots and lots of hard work.” Linda, he noted, proved to be an excellent candidate.

“When I first saw the ‘before’ and ‘after’ videos of people using the C-Brace, I naively thought this new brace was ‘magic’ in that it would ‘do all the work,’” Linda admitted. “I didn’t realize that much focused effort would be required of me. I was told that polio survivors don’t take well to new types of braces as ‘they don’t like change.’ But I want to offer upfront that using it has been an overwhelmingly positive experience, and I am incredibly grateful for the increased mobility and independence it has provided!”

Linda’s C-Brace incorporates a sophisticated computerized unit positioned between the knee and the thigh that is attached to the outside of the carbon fiber KAFO. To tailor the device to Linda’s specific needs, the orthotist used the master controls on the Cockpit app on his smartphone to communicate with this unit, precisely setting the different tensions.

After Linda obtained her approval letter, her orthotist meticulously created a mold of her right leg. This served as the basis for creating a preparatory device called a ‘check socket.’ He asked her to stand, sit and walk, carefully observing her movements and making finely tuned modifications. Approximately five weeks later, the finished carbon fiber C-Brace was ready. Linda was understandably thrilled to finally try it on.

Physical Therapy Challenges

Physical therapists play a crucial role in training individuals to use the C-Brace and guiding them in adapting to its use. If a therapist is unfamiliar with the C-Brace, then Hanger, which has locations across the country, is ready to connect them with a C-Brace-trained orthotist. Ottobock itself provides comprehensive training videos on YouTube for therapists working with new users (https://tinyurl.com/5fm6kb5h).

Linda completed her prescribed initial 16 weeks of physical therapy and reported that she had become a “fluent” user of the C-Brace, now her default brace. Because polio survivors are at risk of overusing polio-affected muscles, not every exercise offered by a physical therapist unfamiliar with post-polio syndrome may be suitable. Some of the initial physical therapy sessions presented significant hurdles.

“Decades of relying on a locked right knee for stability meant that even basic instructions to bear weight walking on my bending leg felt inherently risky,” Linda related. “I vividly recall the challenge of attempting stairs ‘step-over-step’ for the first time, the descent feeling particularly precarious with an unlocked knee. Another exercise—the ‘heel slide’ while lying down—starkly revealed the lack of strength in my right leg, and required significant assistance for even a single, simulated movement.”

Positive Steps

The physical therapy exercises that focused on gait were genuinely beneficial, according to Linda. “My therapist guided me to walk with greater awareness, engaging my muscles and increasing the time spent on each leg, emphasizing deliberate steps rather than leaning heavily on my walker or veering to my weak side. Later, we progressed to exercises like single-leg stands on my C-Brace leg and using a cane, where I learned to lean into my weak side while engaging my buttock muscles with each step.

My current therapy goals include confidently navigating stairs while carrying items and walking independently within my apartment. Overcoming the ingrained habit of a locked right knee has been a gradual process. The fear of instability was a significant barrier for months, limiting me to walking with a walker or cane.

“However, I recently experienced a breakthrough: taking a few unassisted ‘normal’ steps at home. That first step with a bent knee and no support was incredibly significant, especially because needing a device indoors severely restricted my ability to carry things. Even the transition to using a cane, although improving mobility, made carrying items much harder compared to using the walker’s pouch. Public situations, like carrying a tray at the bagel shop while using my walker, remain challenging, and walking without any support outside is not yet an option.”

Better Shoes, Lifts, Beeping and a Loaner

Linda admits that early on, wearing the brace was not easy. She depended on her Rollator for full support, and the extra two pounds from the C-brace felt like an enormous burden. But as she progressed, she integrated that perception into her “new normal.” Her physical therapist advised that better shoes—ideally athletic shoes—would better accommodate the considerably larger C-Brace footplate.

In the early days of wearing the C-Brace, her orthotist had set it to a “beeping” mode providing feedback that each step was done properly. “While bending my leg, the brace would go ‘beep,’ and it wasn’t too long before this began to drive me crazy! He thankfully turned this feature off.” A few months later, though, a sudden loud beeping noise and flashing red light came on as she put on the brace. It turned out to be a malfunction requiring service. Fortunately, Ottobock provided a loaner while the unit was being repaired, a testament to their support system.

Transition to Using a C-Brace

Linda acknowledged that the early days of wearing the brace, even at home, required a significant shift in how she approached everyday activities. She still depended on the support the Rollator provided. She soon realized that simple tasks like picking up an item in another room now required a deliberate strategy for carrying it. Additionally, standing up from the couch demanded focused effort, and the weight of the brace and lift was more pronounced in the context of frequent, short movements within a limited area.

“Now,” she said, “I am currently using my C-Brace primarily for going out, finding it most helpful when I’m focused on reaching a destination rather than moving around my home. Since I’ve only had it for eight months and I am now continuing physical therapy, I’m optimistic that with more practice, I’ll feel more comfortable using it hands-free at home. There’s no rush though, as safety and comfort come first.”

“First Times” with the C-Brace

Taking the bus: Ascending the ramp; sitting with flexion; walking to the exit door with a bending leg; and often uncertain descent/steepness of the ramp.
Taking a taxi: I had to relinquish my usual support by giving the driver my Rollator and using the cab door for balance as I entered.
Wearing the C-Brace to PT sessions: This was a significant achievement that liberated me from the cumbersome initial trips where I wore my old KAFO while transporting the C-Brace on my Rollator.
Turning my head to the right to wave to my sister across the street: This seemingly simple gesture required a new level of coordination as the weight of my head now subtly affected my balance.
Using the C-Brace in social situations: This demanded a new kind of focus. Initially, the mechanics of walking consumed me, making socializing overwhelming. With time, I adapted, freeing up mental space for interactions.
Safely navigating streets: I needed vigilance on the uneven sidewalk and street pavement.
Boost of confidence: When walking home from church at night with a straighter gait, I experienced an enhanced feeling of confidence in my steps.
Bossa Nova music: I felt the vibrant enjoyment of outdoor walking in its rhythm, instantly amplifying the pleasure of each step!

Responsibility and Care

The C-Brace must be handled with a certain amount of care, as its unwieldiness can lead to accidental drops, something Linda learned early on. One must remember to always turn it off after use and plug it in to charge fully every night. It’s important to familiarize oneself with the instructions and consult one’s orthotist for any unusual activity, such as unexpected lights or beeps.

Benefits and Overall Impression

In Linda’s case, the benefits of using the C-Brace have been significant. “Improved gait has been the most important benefit of wearing the C-Brace,” said Linda. “My reward is an upright posture and significantly longer strides, allowing me to cover more ground in less time.”

“The newfound freedom in movement I’ve experienced with the C-Brace, as evidenced by the significant increase in my overall step count between destinations, stands in stark contrast to the limitations of my old brace. Before the C-Brace, even a seemingly simple act like standing in one place for any length of time would result in a significant backache. Now, the C-Brace has become my default, offering a profound sense of alignment, making me feel straighter and taller with a gait that is undeniably closer to normal. While the journey to fully independent outdoor mobility continues, the overall experience of using the C-Brace is a genuine pleasure, and for that, I am deeply grateful.”