Orthotics for Neurological Disorders

what is an orthosis?

external appliance worn to restrict or assist motion or to transfer load from one area to another

what are the functions of orthotics?

• maintaining proper joint alignment

• preventing deformity

• inhibiting tone

• reducing contractures

• assisting weak limbs to improve function

what are the lower extremity orthoses?

• Foot orthoses (FOs)

• supramalleolar orthoses (SMO)

• ankle-foot orthoses (AFO)

• ankle-knee-foot orthoses (KAFOs)

• hip-knee-ankle-foot orthoses (HKAFOs)

• Trunk-hip-knee-ankle-foot orthoses (THKAFO)

what are the advantages of orthoses?

• improve balance, gait speed, toe clearance and stability in stance

• decrease energy expenditure

• decrease demand/stress of joints on sound limbs

• improve patient satisfaction

• improved joint alignment

what are the disadvantages of orthoses?

• decreased balance reaction

• decreased gait speed

• decreased ability to adapt gait pattern

what do you need to consider as a PT before giving/recommending an orthoses?

• ROM

• muscle strengths

• movement pattessn

• existing deformities

• proprioception and sensation

• gait analysis

• skin integrity

• patient/family goals

• patient cognitive status

what is the function of the AFO?

control ankle motion by limiting PF and/or DF or by assisting motion

what are types of AFOs?

• solid ankle

• articulate solid ankle

• carbon graphite design

what is functional neuromuscular electrical stimulation?

a task specific intervention that uses electrical currents to activate muscles in a coordinated way during functional movements- purpose is to improve motor control and strength, facilitate neuroplasticity, and promote functional independence

based on the CPG, which impairment DO NOT warrant the use of AFOs/FES in patients with acute or chronic stroke?

patients with tone or spasticity

based on the CPG, which impairment DO warrant the use of AFOs/FES in patients with acute or chronic stroke?

stroke patients with impaired gait speed, dynamic balance, other mobility deficits, or to increase QOL

based on the CPG, which impairment MAY warrant the use of AFOs/FES in patients with acute or chronic stroke?

stroke patients with decreased strength/muscle activation, deficits in gait kinematics, or decreased walking endurance

what causes gait deviation?

• abnormal joint ROM

• decreased muscle strength

• CNS deficits

• impaired sensation

• pain

• compensation for a problem at another joint or contralateral limb