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Introduction[edit | edit source]

AFO brace for foot drop.jpeg

The aim of orthotics are to increase the efficiency of function during acute or long-term injury. This includes soft-tissue and boney injury, as well as changes as a result of neurological changes. They can be an effective adjunct alongside physiotherapy techniques such as muscle strengthening and stretches, gait and balance retraining and reach and grasp strategies.

A number of considerations need to be made before deciding on the type of orthotic needed:

  • What are the patient’s goals?
  • What are the specific impairments impacting on their function (thinking of head-to-toe and gait analysis).
  • Are impairments the result of soft-tissue changes? Can they be changed with therapy input?
  • Is a walking aid needed?
  • Does the injury need to be protected from particular movements?
  • Can an orthotic improve the efficiency of an activity?
  • Can the patient cope with any adjuncts given?

Orthotics can be pre-made or customised, depending on the patient's needs. 

"Off the Shelf" Orthotics[edit | edit source]

Many patient's can utilise ready made orthotics, which can often be adjusted to fit their size. These may come in small, medium and large sizes and can often be sized to the patient, e.g. with velcro straps. These are often lighter materials. They can also be good for an assessment, to confirm or deny a theory before a custom orthotic is made.

Custom Orthotics[edit | edit source]

Some individuals have more complex injuries / changes to one of multiple joint structures, and therefore require a customised orthosis. This may be particularly true in neurological conditions, such as Cerebral Palsy (CP), Parkinson's Disease (PD) or after brain injury, such as traumatic brain jury (TBI) or stroke. In these cases, spasticity of muscles may have an impact on the patient's function. Orthotics can be used both in resting and during mobility to improve affects of spasticity or reduce risk of contractures. In which case the orthotic will be specifically measured to the individual, and likely to be redone as the individual grows (in paediatrics) or as changes are made to joint structures.

Advantages[edit | edit source]

Lower limb: Influence both swing and stance phase of gait[1].

  • Prevent or correct deformity and reduce pain during weight bearing
  • Improve efficiency of gait and maintain balance
  • Improve base of support / lateral support
  • Reduce need for compensation of ipsilateral and contralateral limbs and secondary pain
  • To facilitate training in skills

Upper limbs: Can be used after an injury to prevent further injury, or reduced pain by supporting an injured limb.

  • Prevent or correct deformity reducing pain and maximising function in reach and grasp tasks.
  • In prove efficiency of reach and grasp tasks
  • Off load an injured limb to allow healing
  • Reduce need for compensation of ipsilateral and contralateral limbs and secondary pain
  • Improve role of upper limb in maintaining balance

Spine: Stabalise spinal fractures to allow the patient to return to some normal activies (although they may be restricted) and protect the spinal cord.

Possible Complications[edit | edit source]

  • Loss of sensation (check skin regularly- risk of pressure areas)
  • Compensations in ipsilateral or contralateral limbs.
  • Impact on spasticity (is the patient utilising spasticity to allow some function in absence of muscle strength?)
  • Complications of casting at incorrect angle: Foot deformities[2], increased knee flexion in stance[3], muscle contractors[3]
  • Loss of sensory feedback and proprioception loss
  • Ristricted range of motion
  • Loss of natural shock absorption and long term joint damage
  • Spinal orthotics must be put on and taken off within the guidelines of a spinal professional. Patients may be able to moblise within set restrictions, depending on the severity of their injury. Non-adherence to guidance may result in spinal cord injury.

Also, success depends on patient's acceptance. Consider:

  • Cosmesis
  • Footwear
  • Weight/rigidity
  • Ability to Don Doff
  • Compensations preferred
  • Compensations required

Types of Orthotics[edit | edit source]

Upper Limb[edit | edit source]

Useful Resources:

Lower Limb[edit | edit source]

Orthotics can be used to optimise the alignment of the lower limb. This can be used to stabilise a joint to allow it to heal, or to facilitate ease of function. It can also be used to prevent or correct deformity in the lower limb, increasing efficiency.
Useful Resources:

  • Functional Electrical Stimulation (FES): In patient's with central nervous system disorders / leisions, it may be possible, and safe, to use FES as a dynamic orthotic[4]. [5]Can be used on a number of muscle groups to simulate electrical impulses in peripheral nerves. It is often used to reduced impact of foot drop or knee hyperextension as a result of muscle weakness. There is also some evidence that it may contribute to strengthening of muscles[6]. In this way, FES may reduce the patient's risk of falls [7] and has been shown to improve quality of life scores [8]  

Spinal  Orthotics[edit | edit source]

Spinal orthotics can be used to give support to a spinal fracture. It is important to have clear instructions about the position that the patient should be in to put the brace on and off. This will be based on spinal scans and an multidisciplinary discussion of the stability of the spinal fracture.
Useful Resources:

Use of Orthotic in Neurology[edit | edit source]

Paediatrics[edit | edit source]

References[edit | edit source]

  1. Condie & Meadows Report of a consensus conference on the lower limb orthotic management of cerebral palsy International Society for Prosthetics and Orthotics(1995) ISBN 9788789809021
  2. Karakas & Hoy (2002)
  3. 3.0 3.1 Owen E. The Effects of Tuning an Ankle-Foot Orthosis Footwear Combination on Kinematics and Kinetics of the Knee Joint of an Adult with Hemiplegia Prosthetics and Orthotics (2014) 34(3): 270-6
  4. NICE Functional Electrical Stimulation for Foot Drop of Central Neurological Origin (2009)[Online] <available from: https://www.nice.org.uk/guidance/ipg278> [Accessed 4/10/20]
  5. RCP Stroke guidelines , 2016
  6. Glinsky, J et al. Efficacy of Electrical Stimulation to increase muscle strength in people with neurological conditions: A systematic review. Physiotherapy Reseach Int. 12(3): 175-194 (2007)
  7. Esnouf, J.E. (2010) Impact Activities of Daily Living Using a Functional Stimulator (FES) device to Improve Dropped foot in people with Multiple Sclerosis, measured by the Canadian Occupational Performance Measure. Mult Scler. Sept: 1141-1147
  8. Juckes, F., Marceniuk, G., Seary, C., & Stevenson, V. (2019). A cohort study of functional electrical stimulation in people with multiple sclerosis demonstrating improvements in quality of life and cost-effectiveness. Clinical Rehabilitation, 33(7), 1163–1170.