Orthoses for Management of Neuromuscular Impairment: Difference between revisions
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* balance problems, loss of postural control | * balance problems, loss of postural control | ||
These impairments often cause mobility problems and affect the quality of life of the individual adversely. They have to rely on assistive devices like [[Orthotics|orthoses]] to improve function and mobility. | These impairments often cause mobility problems and affect the quality of life of the individual adversely. They have to rely on assistive devices like [[Orthotics|orthoses]] to improve function and mobility. Recommendations for orthoses can be made by a physiotherapist, an orthotist, or a doctor<ref name=":0">Demir Y. Neuromuscular Diseases and Rehabilitation, Neurological Physical Therapy, Toshiaki Suzuki, IntechOpen, 2017. DOI: 10.5772/67722. Available from: <nowiki>https://www.intechopen.com/books/neurological-physical-therapy/neuromuscular-diseases-and-rehabilitation</nowiki></ref>. | ||
== Types of orthoses == | == Types of orthoses == | ||
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* Stability | * Stability | ||
* Prevent contractures | * Prevent contractures | ||
* Flexibility | |||
The orthoses used can be divided into: | The orthoses used can be divided into: | ||
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The clinician has to identify the impairments and functional limitations, understand the prognosis, take into account the lifestyle and risk factors before selecting the most appropriate treatment method and/or assistive device. | The clinician has to identify the impairments and functional limitations, understand the prognosis, take into account the lifestyle and risk factors before selecting the most appropriate treatment method and/or assistive device. | ||
It is important to assess the body holistically when planning a rehabilitation programme. This may include evaluation of | It is important to assess the body holistically when planning a rehabilitation programme. This may include evaluation of<ref name=":0" /> | ||
# muscle testing, normal joint movement, | # muscle testing, normal joint movement, | ||
| Line 84: | Line 85: | ||
# computer scanner | # computer scanner | ||
# foam prints/ ink prints | # foam prints/ ink prints | ||
# 3D scanner<ref>Telfer, S., Woodburn, J. The use of 3D surface scanning for the measurement and assessment of the human foot. J Foot Ankle Res 3, 19 (2010). <nowiki>https://doi.org/10.1186/1757-1146-3-19</nowiki></ref> | # 3D scanner<ref>Telfer, S., Woodburn, J. The use of 3D surface scanning for the measurement and assessment of the human foot. J Foot Ankle Res 3, 19 (2010). <nowiki>https://doi.org/10.1186/1757-1146-3-19</nowiki></ref> | ||
For measuring for an AFO: | For measuring for an AFO: | ||
{{#ev:youtube|gwVl_LipyGg|300}}<ref> Foot and Ankle Associates of North Texas. AFO - Measuring Leg Size. Available from: https://www.youtube.com/watch?v=gwVl_LipyGg [Last accessed: 16 June 2021] </ref> | {{#ev:youtube|gwVl_LipyGg|300}}<ref> Foot and Ankle Associates of North Texas. AFO - Measuring Leg Size. Available from: https://www.youtube.com/watch?v=gwVl_LipyGg [Last accessed: 16 June 2021] </ref> | ||
== Complications == | == Complications and Barriers == | ||
There are some complications can arise with orthotic management: | There are some complications can arise with orthotic management: | ||
| Line 97: | Line 98: | ||
# inadequate support/stabilization | # inadequate support/stabilization | ||
Thus, it is important to evaluate the skin, neurological function, vascular status, and musculoskeletal system in patients who will be using an orthosis. | Thus, it is important to evaluate the skin, neurological function, vascular status, and musculoskeletal system regularly in patients who will be using an orthosis. | ||
It is also important to re-evaluate a device fitting regularly and alter the dimensions of the orthosis as required. | |||
There may be several barriers to device utilization, such as: | |||
# appearance, | |||
# weight, | |||
# ability to don and doff the orthoses | |||
# incorrect understanding of environmental needs and requirements. | |||
It is important for the entire medical team to work in conjunction with the patient to overcome them<ref>Boyce SH, Quigley MA, Campbell S. Management of ankle sprains: A randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an aircast ankle brace. Br J Sports Med. 2005. doi:10.1136/bjsm.2003.009233</ref>. | |||
== Evidence == | == Evidence == | ||
| Line 104: | Line 116: | ||
== Conclusion == | == Conclusion == | ||
There have been innumerable advances in materials, 3-D printing, and robotic exoskeletons that are changing manufacturing, overall function, and level of assistance provided by orthotic devices<ref>Ford C, Grotz R, Kope Shamp J. The Neurophysiological Ankle-Foot Orthosis. Clin Prosthes Orthot. 1986;10:15-23.</ref>. | |||
== References == | == References == | ||
<references /> | <references /> | ||
Revision as of 10:17, 16 June 2021
Original Editors - Rucha Gadgil
Top Contributors - Rucha Gadgil, Naomi O'Reilly and Kim Jackson
Introduction[edit | edit source]
The neuromuscular system can be called as the biomechanical apparatus through which the CNS executes postural actions[1]. It includes all the muscles in the body and the nerves serving them.
The term ‘neuromuscular disorders' encompasses conditions which affect either the muscles, such as those in the arms and legs or heart and lungs, or the nerves which control the muscles[2]. Common examples may include: Cerebral palsy, Stroke, Spinal cord injury, Post-polio syndrome, Muscular dystrophies, Spinal muscular atrophy,etc.
Impairments in these diseases may vary widely by person and condition, in type and severity, and may include:
- increased or decreased tone,
- atrophied muscle mass, weakness,
- muscle twitching, shaking, cramping,
- stiff or tight muscles (spasticity),
- walking on the toes,
- a crouched gait,
- drop foot, numbness and tingling
- balance problems, loss of postural control
These impairments often cause mobility problems and affect the quality of life of the individual adversely. They have to rely on assistive devices like orthoses to improve function and mobility. Recommendations for orthoses can be made by a physiotherapist, an orthotist, or a doctor[3].
Types of orthoses[edit | edit source]
The main aim of using orthoses for neuromuscular impairments is:
- improving the quality of life
- independence
- maintaining optimal functioning of muscles
The orthoses should fulfill the following criteria for an individual:
- Optimal Alignment
- Stability
- Prevent contractures
- Flexibility
The orthoses used can be divided into:
- Lower limb orthoses[4]:
- shoe inserts
- ankle-foot orthoses (AFO): AFOs are the most common and vary greatly in the design and the types of materials used. AFOs may be solid or hinged at the ankle and may have a removable foot plate.
- knee-ankle-foot orthoses (KAFO) and
- hip-knee-ankle-foot-orthoses (HKAFO).
- Thoracolumbosacral orthoses (TLSOs) correct spinal curvatures, scoliosis, and can improve balance and stability as well as control of the extremities, head, neck and trunk.
- Cervical orthoses: to assist in positioning head and neck in case of muscle weakness. eg. in ALS patients
- Upper limb orthoses:
- Wilmington Robotic Exoskeleton (WREX): a functional upper limb orthosis designed to enhance movement for individuals with neuromuscular disabilities.[5]
- Functional electric stimulation (FES) devices: alternative to traditional orthoses. They generate an electrical current stimulating a muscle causing muscle contraction in a predictable movement pattern creating a physiological bracing[6].These have shown gait improvements when compared to traditional AFO.
Assessment[edit | edit source]
The clinician has to identify the impairments and functional limitations, understand the prognosis, take into account the lifestyle and risk factors before selecting the most appropriate treatment method and/or assistive device.
It is important to assess the body holistically when planning a rehabilitation programme. This may include evaluation of[3]
- muscle testing, normal joint movement,
- evaluation of flexibility,
- evaluation of motor and sensory functions, and functional capacities,
- functional posture, and gait analysis
- respiratory functions.
Orthotic prescription has to be preceded by a complete biomechanical assessment, gait analysis (for lower limb), functional assessment and patient counselling and education. Each orthosis has to be custom made and proper fitting to avoid complications.
Fitting and Measurements[edit | edit source]
It is important to consider the fitting of the orthoses for the individual. Weight of the material of the device also has to be taken into account. The measurements of the limb can be taken by:
- measuring tape
- plaster cast
- computer scanner
- foam prints/ ink prints
- 3D scanner[7]
For measuring for an AFO:
[8]Complications and Barriers[edit | edit source]
There are some complications can arise with orthotic management:
- pressure sores and broken skin[9]
- infection, and
- pain
- inadequate support/stabilization
Thus, it is important to evaluate the skin, neurological function, vascular status, and musculoskeletal system regularly in patients who will be using an orthosis.
It is also important to re-evaluate a device fitting regularly and alter the dimensions of the orthosis as required.
There may be several barriers to device utilization, such as:
- appearance,
- weight,
- ability to don and doff the orthoses
- incorrect understanding of environmental needs and requirements.
It is important for the entire medical team to work in conjunction with the patient to overcome them[10].
Evidence[edit | edit source]
Add your content to this page here!
Conclusion[edit | edit source]
There have been innumerable advances in materials, 3-D printing, and robotic exoskeletons that are changing manufacturing, overall function, and level of assistance provided by orthotic devices[11].
References [edit | edit source]
- ↑ Alghwiri A, Whitney S; Guccione's Geriatric Physical Therapy, (Fourth Edition), Mosby,2020.
- ↑ Potikanond, S., et al. Muscular Dystrophy Model. Adv Exp Med Biol, 2018; 1076: 147-172.
- ↑ 3.0 3.1 Demir Y. Neuromuscular Diseases and Rehabilitation, Neurological Physical Therapy, Toshiaki Suzuki, IntechOpen, 2017. DOI: 10.5772/67722. Available from: https://www.intechopen.com/books/neurological-physical-therapy/neuromuscular-diseases-and-rehabilitation
- ↑ Webster J, Murphy D. Atlas of Orthoses and Assistive Devices. 5th Edition. Elsevier. 2017
- ↑ Rahman T, Sample W, Jayakumar S, King MM, Wee JY, Seliktar R, Alexander M, Scavina M, Clark A. Passive exoskeletons for assisting limb movement. J Rehabil Res Dev. 2006 Aug-Sep;43(5):583-90. doi: 10.1682/jrrd.2005.04.0070. PMID: 17123200.
- ↑ Prenton S, Hollands K, Kenney L, Onmanee P. Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research. J Rehabil Med. 2018;50(2):129-139. doi:10.2340/16501977-2289
- ↑ Telfer, S., Woodburn, J. The use of 3D surface scanning for the measurement and assessment of the human foot. J Foot Ankle Res 3, 19 (2010). https://doi.org/10.1186/1757-1146-3-19
- ↑ Foot and Ankle Associates of North Texas. AFO - Measuring Leg Size. Available from: https://www.youtube.com/watch?v=gwVl_LipyGg [Last accessed: 16 June 2021]
- ↑ Witherow E, Peiris C. Custom-Made Finger Orthoses Have Fewer Skin Complications Than Prefabricated Finger Orthoses in the Management of Mallet Injury: A Systematic Review and Meta-Analysis; Archives of Physical Medicine and Rehabilitation, 2015; 96(10):1913-1915. https://doi.org/10.1016/j.apmr.2015.04.026.
- ↑ Boyce SH, Quigley MA, Campbell S. Management of ankle sprains: A randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an aircast ankle brace. Br J Sports Med. 2005. doi:10.1136/bjsm.2003.009233
- ↑ Ford C, Grotz R, Kope Shamp J. The Neurophysiological Ankle-Foot Orthosis. Clin Prosthes Orthot. 1986;10:15-23.
