Orthoses for Management of Neuromuscular Impairment
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. 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.
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 used can be divided into:
- Lower limb orthoses:
- shoe inserts
- ankle-foot orthoses (AFO)
- knee-ankle-foot orthoses (KAFO) and
- hip-knee-ankle-foot-orthoses (HKAFO).
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. Most AFOs are made of plastic but can also be made from leather, carbon fiber, silicone or metal.
- Spinal orthoses:
- 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.[3]
Measurement [edit | edit source]
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Fitting[edit | edit source]
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Evidence[edit | edit source]
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Conclusion[edit | edit source]
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.
- ↑ 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.
