Orthotics

The use of the International Standard is promoted to reduce the widespread variation in the description of orthoses, which is often a barrier to interpreting research studies.

[7] In the United States, while orthotists require a prescription from a licensed healthcare provider, physical therapists are not legally authorized to prescribe orthoses.

In many countries the physician or clinician defines the functional deviations in his prescription, e.g. paralysis (paresis) of the calf muscles (M. Triceps Surae) and derives the indication from this, e.g. orthotic to restore safety when standing and walking after a stroke.

In the case of paralysis due to disease or injury to the spinal/peripheral nervous system, a physical examination is needed to determine the strength levels of the affected leg's six major muscle groups and the orthosis's necessary functions.

In ambulatory patients with paralysis due to cerebral palsy or traumatic brain injury, the gait pattern is analysed as part of the physical examination in order to determine the necessary functions of an orthosis.

[21] The five gait types are: Patients with paralysis due to cerebral palsy or traumatic brain injury are usually treated with an ankle-foot orthosis (AFO).

The compensatory gait is an unconscious reaction to the lack of security when standing or walking that usually worsens with increasing age;[20] if the right functional elements are integrated into the orthosis to counter this, and maintain physiological mobility, the right motor impulses are sent to create new cerebral connections.

[25][26][27] With the help of an orthosis, physiological standing and walking can be relearned, preventing long term health consequences caused by an abnormal gait pattern.

[citation needed] An important basic requirement for regaining the ability to walk is that the patient trains early on to stand on both legs safely and well balanced.

With the right functional elements that maintain physiological mobility and provide security when standing and walking, the necessary motor impulses to create new cerebral connections can occur.

This can lead to insufficient foot lifting during swing phase of walking, and in these cases, an orthosis that only has functional elements to support the dorsiflexors can be helpful.

When configuring a foot lifter orthosis, adjustable functional elements for setting the resistance can be included, which make it possible to adapt the passive lowering of the forefoot (plantar flexion) to the eccentric work of the dorsal flexors during loading response.

[12][13] In cases where the muscle group of the plantar flexors is supplied with wrong impulses from the central nervous system, which leads to uncertainty when standing and walking, an unconscious compensatory gait can occur.

When determining the strength levels of the six major muscle groups as part of the patient's medical history, fatigue can be taken into account by using a standardized six-minute walking test.

[35] There is a risk of stumbling, and the patient cannot influence the shock absorption when walking (gait phase, loading response), as the eccentric work of the dorsiflexors is limited.

Initial contact with the heel should be achieved by lifting the foot through the orthosis, and if the dorsiflexors are very weak, control of the rapid drop of the forefoot should be taken over by dynamic functional elements that allow for adjustable resistance of plantar flexion.

For example, adjustable spring units with pre-compression can enable an exact adaptation of both static and dynamic resistance to the measured degree of muscle weakness.

[medical citation needed] A drop foot orthosis is an AFO that only has one functional element for lifting the forefoot in order to compensate for a weakness in the dorsiflexors.

In 2006, before these new technologies were available, the International Committee of the Red Cross published in its 2006 Manufacturing Guidelines for Ankle-Foot Orthoses, with the aim of providing people with disabilities worldwide standardized processes for the production of high-quality, modern, durable and economical devices.

DAFOs are not stable enough to transfer the high forces required to balance the weak plantar flexors when standing and walking, and SAFOs block the mobility of the ankle joint.

[48][49] With a focus on caring for children with cerebral palsy there is a recommendation to investigate the potential for gait pattern improvement via the design and manufacture of orthotics made of polypropylene.

[47] The intent was to provide standardized procedures for the manufacture of high-quality modern, durable and economical devices to people with disabilities throughout the world.

In order to be able to walk efficiently, without stumbling, and without compensating mechanisms, the joint should allow knee flexion of approximately 60° in the swing phase.

Different functional elements to compensate for weakness of the dorsiflexors or plantar flexors can be integrated into the ankle joint of the orthosis depending on the degree of paralysis of the two muscle groups.

The plantar portion of the L-shaped member has at least one ulcer-protecting hollow to allow the user to transfer their weight away from the ulcer to facilitate treatment.

The anterior support shell is designed with a lateral hinged attachment to take advantage of the medial tibial flare structure to enhance the weight-bearing properties of the orthosis.

[59][60] A real-time weight bearing orthotic can be created using a neutral position casting device and the Vertical Foot Alignment System VFAS.

[64] A knee brace is not meant to treat an injury or disease on its own, but is used as a component of treatment along with drugs, physical therapy and possibly surgery.

[67] At present, the scientific literature does not provide sufficient high quality research to allow for strong conclusions on their effectiveness and cost-effectiveness.

In general, musculoskeletal problems that may be alleviated by the use of upper limb orthoses include those resulting from trauma[69] or disease (arthritis for example).