Lower limb orthotic practice: orthotic management of stroke and traumatic brain injury

While the population of stroke and traumatic brain injury (TBI) survivors is clearly not homogeneous, the similarities in the common sequelae of stroke and TBI mean that comparable orthotic approaches may be adopted in the management of both conditions.
Historically, the use of lower limb orthoses in the treatment of persons who have sustained a stroke or TBI has been resisted by some in the rehabilitation community, particularly those in the therapy professions who have been trained in certain neurological and neurodevelopmental approaches. The belief that the orthoses may in some way interfere with the normal physiological recovery of the patient is being replaced by an increasing acceptance that orthotic intervention, as an adjunct to other therapeutic interventions, can form an integral component of the rehabilitation of these patient populations. The all too common practice of considering the use of orthoses almost as a last resort, at a late stage in
the rehabilitation process, is also changing as the benefits of early intervention are being recognized.
When considering orthotic treatment, it is important that prescription of the orthosis is based on a thorough biomechanical analysis of the patient’s functional deficit, involving the establishment of clearly defined objectives. Over the years, a variety of designs of orthoses have been employed with mixed success in the rehabilitation of persons who have survived a stroke or TBI. Some are made in traditional materials like metal and leather, but nowadays the most commonly used and the most effective are made from plastic, a material which has
many benefits, including the ability for close contouring to the anatomy of the limb, and optimal pressure distribution. The most common orthotic intervention is the ankle-foot orthosis (AFO), and discussion of the various designs of this orthosis will form the bulk of the remainder of this paper.