In the United States alone, more than 700,000 people suffer a stroke each year, and nearly two-thirds of these individuals require rehabilitation and benefit from it.
The primary goal of the rehabilitation team is to help survivors regain as much independence as possible to lead a good quality of life. Even though rehabilitation does not “cure” the effects of stroke, which means that it does not reverse brain damage, but rehabilitation can substantially help people achieve the best possible long-term outcome.
Rehabilitation experts believe that the key element in any rehab program is careful, directed, focused and REPETITIVE practice, just like when one is learning a new skill like playing a piano. Although therapy plays a key role with regards to passive and active ROM exercises for muscle strengthening, an orthotic support can greatly enhance and speed up the recovery process as they advance to more complex tasks like standing, transferring and walking on their lower extremities, and learning grasp and precision tasks on their upper extremities. The use of orthotic devices can also help prevent tightness and contractures in the affected joints, and in cases where the therapy program is directed towards releasing an already existing tightness or contracture, orthotic devices can help to maintain a low-load prolonged stretch long after the short therapy sessions for quicker positive outcomes.
Common Orthotic Solutions for Post-Stroke Rehabilitation:
Carbon Fibre AFO’s
Lighter, thinner and stronger than traditional plastic AFOs, these sleek new-generation braces manage footdrop, provide stability at mid-stance, and help propel the patient through the gait cycle due to their energy return characteristics without sacrificing comfort or appearance, and in most cases, patients may not have to get larger shoes to accommodate them. The anterior strut design can provide added stability for knee flexion weakness and posterior strut design can resist hyperextension at the knee. Lateral struts provide medial ankle stability and medial struts may be useful for patients that invert, supinate or have varus. Minimal contact means less risk of pressure!
Custom Fabricated AFO’s
When a patient exhibits a multiplanar deformity, like equino-varus, or needs extensive support, use of assist or resist features, is obese, has disproportionate shape of the lower extremity, has used an off-the shelf device with limited success, has the need of the device for a long-duration (exceeding 6 months), they may need a more customized device that is designed specifically for them from a cast or an impression of their limb. The number of customization options in such devices can meet the unique needs of individual patients.
When patients demonstrate weakness at the ankle and knee both that need support and stability, in some cases, a custom KAFO with either a free, locked or stance control knee joints may be a useful orthotic solution. As compared to a locked “long-leg” brace, the stance control orthosis locks automatically during stance phase from heel strike until toe-off and then automatically unlocks in swing phase between toe-off and heel-strike, allowing patients to clear the ground without a compensatory gait deviation like circumduction or hip hiking.
(watch video below to see the comparison between locked and stance control KAFO)
Neuro-Rehabilitation Devices (Walkaide)
The WalkAide is a battery-operated, single-channel electrical stimulator that can be used to address dropfoot with functional electrical stimulation. The WalkAide can effectively counteract foot drop by producing dorsiflexion of the ankle during the swing phase of the gait. The small device attaches to the leg, just below the knee, near the head of the fibula. During a gait cycle, the WalkAide stimulates the common peroneal nerve, which innervates the tibialis anterior and other muscles that produce dorsiflexion of the ankle. Users of the WalkAide are people who have lost the ability to voluntarily lift their foot, often as a result of damage to the central nervous system such as stroke, incomplete spinal cord injury, traumatic brain injury, cerebral palsy and multiple sclerosis. This type of stimulation will not work with people who have damage to the lower motor neurons/peripheral nerves. Our team of orthotists at Bionic are specially trained in fitting of these complex devices, and have extensive experience in the same.
Preventing and/or Reducing tightness and contractures in joints is one of the primary targets of post-stroke rehabilitation for the extremities involved. With limited therapy time available to patients, having a device that can maintain the stretching performed by the therapist and provide a low load prolonged stretch can help drastically in the treatment regime of the patient. We at Bionic fabricate our contracture management devices using components from the industry leaders in the field, including ultraflex, saebo, townsend design, among others.
Upper Limb Orthoses for Stroke Management
The primary goal in upper limb stroke rehabilitation from the stand point of orthotic intervention is to prevent and/or reduce tightness, positioning and enable use of assistive devices. Our solutions range from passive cock-up positioning splints to dynamic stretching devices, individually customized for each patient.