this presentation include different types of orthosis used in different neurological conditions with recent advances.

1. Orthotics Used In
Neurological Dysfunction
Presenter: Sana Rai (MPT 1st Year)
Guide: Dr. Suvarna Ganvir (PhD)
Department of Neurophysiotherapy
D.V.V.P.F’s College of Physiotherapy, Ahmednagar

2. Objectives
 Introduction .
 Definition.
 Classification of orthoses .
 Uses of orthotic devices.
 Orthosis used for different conditions.
1. Stroke and brain injury
2. Spinal cord injury
3. Peripheral nerve injury
4. Cerebral Palsy

3. Introduction
Modern orthotic devices play a vital role in
the field of orthopaedic and neurological
rehabilitation.
They are given to improve function, restrict or
enforce motion, or increase support to a part
of the body, like the spine or lower limbs.

4. Definition
An orthosis is a mechanical device fitted to
the body to maintain it in an anatomical or
functional position.

5. Classification of orthoses
Static Orthoses: These devices do not allow motion.
Dynamic/Functional Orthoses: These devices
permit motion.
Progressive Orthoses: ROM of the affected joint
gradually the amount of stretch created in the
joint.
Serial Orthoses: These devices are used in a series
to gradually the ROM of a joint.

6. Uses of orthotic devices.
1. Correcting a mobile deformity.
2. Fixed deformity.
3. Limitation of movements.
4. Maintaining limb in position.
5. Functional aids.

7. Stroke and brain injury
Stroke and brain injury are often complicated by
the development of upper motor neuron syndrome.
Upper motor neuron syndrome is characterized by
impairment of motor control, spasticity, muscle
weakness, and stereotypical patterns of movement
(synergy).

8. Shoulder orthosis
Shoulder subluxation is one of the major
complications experienced among stroke survivors.
It may occur early on in the hemiplegic arm due to
flaccid supporting shoulder musculature and can be
exacerbated by external forces.
In the case of a shoulder orthosis for the
neutralization of subluxation it is sufficient to
consider only static forces acting on the paralysed
arm.

10. Nadler et al. (2017) conduced a study on shoulder
orthoses for the prevention and reduction of
hemiplegic shoulder pain and subluxation:
systematic review.
• Conclusion: observational studies suggest that orthoses reduce vertical
subluxation.
• Available evidence from heterogeneous studies after stroke suggests
that orthoses may reduce pain and are well-tolerated with prolonged use.
• No studies have tested whether subluxation and pain can be prevented
by immediate post-stroke application of orthoses.

11. Wrist and hand orthosis
• Of all stroke survivors, more than half experience
impairments of the upper limb in the chronic phase,
including loss of strength and dexterity, spasticity,
muscle contracture, pain, and edema.
• The evidence of clinical effort to reduce spasticity
as well as muscle contracture by applying resting
hand splint is that it is possible through applying
low-load intensity to hypertonic muscle in a fixed
posture or prolonged stretching.

13. Jong-Bae Choi et al (2016) conducted a study
on The Effect of Different Types of Resting
Hand Splints on Spasticity and Hand Function
among Patients with Stroke.
They concluded that dorsal resting hand splint was more effective in
the reduction of wrist spasticity and improving AROM than volar
resting hand splint in stroke patients.

14. Dorsal hand splint
Volar hand splint

15. Lower limb orthosis
 An ankle-foot orthosis (AFO) is a brace that is worn on
the lower leg and foot. It helps to support the ankle and
foot in the correct position, preventing the foot from
dragging along the ground.
Ankle foot orthoses (AFO) are prescribed to facilitate
ankle control in cases of equinus and/or varus foot,
provide mediolateral stability of the ankle in the stance
phase, facilitate gait in the swing phase, and reduce
energy expenditure while walking.

16. Ankle foot orthoses

17. Kannit Pongpipatpaiboon et al (2018) conducted a
study on The impact of ankle–foot orthoses on toe
clearance strategy in hemiparetic gait: a cross-
sectional study.
• They concluded that AFO use increased the extent of toe
clearance and limb shortening during the swing phase, while
reducing compensatory movements.
• Improved joint motions and decreased compensatory movement
when using AFOs could potentially contribute to efficient gait and
promote walking activity in hemiparetic patients.

18. Spinal cord injury
The spinal cord is the major means through which
motor, sensory, automatic, and conscious
information travels between the brain and the body.
Spinal cord injury (SCI) interrupts the conduction
of both sensory and motor signals and, based on
the level of the injury, results in varying degrees of
motor and sensory loss.

19. Lower limb orthosis
1. Ankle foot orthosis:
 The AFO orthoses are usually designed to permit
safe and effective ambulation of SCI individuals
with lesions between L4 and S2.
 To prevent a plantarflexion contracture, the
ankle should be held in a neutral position, which
is easily accomplished using a prefabricated
antifootdrop orthosis.

20. 2. Knee–ankle–foot orthosis:
The KAFO orthoses are prescribed for SCI
individuals with lesions below T10. Various kinds
of KAFO orthoses, with different types of knee
joints and locking mechanisms have been
designed for paraplegic subjects.
 It typically is prescribed for individuals
who have little to no quadriceps
strength.

21. Knee ankle foot orthosis

22. 3. Hip–knee–ankle–foot orthosis:
A hip–knee–ankle–foot orthosis (HKAFO) is an
orthosis whose components stabilize or lock the
hip, knee, and ankle.
The HKAFO orthoses are used to control the
selected motions of the hip joint using various
kinds of hip hinges, which are inserted between a
pelvic band or spinal rigid orthosis and the
KAFO segments.

24. Peripheral nerve injury
 The effects of peripheral nerve injuries are vary
depending on the cause and severity of the injury.
 These are:
1. Pain (ranging from a tingling to intense burning pain),
2. numbness or altered sensations,
3. muscle weakness in the affected body part,
4. loss of function (eg. a hand or leg being difficult to use
whilst performing tasks),
5. Loss of active movement (eg. wrist drop and foot drop)
joint stiffness and skin sores.

25. 1. Radial nerve palsy:
 A radial nerve palsy occurs when the radial nerve
has been damaged in the arm - typically by
compression or laceration, sometimes by fracture of
the humerus.
 Nerve damage then results in an inability to extend
(lift) the wrist or to straighten the fingers/thumb.
 The injured hand is floppy, able to grip (because the
flexors are still innervated) but unable to grasp
effectively due to poor wrist position (Wrist Drop).

26. Cantero-Téllez Raque et al (2016) conducted a study
on Effects on Upper-Limb Function with Dynamic
and Static Orthosis Use for Radial Nerve Injury: A
Randomized Trial.
• They concluded that Results were significantly better for the static
orthosis/splint group than for the dynamic splint group.
• Treatment with static orthosis produces further improvement in
function compared to the treatment with dynamic orthosis.

28. 2. Ulnar nerve palsy:
Ulnar nerve palsy are more commonly caused
from trauma to the elbow
 The symptoms associated with ulnar nerve
palsy include:
i. a loss of sensation in your hand,
ii. especially in your ring and little fingers.
iii. a loss of coordination in your fingers.
iv. a tingling or burning sensation in your hand.

29. Knuckle Bender Splint:
The Knuckle Bender Splint is a finger flexion
splint designed for use by individuals with
disabilities of the fingers.
 This splint simultaneously flexes the metacarpal
phalangeal (MCP) joints of all digits without
blocking interphalangeal (IP) or wrist motion.

31. Cerebral Palsy
 By definition, the impairment known as cerebral palsy (CP) describes
damage to the immature brain resulting in problems with balance,
coordination, and movement.
 The aims of lower limb orthotic management of CP were identified
by the consensus conference convened by the International Society of
Prostheticsand Orthotics:
i. To correct and/or prevent deformity
ii. To provide a base of support
iii. To facilitate training in skills
iv. To improve the efficiency of gait

32. Lower limb orthosis
1. A leaf-spring AFO
 Helps overcome mild equinus spasticity and can improve
ground clearance during ambulation swing phase
 It is not normally rigid enough to control stance phase
equinus.
 Limited, resisted, planterflexion and dorsiflexion, with only a
few degrees of motion, posterior trim line behind malleolus,
giving it thin posterior heel support that widens into a calf
band

34. 2. The solid-ankle AFO:
 One of the most commonly used designs for the C.P.
population, essentially prevents dorsiflexion and
plantarflexion as well as varus or valgus deviations of
the ankle and hindfoot.
 The solid AFO allows no ankle motion, it covers the
back of the leg completely and extends form just below
the fibular head to metatarsal heads.

35. • This design is a primary choice
for controlling equinus in both
stance and swing phase and for
contracture prevention.
•It is prescribed to children's
with CP when there is:
i. Moderate to high tone in the
gastrocneminus muscles.
ii. A requirement to provide
proximal control at knee
and hip joint.

36. 3. An Articulating AFO:
 Which typically incorporates medial and lateral joints to allow
plantarflexion-dorsiflexion, can be beneficial for C.P.
 patients who require increased ankle motion for higher-level
balance and functional activities, including walking and sit-to-
stand transitions.
 Stops can be incorporated to restrict plantarflexion and/or
dorsiflexion beyond optimal limits.

37.  With a plantarflexion stop, for
example, the ankle can be
maintained in neutral from
heelstrike through midstance,
then allowed to dorsiflex from
midstance through toeoff.

38. • Half of all children with CP in Sweden use AFOs to improve function and/or
to maintain or improve range of motion.
• In this study, three quarters of the children treated with AFO attained the
treatment goals, i.e. improved function and/or maintained/improved range of
motion.
• A higher proportion of the children with a lower range of motion at baseline
improved their ankle dorsiflexion using AFOs compared to children with a
higher initial range of motion.
Maria Wingstrand et al (2014) conducted a study on
Ankle-foot orthoses in children with cerebral palsy: a
cross sectional population based study of 2200
children.

39. Summary
 Introduction.
 Classification of orthoses.
 Uses of orthotic devices.
 Orthosis used for different conditions.
1. Stroke and brain injury
2. Spinal cord injury
3. Peripheral nerve injury
4. Cerebral Palsy

40. References
 Atlas Of Orthosis And Assistive Device 4th edition by JD Hsu, J
Michael, J Fisk .
 Textbook of Rehabilitation 3rd edition by S Sunder.
 Physical Rehabilitation 5th edition by Susan B. O’sullivan.
 Nadler M, Pauls MM. Shoulder orthoses for the prevention and
reduction of hemiplegic shoulder pain and subluxation: systematic
review. Clinical rehabilitation.2017 Apr;31(4):444-53.
 Cantero-Téllez R, Miguel GM, Cristina LT. Effects on Upper-Limb
Function with Dynamic and Static Orthosis Use for Radial Nerve
Injury: A Randomized Trial. J Neurol Disord. 2016;4(265):2.

41.  Wingstrand M, Hägglund G, Rodby-Bousquet E. Ankle-foot orthoses
in children with cerebral palsy: a cross sectional population based
study of 2200 children. BMC musculoskeletal disorders. 2014
Dec;15(1):327.
 Pongpipatpaiboon K, Mukaino M, Matsuda F, Ohtsuka K, Tanikawa
H, Yamada J, Tsuchiyama K, Saitoh E. The impact of ankle–foot
orthoses on toe clearance strategy in hemiparetic gait: a cross-
sectional study. Journal of neuroengineering and rehabilitation. 2018
Dec;15(1):41.
 Choi JB, Yang JE, Song BK. The effect of different types of resting
hand splints on spasticity and hand function among patients with
stroke. Journal of Ecophysiology and Occupational Health. 2017 Jun
7;16(1-2):42-51.