Lower Extremity Orthotic Treatment in Stroke Rehabilitation
Orthotic approaches and motor learning-based neurophysiological methods are crucial in stroke rehabilitation. Traditionally used in the subacute phase, recent studies indicate that early use of orthotics in the acute phase enhances patient functionality.
Orthotics in stroke rehabilitation aim to prevent complications and provide functional independence, adapting to both acute and chronic phases. They support neurophysiological treatments, maintain ankle neutrality, prevent contractures, correct walking compensations, and offer sensory input through proper positioning and joint stabilization.
Types of Orthotics:
Positioning Orthoses:
- Used early to maintain proper positioning during bed rest and ambulation.
Functional Orthoses:
- Provide biomechanical support for walking, conserving energy to combat fatigue common in stroke patients. Examples include in-shoe supports, insoles, and shoe modifications for addressing deformities like inversion, flexion, extension, and equinus deformities.
Static Ankle-Foot Orthoses (AFO):
- Commonly used to keep the foot in a neutral position during walking. They provide correct sensory input, prevent synergistic walking patterns, facilitate balance, and reduce energy consumption and fatigue.
- Knee Orthoses:
- Address knee problems such as genu recurvatum due to quadriceps weakness, spasticity, or plantar flexor issues. They may involve AFOs or specialized orthoses like Supracondylar Recurvatum Orthosis or Swedish Knee Cage.
Walking Orthoses (KAFO, HKAFO):
- Used for patients needing long-term support, although they are generally avoided in stroke rehabilitation due to their extensive support. Suitable for those unable to regain ambulation after multiple cerebrovascular events or prolonged acute care.
Using appropriate orthotics can significantly improve postural control, gait velocity, and overall mobility in stroke patients by addressing specific biomechanical issues and supporting the recovery process.
Scoliosis Overview and Treatment
Scoliosis is defined as a lateral curvature of the spine greater than 10 degrees in the coronal plane but is actually a complex three-dimensional orthopedic deformity affecting the spine, shoulder girdle, and pelvis. The etiology of scoliosis remains unclear in 80% of cases, classified as idiopathic scoliosis. Other causes include neurological, bone-related, trauma, joint, and connective tissue pathologies. Scoliosis prevalence varies between 0.13% and 13.6% depending on ethnic and geographic factors. In regional studies in Turkey, the rate of idiopathic scoliosis ranges from 0.2% to 1%.
Scoliosis usually affects young adults, making it a significant public health issue due to associated health, cosmetic, social, and psychological problems. This review focuses on exercise prescription for idiopathic scoliosis. Exercise protocols for scoliosis caused by neurological or other reasons differ due to deficiencies in spinal control and muscle imbalance.
Treatment Approaches:
Observation: Monitoring scoliosis progression.
Bracing: Using braces to prevent curvature progression.
Physical Therapy and Rehabilitation: Exercises and physical therapy aimed at normalizing the locomotor system altered by scoliosis.
Surgery: Considered based on the risk of curvature progression.
Goals and Criteria for Conservative Treatment:
Preventing Curvature Progression: The main aim is to halt the progression of scoliosis.
Conservative Treatment Components:
Early use of braces.
Physical therapy and exercises targeting the altered locomotor system.
Increasing respiratory capacity to address rare respiratory and cardiac symptoms associated with scoliosis.
Scoliosis affects not only the spine but also the shoulder girdle, pelvis, and lower extremities, leading to postural problems. Detailed clinical analysis and evaluation of the entire musculoskeletal system are necessary to identify issues related to muscle and ligament length, strength, and function. Factors such as scoliosis location, degree, patient maturity, and adult status are crucial in determining the progression and impact of scoliosis.
Exercise Prescription for Scoliosis:
Each patient requires a personalized exercise regimen due to the varying musculoskeletal issues stemming from scoliosis. Physical therapists must evaluate body cosmetics, coronal plane alignment, dorsal kyphosis and lumbar lordosis in the sagittal plane, thoracic cage and gibbosity in the transverse plane, and pelvic orientation. Additionally, spinal flexibility and segmental motion loss, pelvic rotation issues, gait, and lower extremity movements should be assessed to prescribe suitable exercises and supportive footwear.
Locomotor System Changes Due to Scoliosis:
A healthy body posture is balanced in three planes with aligned shoulders, thoracic cage, and pelvis. In scoliosis, curvature disrupts posture, causing pelvic and thoracic cage rotation. This three-plane deviation affects the shoulder girdle, thoracic cage, and pelvis, leading to cosmetic issues. Different exercise approaches like Schroth, Dobomed, SEAS, FITS, and Lyonnaise aim to control spinal deformity, stretch shortened muscles, and strengthen weak segments. These programs focus on sensorimotor, cognitive, kinesthetic approaches, postural control with breathing, and postural reflex activation.
Exercise Approaches:
The primary principle is controlling lumbar lordosis, pelvic tilt, and stabilization in the sagittal plane. Activating weak segments and using asymmetrical and rotational breathing to correct the collapsed concave side is also essential. Recent trends emphasize functional exercises performed standing and walking over static exercises. Exercise programs should incorporate daily activities specific to the patient’s scoliosis, teaching necessary corrections and protections.
Therapy Found Effective for Carpal Tunnel Syndrome
Customized physical therapy may be a useful way to ease low back pain, which affects an estimated 31 million Americans a new study says. Researchers from La Trobe University observed that ‘many patients with low-back disorders persisting beyond 6 weeks do not recover.
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