Can Orthoses Play a Therapeutic Role in Early Post-Stroke Management

Abstract

Motor control deficits are common and a major contributor to mobility problems post-stroke, with walking limitations present in 75% of persons post-stroke. Research regarding orthotic intervention post-stroke during the acute phase is limited. This is despite the idea that a “window of opportunity” exists for optimal rehabilitation after stroke. The most common feature of motor impairment early post-stroke is a reduction in the force generating capacity of lower extremity muscles. Of particular relevance to gait re-training, is the idea that the nervous system responds best to interventions that provide an appropriate dynamic stimulus to drive recovery. These ideas have led to development of “assist-as-needed strategies” in lower-limb assisted robotic gait training that guide the leg by applying a force rather than imposing a trajectory. Similar principles may be harnessed when using orthoses to facilitate gait re-training. The major demand on the lower-limbs during standing and walking is gravity, which applies moments across the joints that need to be controlled by the neuromuscular system. An ankle-foot orthosis (AFO) may be used to re-adjust and manipulate the neuromuscular demands placed upon the individual by positioning the foot in relation to the lower leg to provide optimal alignment of the lower-limb to the ground during walking. We hypothesize that an AFO can facilitate re-learning of the skilled coordination required for walking in early post-stroke gait re-training by influencing both biomechanical and neurophysiological variables.

Statement of the objective / learning objectives

To discuss theoretical concepts and research evidence that may support a hypothesis regarding the therapeutic role of orthoses in early post-stroke gait re-training.

This session focuses on the topic Orthotics: Lower Limb Neurological.