6 - Orthotics in neurological rehabilitation

Summary

An orthotist once told me that there are thousands of types of ankle–foot orthoses (AFOs) and that he finds it difficult to keep up with all the changes taking place within his speciality. That was reassuring, as I always feel that it is unreasonable to expect rehabilitation clinicians, whether they are physicians or therapists, to be able to prescribe or even suggest the best orthotic management plan for their patients. However, I feel that it is extremely important to understand the basics of biomechanics and gait analysis to be able to assess and manage neurologically impaired patients properly. This will not only facilitate the clinical decision making when dealing with issues such as medical or surgical interventions for lower limb spasticity but can also help the treating clinician in deciding which patient will benefit most from an orthotic opinion.

If orthotists welcome referrals detailing the clinical situation, leaving the ultimate decision to the orthotist to decide the appropriate intervention, gait analysis laboratories do not. Some clinicians refer their patients for gait analysis expecting the report to provide the answers or explanation for the patient's gait impairment plus a recommendation of the appropriate management plan. This is rarely the case, as gait analysis is most valuable in establishing or refuting a particular hypothesis. It always helps when the referring clinician is able to formulate a hypothesis and then ask if the gait analysis can confirm or reject it.