Orthotic Management of Hemiplegia

Definition
Hemiplegia is a condition in which one-half of a patient’s body is paralyzed

Causes
Stroke (Cerebro Vascular Accident)
Diabetes
Cerebral Palsy

Signs & Symptoms
Aphasia, ataxia, difficulty using arms to dress, visual impairments, the inability to control urination, decreased sensation, numbness, or tingling on affected side of the body, Slow, labored and uncoordinated limb movements. Residual muscle weakness, abnormal movement synergies, and spasticity result in altered gait patterns and contribute to poor balance, greater risk of falling and increased energy expenditure during walking, or single-limb balance and difficulty controlling forward progression.

Objectives of Orthotic Intervention
a. To correct and/or prevent deformity
b. To provide a base of support
c. To facilitate training in skills
d. To improve the efficiency of gait

Orthotic Treatment
When hemiplegia are present, ankle-foot function is disrupted and an Ankle Foot Orthoses (AFO) may be worn in an attempt to restore function. AFOs are used to improve toe clearance during swing and ankle position at initial contact. Leaf Spring AFO which are mainly Dorsi Flexion assist is often used. Plantar flexion-stop dynamic ankle-foot orthoses (DAFOs) can also be the option. in upper limb, spasticity is usually present, orthotic treatment mainly is to reduce the tone, and prevent contracture & deformity, Elbow Orthosis, Resting Hand Orthosis are the options

Complications

Equinus varus deformity, knee flexion contracture, Hip Flexion contracture, clenched hand position, elbow & wrist flexion contractures, Scoliosis

Orthotic Treatment post complication
When the deformity present, orthotic treatment is to reduce or correct the deformity. In equinus varus deformity, Solid AFO which maintains the correction of manipulation or surgery can be used. Knee Orthosis is used for Knee Flexion contracture, Elbow orthosis for Elbow Flexion contracture. For the Scoliosis has to be treating not with spinal orthosis, but by correction of the underlying cause in lower limb.

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