Orthotic Treatment Management of Paraplegia

Definition
Paraplegia is impairment in motor and/or sensory function of the lower extremities

Causes
The causes range from trauma (acute spinal cord injury: transaction or compression of the cord, usually by bone fragments from vertebral fractures) to tumors (chronic compression of the cord), myelitis transversa and multiple sclerosis.

Signs & Symptoms
• Difficulty walking (may trip and stumble frequently)
• Difficulty with balance
• Urinary frequency and urgency
• Muscle spasms

Complications
• Pressure sores, thrombosis, Pneumonia
• Deformities-
• Pes Equinus
• Knee flexion contracture
• Hip flexion contracture
• Scoliosis
• Lumbar lordosis

Orthotic Treatment

Type and design of orthosis should be considered according to muscle grading, ROM level of loss of function & stability of joint.
• HKAFO- If hip flexor/ extensor are weak
• KAFO- If knee extensors/extensor affected
• AFO-If quadricep weakness with genu recurvatum
• Rigid AFO- If tibialis anterior and tricep surae weakness
• In case of AFO- If muscle grading is 3- , Solid AFO
• If muscle grading is 3+, AFO with Ankle joint
• In case of KAFO- If knee flexor is 3-, Knee extensor is 3+, KAFO with drop lock knee joint
• If knee flexor is 3+, Knee extensor is 3-, KAFO with free lock
• For Spine: Spinal orthosis – TLSO

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