Paralysis Resource Guide - (Page 239) TOOLS ORTHOSES AND BRACES Orthoses and braces are tools common in rehabilitation, though somewhat less so than in years past. This is due in part to cost cutting, limited clinical expertise and reduced patient time in rehab. There is also a general feeling among many users that orthoses are cumbersome and appear too bionic or “disabled” looking. An orthosis might be used for positioning a hand, arm or leg, or to magnify or enhance function. The orthosis could be as simple as a splint or as complex as a functional electrical stimulation (FES) brace that facilitates a walking maneuver in paraplegics. Here are several options for orthoses: The Wrist-Hand Orthosis (WHO) transfers force from an active wrist to paralyzed fingers; this offers prehension (grasping) function for those with cervical injuries (usually between C4 and C7). The WHO, also called a tenodesis splint, has been modified over the years with the addition of CO2 or batteries for power; current designs are more simple and easier to maintain. There are several types of orthoses for lower limb function: The Ankle-Foot Orthosis (AFO) is commonly used in people who’ve had strokes, multiple sclerosis and incomplete spinal cord injury to assist the ankle and allow the foot to clear the ground during the swing phase of walking. There are many varieties of AFO; most have a molded heel cup that extends behind the calf. The Knee-Ankle-Foot Orthosis (KAFO) allows a paralyzed person (usually L3 and above) to stabilize the knee and ankle. While it’s very hard work, people using KAFOs, even those with no hip flexion, can ambulate by swinging their legs through steps while supported by forearm crutches. There are many varieties of KAFO, including both plastic and metal braces. The Reciprocating Gait Orthosis (RGO) originated in Canada to help children with spina bifida. After various evolutions, the RGO now consists of a pair of KAFOs with solid ankles, locking knee joints, and leg and thigh straps. Each leg of the brace is attached to a pelvic unit with a hip joint; this permits hip flexion and extension. A steel cable assembly joins the two hip joints to limit step length. By rotating the torso, the user shifts the weight to the forward leg; this permits the opposite leg to move forward. 239
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