Orthotic Intervention for Neuromuscular Disorders
Scott Riddle, CPO
Neuromuscular disorders present unique challenges for orthotic intervention, and a clinician’s thorough understanding of symptoms, prognosis and patient challenges is necessary to achieve successful orthotic outcomes. Common neuromuscular disorders seen in orthotic practice include:
– ALS (Amyotrophic Lateral Sclerosis)
– CMT (Charcot Marie Tooth)
– Diabetic Neuropathy
– FSHD (Facioscapulohumeral Disorder)
– IBM (Inclusion Body Myositis)
– MS (Multiple Sclerosis)
– Muscular Dystrophy
Each of these cases present unique orthotic challenges. For example, IBM typically weakens the leg muscles above the knee first while ankle strength remains intact, whereas CMT typically weakens the lower leg muscles around the ankles first, with little effect on the muscles above the knee. This difference between diagnoses illustrates the importance of treating the symptom in the context of the disorder, as opposed to lumping all Neuromuscular disorders into a singular orthotic category.
There are however some important keys to successful orthotic outcomes for patients suffering from these disorders. Every attempt should be made by the treating orthotist to follow these principles. Additionally, these principles apply to all types of devices – Ankle Foot Orthoses (AFOs), Knee Orthoses (KOs) and Knee-Ankle-Foot-Orthoses (KAFOs).
The orthosis should be as light as possible! Orthotic intervention generally begins when the leg is already weakened, and given the nature of many neuromuscular disorders, it is likely the weakness will worsen, so the device should be light enough that it doesn’t cause additional fatigue during walking. This is very important, as the primary goal of the device should be to allow for more activity. Fatigue due to heavy orthoses would hinder this goal.
Keeping the device flexible across the involved joint allows for normal range of motion during walking and other activities. This allows the muscles to keep working and firing, and it allows for the joint to stay flexible. Additionally, with the primary goal of device usage being more activity, it’s important to allow for a smooth, natural gait. Think about how tiring it is to walk in ski boots.
These devices need to be lightweight and flexible without cost to their strength and reliability. Neuromuscular disorder happens to people of all body types and functional levels, and the device, which is depended upon for regular activities, must hold up.
Fortunately there are new materials being utilized for orthotic management that are able to meet each of these goals. Carbon Fiber and fiberglass is now regularly utilized, and can be used in custom and off-the-shelf devices. Lightweight aluminium is used for knee bracing. These materials allow for devices that truly meet the needs of patients with neuromuscular disorder.
When to start
The recommendation is to start as soon as daily life is disrupted by weakness related to the disorder, if not before. The orthosis during this earlier stage can be thought of as a tool to have when needed – longer walks, hikes, shopping, working. If weakness progresses, the device is available and can then be worn more regularly. These devices do more than minimize falling, they allow you to continue with regular activities with reduced fatigue, which enables higher activity and delay in lifestyle change.
Our team at Creative Technology Orthotic and Prosthetic Solutions has experience serving the neuromuscular patient population across Colorado. Contact us for a consultation and evaluation at 303-346-1906. We have demo devices in our offices, which allow you to trial various devices in order for us to come up with a successful plan. We like to work with you in device determination – taking time to understand your own goals, lifestyle, and reservations. Having a strong understanding of core orthotic principles and neuromuscular disorder is our key to achieving great outcomes.