Application of test-orthoses on lower extremities for determination of physical abilities and rehabilitation potential of persons with serious impairments of function of support and walking

Abstract

The most numerous and most complex group of diseases which result in impairment of human function of support and walking are neuro-muscular diseases and traumas of a spine and a spinal cord. Impairments which rise as a consequence of such diseases, require effective orthotic management which will allow the patient to compensate the lost functions necessary at stable walking. For the last 15 years in Ukraine, as well as in the world, a great many of various constructions of orthoses on different levels of the lower extremity, which cover all existing pathologies, has appeared. But as practical experience of global and domestic orthotic management indicates, a significant amount of adult patients who have serious impairments of function of the lower extremities, and first of all new patients, do not use orthoses manufactured for them. The principal causes are:

– Absence of comprehension by the patient, whether orthoses are necessary for him, whether he and his family can create conditions at home for his training;

– Complexity of choice of an orthosis with correct functionality, made by the doctor and the orthotist.

Recently in medical practice for the decision of this problem therapeutical – training orthoses or test-orthoses start to play the increasing role. More often test-orthoses are used before manufacturing of expensive orthoses, for example, knee-ankle-foot orthoses with a knee joint with electronic control. Use of such test-orthoses considerably reduces the time of orthotic management, but, unfortunately, they are not used for persons with serious pathology of lower extremities and cannot be used for determination of functional abilities of patients, especially in new ones. Therefore development of a new construction and a technique of application of test-orthoses (modular orthopedic systems) becomes an important stage in rehabilitation process of persons with serious pathological condition of a locomotor system.

Purpose – to present and analyze the experience of application of new constructions of knee-ankle-foot test-orthoses for persons with impairments of functions of support and walking at the final stage of accomplishment of rehabilitation measures, namely provision with individual orthoses in hospital environment.

Materials and methods. During realization of the research in the clinic of Ukrainian Research Institute for Prosthetics and Rehabilitation 28 patients (8 women and 20 men) from 21 to 50 years of age were examined, passed a course of rehabilitation treatment and were provided with new constructions of test-orthoses. 25 patients had consequences of traumatic injury of a spine (10 persons with injury at cervical level of a spine, 15 persons – at thoracic and lumbar levels of a spine), 2 persons – with consequences of a cerebral stroke, 1 – with consequences of a spinal stroke. All of them could not stand and walk independently. Rehabilitation measures directed on increasing of general physical status, elimination or decreasing of neurotrophic disorders have been earlier carried out for a significant amount (85.0%) of the examined persons; 72.0% of patients had experience of verticalization in a knee support device. Depending on a seriousness of a lesion the patients were divided into two groups: I group – patients with a lesion of the upper and lower extremities (12 persons); ІІ group – patients with a lesion of the lower extremities (16 persons). For each group the individual technique of application of test-orthoses and modes of their mastering have been developed. Test-orthoses, on the average, were used for one hour per day, within 8–11 days, for mastering of independent walking according to the developed techniques under supervision of the instructor. Service properties of testorthoses and their reliability were evaluated. Clinical, biomechanical diagnostic study of patients and manual testing of affected lower extremities of patients on residual muscle power were carried out, namely: muscle power on was evaluated five-scored Janda scale.

Results. In Ukrainian Research Institute for Prosthetics and Rehabilitation within the framework of research work a new construction of a knee-anklefoot test-orthosis and a technique of its application for 2 groups of persons with serious lesions of a locomotor system have been developed. The feature of new constructions of test-orthoses is the possibility of their quick assembly and adjustment (within 2–3 hours) in view of the individual sizes of the patient, due to a modular approach of selection and connection of components. All patients of the group I could stand independently in orthoses in high walkers. Seven patients could move independently in walkers on the distance up to 30 meters, five moved on distance of 10 meters with the help of the instructor. After a 10-day course of mastering of verticalization and walking with test-orthoses a decision was made concerning the design of individual orthoses. Six patients have refused orthotic management for the lack of conditions for training at home. In their case test-orthoses were used as a trainer for verticalization and exercises in a standing position on a designed technique. Patients of the group II moved in bars and in low walkers on a distance from 100 to 300 meters. After mastering walking within 8–10 days with test-orthoses a decision was made concerning the design of individual orthoses. Knee-ankle-foot orthoses with locking knee joints were manufactured to seven patients, inarticulated knee joints and pneumocylinders – to four patients, an inarticulated floor reaction ankle-foot orthosis – to one patient. One patient with consequences of a spinal stroke used test-orthoses at home within 3.5 months. As a result of regular training the muscle power of her left leg and in part of her right leg was restored. In her case test-orthoses helped to avoid expenses on manufacturing of two individual knee-ankle-foot orthoses. The orthosis on her right leg was manufactured which has allowed her to save function of muscles of the leg during walking due to installation of the pneumatic cylinder in the field of the knee joint, that compensated weakness of the quadriceps muscle of the hip in the stance phase.

Conclusions. Application of standard test-orthoses allows to estimate physical abilities of patients, to learn them to use orthoses on the lower extremities, to determine for everyone an optimal construction of individual orthoses that enables to refuse long and expensive process of manufacturing of a non-effective and not comfortable individual orthosis beforehand. The further research is necessary for expansion of possibilities of use of testorthoses for children with serious lesions of functions of support and walking.

The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.