Dustin on Vancouver Island asks, “I’m ambulatory but I didn’t figure out that braces could help me with walking until I was out of rehab. How do I find out what braces are the best fit for me?”
To answer this question, we reached out to GF Strong Rehab SCI physiotherapists.
There are many braces, or orthoses, that can help you walk. The goal is to prescribe the least restrictive device that allows for safe stepping or standing and normal muscle and walking patterns. During rehab, you might test drive some braces to see what might work for you before you buy your own. After rehab, you can talk with your physiatrist about braces in order to get a referral to an orthotist. Braces prescribed by a physician are often covered by funding sources.
People with incomplete injuries are the most common users of braces, and their needs depend on the level and completeness of injury, and whether they have spastic (upper motor neuron or UMN) or flaccid (lower motor neuron or LMN) paralysis.
For people with complete UMN injuries, brace-walking is challenging—it requires a tiring walking pattern that relies on the upper body to bear their body weight as they use a walker or crutches. Knee-ankle-foot orthoses (KAFO) are the most common braces used, with variations for higher injury levels. These rely on splints that immobilize the knee, ankle and foot, with hinges for knee bending. Some variations of these provide trunk support and have spring locks that allow the user to swing through at the hip joint. KAFOs are generally used for short distance stepping and weight bearing.
Several types of braces are prescribed for those of various injury levels with some lower leg strength that provides the potential to stand or step. The right brace will depend on strength, joint position, spasticity and where/when the brace will be used.
Solid ankle-foot-orthoses (AFO) stabilize the ankle and enable the front of the foot to clear the ground while stepping. Rigid AFOs, suitable for those who need more support, are often thicker and provide more ankle and foot control, and are also available with a hinge at the ankle to allow for a more normal gait. Spring AFOs are made of lighter materials and do the same thing, but allow some flexibility of the ankle for easier climbing of stairs or inclines.
Dynamic AFOs are made of strong but flexible lightweight materials that allow a more natural range of motion while using the spring action of the materials to assist with push off from the ground and raising the foot. These are for users with at least minimal strength in the muscles that pull the leg back.
Dictus is a soft AFO for users who have ankle stability. They have a short ankle strap that connects to the top of the shoe or a brace on the foot to hold the front of the foot up when stepping through. Leaving the ankle free enables the user to use hip extensors and help with toe push off from the ground. Heel lock ankle braces are an off-the-shelf product that prevent the ankle from rolling, offering stability and preventing injury. Knee braces are frequently used to control knee hyperextension and protect the joint when standing.
Finally, neuroprostheses are also available which incorporate electrical stimulation with a brace to cause a muscle contraction while stepping.
It’s essential to speak with your physiatrist, and physiotherapist and orthotist, when considering new bracing options. And if you do start wearing braces or change to new braces, don’t forget to check your skin for signs of breakdown every time you use them
This article was originally published in the Fall 2020 issue of The Spin. Read more stories from this issue, including:
- Music
- Ambulatory SCI
- Medication Costs
- AD & Cannabis
And more!
