Orthotic management of stroke for mobility --- Madeshanaika (India)

This PPT was made to teach about the Orhtotic management of stroke for Mobility purpose when i was working in Bangladesh .And design was done by considering the sponsors for the programme. If this PPT is useful please go ahed and i am happy if you use this information for teaching....Madesh

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2. ggggg ORTHOTIC MANAGEMENT OF STROKE FOR IMPROVEMENT OF MOBILITY By MADESHANAIKA (P & O) Consultant School of Prosthetics and Orthotics, BHPI,CRP

3. ggggg KNOWLEDGE CHECK Q1. What is stroke ? And its causes. Q2. Which part of the brain gets damage in stroke ? Q3. If which part of brain damages then speech gets affected? Q4. Stroke is LMNL or UMNL? How will you asses ? Q5. Why if left part of brain affects the right half of the body paralyses? Q6. Is there sensation problem in stroke? Q7. What is the scenario in Bangladesh any idea?

4. ggggg CONTENTS ABOUT STROKE GLOBALLY AND IN BANGLADESH NEURO-MUSCULAR FUNCTIONAL LOSSES IN STROKE ( Related to orthotic prescription ) ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING MOBILITY THE AIM OF THE ORTHOSES THE BIOMECHANICAL FUNCTIONS OF AFO CONCLUSION QUESTIONS REFERENCE

5. ggggg 1. ABOUT STROKE GLOBALLY AND IN BANGLADESH Around 15 million people worldwide suffer from stroke every year (WHO 2003) In Bangladesh Stroke is the third leading cause of death after coronary heart disease The World Health Organization ranks Bangladesh's mortality rate due to stroke as number 84 in the world In Bangladesh hypertension is the main cause of ischemic and hemorrhagic stroke Two non-governmental organizations BRAC and the CRP are actively involved in primary stroke prevention strategies

6. ggggg 2. NEURO-MUSCULAR FUNCTIONAL LOSSES IN STROKE (Related to orthotic prescription) Most stroke survivors regain the ability to walk with deviation Walking after stroke has been identified as top priority for rehabilitation People who have had a stroke have a low level of ambulatory activity The gait improve in stroke after six months reach only 40% to 50% of matched healthy people

7. ggggg 2 . NEURO-MUSCULAR FUNCTIONAL LOSSES IN STROKE (Related to orthotic prescription )….continue Foot frequently adopts plantar‐flexed position in swing and stance due to increased plantar flexor tone. PF resists forward rolling of the tibia over the ankle joint leading to knee hyperextension The ground reaction force (GRF) passes in front of the knee leads to instability and excessive flexion moment of the hip during the late stages of the stance phase Effect of PF to knee and Hip

8. ggggg ,  3 .ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING MOBILITY The management for stroke can be operative (Surgical) or non-operative (PT,OT or orthoses) Mainly for minimizing the gait deviation orthosis is used To promote walking ability Ankle F oot O rthoses (AFOs) are frequently prescribed Ankle Foot Orthosis (AFO’s)

9. ggggg ,  3 .ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING MOBILITY….continue AFO’s designed with sufficient mechanical lever arms to control the ankle complex directly and to influence the knee joint indirectly The orthosis either it can be prefabricated or custom made Short lever arm AFO Long lever arm AFO

10. ggggg ,  3 .ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING MOBILITY …..continue The prefabricate are often used temporarily, such as during early mobilization Custom‐made orthoses are usually prescribed for more complex gait abnormalities associated with stroke Custom‐made orthoses are have more effect and commonly used because it is extremely beneficial Custom - made orthosis commonly used in developed countries Custom made AFO’s

11. ggggg 3 .ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING MOBILITY…..continue The different types of custom made orthosis are The posterior leaf spring AFO The solid AFO The hinged or articulated AFO The dorsiflexion assist AFO The plantar flexion stop AFO The energy return or ground reaction AFO The prescription based on the deficits experienced by each individual and the goals need to achieve.

12. ggggg 3 .ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING MOBILITY…..continue A. Posterior leaf spring AFO B. solid AFO C. The hinged or articulated AFO D . Dorsiflexion assist AFO F. Energy return and Ground reaction AFO E . Plantar flexion stop AFO

13. ggggg ,  Orthotic management for upper extremity ???

14. ggggg ,  UPPER EXTREMITY ORTHOSIS FOR STROKE

15. ggggg 4 . AIM OF THE ORTHOSES The main aims of the orthosis for the treatment of stroke are To maintain or correct body segment alignment To assist /resist joint motion during different phases of gait Protect from external stimuli - Restore Mobility Minimizes risk of deformities

16. ggggg 5. THE BIOMECHANICAL FUNCTIONS OF THE AFO AFOs prevents PF in swing phase and improves ground clearance this is achieved by the three‐point force system And reduces the risk of falling Three point force system for preventing PF

17. ggggg 5. THE BIOMECHANICAL FUNCTIONS OF THE AFO….continue AFOs not only alter the biomechanics at ankle joint also indirectly change the hip and knee alignment by realigning the tibia to a more normal position of approximately 10° forward inclination 80 Ankle joint alignment in AFO for stroke patients

18. ggggg 5. THE BIOMECHANICAL FUNCTIONS OF THE AFO…continue During the stance phase, the GRF is positioned posterior to the knee thereby positively influencing the hip and knee stability—Kinematic chain GRF Effect of GRF over knee and hip due to ankle joint alignment in 10 degree DF

19. ggggg 6 .CONCLUSION Stroke is one of the major global health problem Most stroke survivors regain the ability to walk with deviation To promote walking ability Ankle Foot Orthoses (AFOs) are frequently prescribed AFO by three point pressure system for controlling PF and helps mobility AFO can be custom-made or pre fabricated and most commonly the Custom made are used AFO designs can vary depends on impairment and the set goals AFO aligned approx 10 degree tibia forward inclination for achieving the knee and hip stability

20. ggggg 7.QUESTIONS

21. ggggg 8.REFERENCE WHO Countries Database. Bangladesh: urban health profile. Available at http:// www.who.or.jp/ uhcprofiles /Bangladesh.pdf (accessed 13August 2018). World Health Rankings. Available at http :// www.Worldlifeexpectancy.Com/Bangladesh-stroke (accessed 13August 2018). WHO Countries Database. Bangladesh: urban health profile. Available at http://www.searo.who.int/LinkFiles/WHO_Country_Cooperation_Strategy_-_Bangladesh_Annex-2.pdf (accessed 13 August 2018) 4.Cochrane database of systematic review ankle foot orthosis for walking in stroke rehabilitation. Cochrane Systematic Review - Intervention - Protocol  Version published: 04 August 2014 (accessed 14 August 2018 ) available at https ://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011249/full

22. ggggg THANK YOU FOR LISTENING