Surplus value of orthopaedic shoes in the treatment of the neurological foot.
Grady, Joltanna H
Rehabilitation Centre "het Roessingh", Enschede, the Netherlands
Orthopaedic shoes (O.S.) are, compared to the combination lowerleg splint/brace - ready made shoes, indicated e.g. in a flaccid paresis in the case of:
* a pes cavus: via low O.S., prevention of varus tilt (placing the ball point 1 deep).
* a pes cavo - equino - varus (partly to correct): High O.S. with a supple dorsal splint or socket with open fitting (is also correcting a dropfoot).
* a pes cavo- equino - varus (rigid): High O.S. with a closed socket in equino position (is correcting also a dropfoot) and an artificial roll over.
Starting with a spastic paresis there is an indication for orthopaedic shoes in:
* an intentional pes equinus: via high O.S. with socket (5｡?dorsal - flexion in the ankle) break through/reduction of the spastic extension pattern.
* a intentional/structural pes equinus: High O.S. with a supple or hinging socket in an equinus position for stabilisation (prevention of varus tilt) of the foot.
* a structural pes equinus: high O.S. with rigid socket and an artificial roll over (stabilisation of knee and ankle).
The socket constructions also correct the insufficient active dorsal flexion of the foot.
INTENSIVE USE OF FUNCTIONAL ELECTRICAL STIMULATION (FES) IN CVA
Haim Ring, Harold Weingarden, Nathan Roger (Loewenstein Hosp Rehab Center, Raanna & Tel Aviv University Med School, Sheba Hospital Neurol Rehab Dept and Ben Gurion University, Israel)
Purpose: To determine the effects of daily intensive home Functional Electrical Stimulation (FES), in chronic hemiplegia and if there is an outcome correlation to age, duration post-CVA and sensory status.
Method: 15 patients, l-15 years post-CVA, fit with the Handmaster upper limb FES system, and instructed in intensive home usage for an average of 3 hours per day. Posture and postural response to activity, spasticity (modified Ashworth scale), active motion of the upper limb, active hand movement, and functional ability of the involved hand via the 5-part Frenchay Arm Test and a holding test were assessed prior to fitting and at follow-up 3-26 weeks later. Age range was 32-79, 11 had intact sensation and 4 impaired sensation.
Result: Improvements measured in: posture, 14 patients; spasticity 13 patients; active upper limb motion, 13 patients; active hand movement, 10 patients; Frenchay tests, 5 patients; and holding test, 12 patients.
Conclusions: Daily intensive use of the Handmaster resulted in significant improvements in all categories of the chronic stable post-CVA individuals involved in this study. Shorter duration post-CVA, younger and sensory intact patients tended to show greater degrees of improvement in spasticity reduction and increased active movements, while degree of functional improvement did not include the time post-CVA correlation. No discernible pattern was present to correlate the degree of posture improvement, and the improvement on the holding test with sensory impairment, age or duration post-CVA.