Adult Brain Injury

Definition

A brain injury can be caused by a traumatic event, such as being involved in a road traffic accident, fall or assault or acquired due to a stroke or infection.

The effects of a brain injury depend on the type of injury, how severe the injury is, and also the location of the injury within the brain.

Survivors of brain injury may have limited function of arms or legs, abnormal speech or language, loss of thinking ability or emotional problems. The range of injuries, and degree of recovery, and varies widely, depending on the individual.

Symptoms/causes

Traumatic - this is typically caused by an external force, but can be compounded by complications of the trauma, such as damage to the brain tissue due to swelling, or increased intracranial pressure, or lack of oxygen.

Acquired - this is a brain injury that has occurred since birth. There are many possible causes, including stroke, haemorrhage, infection, hypoxic/anoxic brain injury and medical accidents.

 

Tests and Diagnosis

Imaging using CT and MRI can detect injury in the brain.

A neurological examination will be undertaken to determine physical deficits. There will be occupational and speech and language assessments to determine what each patient requires during their rehabilitation.

There will also be a cognitive evaluation with neuropsychological testing.

Orthotic Treatments

Following initial treatment in an acute setting, a patient will be in rehabilitative care for some time to help them restore their physical and psychological function to its optimum.

Physically, brain injury patients may suffer from strength, balance and posture problems.

The coordination and quality of movement can be affected. They may require help to become upright and more mobile.

In the acute phase of treatment following injury, PRAFOs (pressure relieving ankle foot orthoses) may be prescribed to maintain the range of motion at the foot and ankle while a patient is in hospital. These can also reduce the risk of pressure sores.

Many brain injury patients require furthermore long-term orthotic treatment during their rehabilitation and beyond:

  • helmet may be used to protect the head against falls following a seizure;
  • spinal brace is used to maintain the alignment of the spine;
  • Lycra suits are dynamic orthoses that increase proprioception and allow natural muscle movement but guide weaker or abnormal movement with specifically placed panels, which place pressure and direction on specific muscles. These garments can be gloves, socks or suits;
  • lower limb orthoses include AFOs (ankle foot orthoses) and KAFOs (knee ankle foot orthoses), which aim to control the foot, ankle, knee and hip during gait;
  • To return a patient’s gait pattern to one that is as near normal as possible, we are increasingly recommending and prescribing the Neuro Swing system. This has a number of advantages over traditional AFOs.
  • anti-contracture orthoses are used to stretch out tight muscles during rest such as KAFO's gaitors (for arms or legs) and night AFOs;
  • FES (functional electrical stimulation) can be used to stimulate weaker or affected muscles to function in a more normal pattern.

 

Above: Carbon Fibre Fixed AFO

Above: Carbon Fibre Fixed AFO

The treatment programme varies hugely between each patient, depending on the severity of the brain injury and the impact it has on the patient’s overall mobility. Each patient must, therefore, be carefully assessed by one of our experienced clinicians to determine what orthotic treatment is best suited to them. This may include a gait assessment in our video vector Gait Lab to accurately assess dynamic movement.

Above: Carbon Fibre Fior & Gentz KAFO

Above: Carbon Fibre Fior & Gentz KAFO

FAQs:

An AFO is an Ankle Foot Orthosis which as the name would suggest encompasses the ankle and foot. The objective is to control the position and movement of the ankle. AFOs are used to support weak limbs; they can also be used to immobilise the ankle and lower leg to correct foot drop. When set up correctly they can also have a great influence on the knee and hip joints. They are the most commonly used Orthoses.

The length of time that one needs to wear an AFO very much depends on the condition being treated. If it is a long-term condition like cerebral palsy or post-polio syndrome it is likely to be years as the condition cannot be cured. Your orthotist will advise you.

A patient’s comfort in their AFO is vital for compliance with the prescribed wearing regime.

So there are a number of steps the orthotist should take to ensure a comfortable fit: the patient’s heel should fit fully into the heel cup without excess space, the contours of the plantar surface of the AFO should match the patient’s foot, for children there needs to be up to half an inch growth room in the toe shelf length. At LOC we use our Gait Laboratories at our Kingston and Manchester clinics to fine-tune our bespoke orthotics.

A GRAFO is used to control instabilities in the lower limb by maintaining proper alignment of limbs and controlling their motion. It reaches around to the front of the knee extending down to the ankle. It works by altering a patient’s limb presentation to displace load and impact as well as offering further control to the knee.

The cost of an AFO is dependent on the type of AFO that has been prescribed and the material that it has been made with. Carbon fibre will be more expensive than metal or plastic for example. LOC’s bespoke AFOs cost can be found on our Orthotic Prices page.

The ability to drive while wearing an AFO is dependent on the condition being treated and the orthosis that has been prescribed. If wearing a hinged AFO, for example, you will be able to drive, but if wearing a knee brace, you won’t. Your orthotist will advise you.

The most flexible type of AFO is a Dynamic Ankle Foot Orthosis (DAFO).  It is thin and provides flexible support to the foot and ankle.

Both normal AFOs and DAFOs improve static balance (eg: while standing). Research among MS sufferers suggests that DAFOs aided balance while walking more than AFOs.

The simple answer is: yes they can. However one has to be sensible and look for wide-fitting trousers/jeans preferably of light and thin material.

Typically an AFO is stiff and rigid whereas a DAFO is thin, flexible and wraps around the patient’s entire foot. A DAFO provides support but also allows some range of normal movement.

A Supra Malleolar Orthosis SMO gets its name from the part of the body it encompasses. Thus an SMO supports the leg just above the ankle bone or malleoli. It allows dorsiflexion and plantar flexion(toes up and toes down) but eliminates mediolateral movement.

It typically takes a few weeks but is slightly dependent on the chosen materials and current availability.

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