Multiple sclerosis (MS) is an auto-immune condition. The body’s immune system attacks the myelin that is essential for the proper functioning of the nervous system. When the attack dies down, it leaves behind scarring of the myelin sheath, this is known as sclerosis. Multiple attacks can damage the underlying nerve fibre. This causes interference between the brain and parts of the body affected.
It is the most common neurological condition affecting young adults. Around 100,000 people in the UK have MS and it is twice as common in women as men.
It can be characterised by periods of relapse and remission, or it can follow a progressive pattern.
There is no one reason for someone to develop MS, but it is known to be caused by a combination of genetic and environmental factors.
Given the wide range of physical effects that MS can have on an individual, the initial consultation must be particularly in-depth. We need to establish a person’s goals and expectations from the treatment we can provide. During our detailed assessment, we will explain the different orthotic prescription options to you, and how they can ameliorate your particular symptoms.
Orthotic treatments for MS have to manage a wide range of complex problems, including spasticity, weakness and joint instabilities. Depending on the exact symptoms presented we can offer a range of orthotic prescriptions, from neurological insoles to functional electronic stimulation (FES) and knee ankle foot orthoses (KAFOs) to aid muscle weakness in the leg. More and more we have been prescribing the Neuro Swing snkle system because it provides us with the means to continually fine-tune our prescription to respond to changes in a patient’s symptoms.
All of our orthotics are bespoke/made-to-measure. We can also design hybrid FES orthotic systems. These combine the mechanical advantage of a plastic orthotic with electronic stimulation which can improve function using the body’s own musculature. There is published research about the beneficial effects of FES for MS sufferers.
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.
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 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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