There are more than 150,000 strokes or cerebrovascular accidents (CVA) reported in the UK every year. They happen when the blood supply to an area of the brain is interrupted and the brain cells in that region are damaged or even die. Ischaemic strokes are the most common form of stroke.
Common problems encountered after a stroke include difficulties with speech, cognitive, emotional and visual issues, as well as more physical and balance-related difficulties.
Although some people will have a complete recovery, two-thirds of people who suffer a stroke will have some form of long term problem (lasting more than one year) and this can often involve a person’s ability to walk. When a stroke has an impact on mobility, it will tend to affect only one side of the body, as usually only one side of the area of the brain is damaged. Often, a person will be left with weakness and or spasticity in their affected side. They can also have problems with coordinating their movement.
Ischaemic strokes occur when a blood clot blocks the flow of blood and oxygen to the brain. The clots form where the arteries have been blocked, or narrowed, by fatty deposits. As one gets older, the arteries can narrow, but lifestyle factors can accelerate the process. The culprits are smoking, high blood pressure, obesity, and diabetes, high cholesterol levels and excessive alcohol intake.
The amount a stroke affects someone is determined by the size and position of the original brain injury. If there is significant weakness and spasticity, mobility and gait will be severely affected. The loss of balance due to poor proprioception and the inability to feel where their feet are will cause increased problems with standing, walking and, sometimes, even sitting. If left untreated the rehabilitation process is harder to manage and it is more difficult to achieve improvements.
One of the main problems associated with long-term stroke rehabilitation is the contracture of muscles due to spasticity. This can lead to painful deformities of both the lower and upper limbs. For example, they can prevent people from being able to stand or open their hands. Another concern is the patterns of movements that people adopt to manage their condition. Bad habits can form and these are then difficult to unlearn.
Assessing an individual following a stroke requires a neurological examination. This includes: analysing joint ranges of movement; joint stability; muscle strength; spasticity; standing posture/alignment; and a gait/walking assessment.
A wide variety of upper and lower limb orthotic devices are used successfully by people encountering the physical effects of stroke. These can be used during rehabilitation in the year or more, following the stroke in conjunction with physiotherapy in the post-rehabilitation period. The orthotics are used to help support one part of the lower limb while strength and movement are returning to the muscles near them. These must be adapted and matched to the exact needs of the user since muscle control can change rapidly and complications such as swelling can also quickly change. Secondly, spasticity or muscle imbalance can result in poor joint positioning and a shortening of one or more muscles. Typically, part of the calf muscle becomes shorter, forcing the toes downward and making the ankle give way to the outside. This shortening effect can be prevented by using a properly-formed resting splint. Shortening that has already occurred may sometimes be improved through the use of a dynamic contracture orthosis, which acts like a spring to apply a constant stretch on the affected muscles.
Ultimately our goal is to optimise the patient’s gait so that it looks as normal as possible. More and more we are using a particular orthosis to do this, it is called the Neuro Swing. It is designed with an ankle joint that allows the patient some freedom of movement and it can be fine-tuned incredibly accurately in our gait lab. More traditional AFOs have the drawback of blocking good movement along with the bad.
At LOC, we only fit bespoke ankle foot orthoses. These are designed and manufactured based specifically on the individual’s requirements from a plaster cast of their leg.
There are a large number of therapists who can have a role to play in rehabilitation following a stroke. We work with physiotherapists, occupational and speech therapists who we are confident to recommend.
Milestones Neurorehabilitation Clinic
We have the following facilities and amenities at our Kingston Upon Thames location:
We also have the Gait Laboratory for orthotics patients and Onsite Manufacturing for speedy turnarounds and adjustments whilst you wait.
We have the following facilities and amenities at our Cambridge location:
For more information about The Beechwood Complementary Medical Practice, please visit The Beechwood Practice.
We have the following facilities and amenities at our Bristol location:
For more information, visit Litfield House Medical Centre.
LOC’s clinic is based in the University of Salford’s Podiatry Department and provides treatments for orthotics, scoliosis, pectus deformities, positional plagiocephaly and club foot.
It is also the base for LOC’s northern OSKAR clinic which is run by Sam Walmsley, clinical director of LOC, in conjunction with Elaine Owen MBE MSc SRP MCSP.
Due to COVID-19, we have had to temporarily close the Salford clinic and are operating out of another clinic in Bolton.
508 Blackburn Rd,
For more information, please visit The Good Health Centre
An insole is a contoured orthotic device which alters the characteristics and biomechanics of the foot and ankle area. Biomechanics are concerned with mechanical laws and how they affect the living body, especially the musculoskeletal system.
They are removable devices, often made from plastic, that are designed to fit inside a shoe to provide additional support for your feet. As well as offering shock absorption, an insole can help distribute the weight of your body more effectively across the foot and can be made bespoke to cover a range of biomechanical conditions.
If you have symptoms in your feet, ankles, hips or your lower back that are intermittent or were not there to start with in early life, and have started to cause you pain over a period of time, bespoke orthotic insoles could be an excellent option.
If you have already tried rest, icing, compression and elevation and your feet have not recovered, we recommend a biomechanical assessment to consider the possibility of insoles. They are a non-invasive approach to treatment and in many cases, are a great option for symptoms that are not severe enough to warrant surgical intervention. Alternatively, they can be considered as an option prior to surgery.
We will send patients away when an insole is not appropriate, if a patient is suffering with iliotibial band syndrome for example, the problem can be helped with physiotherapy and a stretching programme. That’s what our biomechanical assessment is all about; determining whether there would be any benefit from altering the alignment of your feet.
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