Lower Limb Orthotics Improve Balance and Gait After Stroke

NEW YORK (Reuters Health) Feb 09 - Ankle and foot splints can improve balance, ambulation and mobility in the immediate post-stroke period, according to British researchers.
This finding is the result of a Cochrane Review undertaken by the researchers to study the effects of upper and lower limb orthotic devices in patients with nonprogressive brain lesions. The review was published online by the Cochrane Database of Systematic Reviews on January 21 in Issue 1 for 2009.
Dr. Sarah F. Tyson of the University of Salford and Dr. Ruth M. Kent of the University of Leeds identified 14 randomized controlled trials, parallel or crossover, that compared use of an orthosis plus normal management with normal management alone, or use of an orthosis with no treatment, normal care, or placebo. The 14 trials involved 429 participants.
The British team found that the "overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial."
In a press release, Dr. Tyson noted that "traditionally, physiotherapists have been reluctant to prescribe" lower limb splints to stroke patients." However, she added, "Views have been slowly shifting in the last few years."
On the other hand, the review found no effect from wrist splints on patients' ability to use the arm, range of wrist, finger or thumb motion, or pain. "This result was also surprising, as the use of orthotics to prevent contractures...is thought to be very important in restoring use of the arm after stroke," Dr. Tyson said, but she pointed out that this finding was based on only three studies.
The studies all looked only at the short-term, immediate effects of orthotics. The long-term effects - good or bad - are unknown.
Even so, Dr. Tyson told Reuters Health, "I would use an ankle-foot orthotic and I would not limit it to a specific time period at this point. I would use it for as long as (the patient) had a problem."
"The current evidence suggests that a wrist and finger orthotic is of no help to reduce pain, limit flexibility or reduce contractures at the wrist, fingers or thumb to promote movement in the hand and use of the arm," Dr. Tyson added. "Further research needs to be done to establish whether they are of any use at all."