Neuro Orthoses for the Lower Extremities

Neuro orthotics focuses specifically on the orthotic treatment of clinical pictures with neurological indications. The most common causes include:

  • spinal cord injury (paraplegia)
  • stroke (apoplexy)
  • multiple sclerosis (MS)
  • cerebral palsy (CP)
  • post-polio syndrome (poliomyelitis)
  • Charcot-Marie-Tooth disease (CMT).

Therefore, orthoses for patients with the paralysed, also known as neuro orthoses, are used in this field. However, other indications and clinical pictures, such as peripheral arterial disease (PAD) or partial foot amputation, can also be treated with neuro orthoses.

In case of a paralysis of the lower extremities, a wheelchair or another device that is not ideally suited to the patient’s condition is often recommended as support. It is essential that patients and patients’ caregivers are aware of the benefits of an orthosis, as a treatment with the appropriate orthosis can have a noticeable positive impact on the life of the affected person. In Germany, § 33 „Medical Devices“ of the Fifth Book of the Social Code (German: Sozialgesetzbuch; SGB) states the right of prescription and cost assumption of an orthosis.

When planning a modern orthotic treatment, it is crucial that it meets the individual requirements of the patient’s condition. This is the only way the desired therapy goal can be achieved. For patients with neurological paralyses, the paralysis origin plays a decisive role.

These are the different origins:

  • paralyses caused by diseases or injuries of the spinal/peripheral nervous system, e.g. by paraplegia, spina bifida, post-polio syndrome or Charcot-Marie-Tooth disease
  • paralyses caused by diseases or injuries of the central nervous system, e.g. by cerebral palsy, traumatic brain injury or multiple sclerosis

In peripheral and spinal paralyses, the focus is often on the safety-giving support function of the orthosis. Whereas in central paralyses, the support function is used to reprogram physiological movement sequences in the brain in order to improve the physiological activation of the muscles.

Compensation Mechanisms in Case of Paralysis of the Lower Extremities

In both paralysis origins, the affected patients usually develop compensation mechanisms resulting in an atypical stance and gait. Patients use these movement patterns during their everyday life to gain stability and prevent themselves from falling. This way, the patient compensates the stability they lost in stance and gait due to their condition. This inevitably leads to an increased wear of the anatomical joints causing back pains and secondary symptoms.

Most Common Compensation Mechanisms

  • People with fully functional muscles use the entire length of their feet to enlarge the stance area, which helps them maintain a stable balance while standing. The necessary lever forces are realised especially by means of the forefoot lever and the calf muscles.
  • People whose calf muscles are functionally limited and who are not able to activate their forefoot lever on their own must bend their upper body forward when standing and lean on crutches. In doing so, the supporting area on the ground is artificially enlarged.
  • Patients with paralyses often rotate their feet inwards while walking. This prevents their knees from buckling. Out of the same reason, some patients overextend the knee of their paralysed leg while standing and/or walking.

Especially in central paralyses, these compensation mechanisms are often passively caused and manifest as spasticities. As soon as a safety need is indicated, the brain sends an impulse for an excessive safety measurement.

The vast amount of causes and manifestations of paralyses is what makes the field of orthotics an exceptional challenge. FIOR & GENTZ has accepted this challenge and is dedicated to a modern orthotic treatment of patients with paralyses.

Treatment Goal with an Orthosis

A modern orthosis should reactivate the lost muscular stability of the patient in such a way that the patient’s range of motion is limited as little as possible. The patient’s safety is always of first priority.

The ultimate treatment goal is a stable stance, which is achieved with an orthosis by means of supporting and stance controlling functional features. In addition, the orthosis should ensure a gait that is as physiological as possible by using dynamic system components. The physiological gait is the supreme discipline in leg orthotics. Modern functional features in an orthosis enable stance control while simultaneously maintaining the dynamic joint functions. Once a suitable combination for the patient is found, secondary diseases, which are most commonly caused by the lack of movement and unphysiological gait patterns, can successfully be prevented.

With the appropriate orthosis, the patient is mobile again and walks in nature as well as outdoor exercise are possible. For this purpose, orthotic joints made of carbon fibres are most suited as they are, in addition to the features mentioned above, water- and dirt-resistant.

How Does an Orthosis Work?

Besides the basic requirements, such as safety, correction and improvement of limited functions, modern orthoses must be precisely adapted to the patient’s needs. In the case of orthoses for paralyses, this is primarily achieved by orthotic joints at knee and ankle height.

Today, new treatment concepts are provided with modern orthoses, which no longer limit the neurological and anatomical functions but enhance them. The basic new approach here is to combine the orthosis’ supporting function with its dynamic function. This way, neurological functions can be (re-)activated, which results in physiological functions taking control of anatomical structures. In case of leg muscle paralyses, an orthotic treatment is often implemented early in the treatment regimen.

In contrast to earlier rigid apparatuses, which restricted the movement like a “knight’s armour”, today’s orthoses enhance the ability to move. To do so, modern materials such as carbon fibres and titanium are used to build lightweight and custom-made orthoses for paralyses. By using orthotic joints, the orthosis’ dynamic can be exactly aligned to the pivot points of the motion axes in the anatomical joints of the lower extremity. The orthosis’ dynamic occurs at the exact same point as the dynamic in the skeletal system of a healthy person. The orthosis shells can be built rigid and torsion resistant because the orthosis’ dynamic is achieved by the orthotic joints.

Patients with paralysed muscles gain safety while standing and walking through the orthosis’ rigidity. This rigidity, combined with the mobility of the system joints, diminish the acquired compensation mechanisms as a result or, when treated early, even prevent them. Consequently, pain resulting from a pathological gait, which often manifests in the shoulders or the back, can be minimised or even prevented. Hence, an ideal orthotic treatment in combination with a competent physiotherapy has the potential to enable a life that is nearly without restrictions.

New Treatment Concepts

FIOR & GENTZ specialises in the development of orthotic joints. With innovative technology, corresponding sensors and electronics, it is possible to build modern, electronically and hydraulically controlled orthoses for the lower extremities. The development of the orthotic joints is based on the approach of combining dynamic and stabilising features. The main focus of concepts regarding the production of modern orthoses for the lower extremities for patients with paralyses lies on holistic treatment strategies, which are regularly updated according to the newest scientific research. Findings of studies are integrated from an objective point of view and described in guides in a way that is clearly structured and easy to understand for everyone.

As the best possible orthotic treatment is important for FIOR & GENTZ, these guides are provided for free. Here, you can find an overview.

FIOR & GENTZ educates orthotists worldwide so that patients are able to participate in daily life again without worries, thanks to their modern orthoses. With an appropriate orthosis, the dependence on a wheelchair or crutches can be significantly reduced.

The Orthosis Configurator was specifically designed to calculate individual and goal-oriented orthoses. The planning process incorporates the neurological and anatomical requirements of the patient’s condition. The configuration result shows a recommendation for the production of a custom-made orthosis for the lower extremities that exactly matches the patient’s needs.


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