Prescription of an Orthosis
If a patient or physician notices gait instability, such as stumbling or paralysis, following an illness or injury to the peripheral or central nervous system, the goal should be to provide the right medical device, ideally a custom-made orthosis, as quickly as possible. A correctly written prescription is the first important step towards a successful therapy.
The right custom-made orthosis can have a positive impact on the quality of life for patients with paralyses due to neurological indications. In recent years, technology has progressed fast and knowledge about the production and use of orthoses has increased.
This rapid progress can also mean that not all physicians are fully aware of the latest treatment options, even if extensive studies and publications already exist. This partial lack of specialised knowledge can lead to patients being prescribed a device that is not optimal or even unsuitable for their indication, which can prevent the desired effect from being achieved.
From an Inadequate Diagnosis to the Right Prescription
Unfortunately, due to a lack of time and knowledge, sometimes only a quick, superficial physical examination is carried out. As a result, important neurological deficits can remain unrecognised and a diagnosis corresponding to the obvious symptoms only is made.
Here a typical scenario: A patient is diagnosed with a stumbling gait and weakness of the dorsiflexors (foot lifting muscles) (1). The fact that the patient also has weakened plantar flexors (calf muscles) (2) remains unrecognised. In such cases, a preproduced foot lifter orthosis is often prescribed as the treatment of choice. However, it is not suitable at all. Although it reduces the risk of stumbling, it does not remedy the insecurity when standing and walking caused by weakened calf muscles.
In many cases, patients with neurological indications should receive a prescription for a custom-made orthosis, as it provides the necessary safety when standing and walking compared to a simple foot lifter orthosis or even a wheelchair. The medical devices selected as a standard are usually inexpensive and are approved without hesitation by the health insurance company. Unfortunately, they often provide inadequate support for the patient.
We would therefore like to make physicians and patients aware of what they should look out for when issuing a prescription. In the case of neurological indications, it should contain a more precise diagnosis text and the word "custom-made" so that the patient receives an individually produced orthosis for their needs and indication that compensates for the functional restrictions of all affected muscle groups.
With the right orthotic treatment and in combination with good physiotherapy, it is quite realistic to achieve a quick mobilisation and improvement up to the restoration of the ability to stand and walk.
Which Custom-Made Orthosis for Which Paralysis?
For neurological indications, it is very beneficial if an appropriate prescription for a custom-made orthosis is issued immediately. An early treatment with the right orthosis reduces the risk of progressive deterioration in muscle function. It also promotes neuroplasticity, which is a central element of modern holistic therapy.
What should physicians and patients look out for to ensure that the right orthosis is prescribed for the type of paralysis?
In the section on Paralyses and Orthoses on our FIOR & GENTZ website, we not only describe the function of the leg muscles, but also provide treatment suggestions for the individual muscle groups affected by paralysis. For example, patients with an isolated weakness of the plantar flexors should be treated with a "custom-made lower leg orthosis made of fibre-reinforced composite material with a mechanical system ankle joint using a dynamic dorsiflexion stop with a precompressed spring unit".
Depending on which muscle group is affected, a different orthosis construction with different system joints is required and must be specified on the prescription.
How the Prescription Works
After receiving the prescription, the patient takes it to a medical supply store. To find a suitable supplier near you, you can use our supplier search.
If the patient has received a prescription for a preproduced device, such as a foot lifter orthosis, the supplier should be consulted in order to have the prescription reissued for a custom-made orthosis if necessary. If, after receiving the simple device, the patient feels that they do not perceive it as sufficiently secure when standing and walking, they should always discuss this. Ideally, an orthotist at the medical supply store will inform the patient about other treatment options with other devices.
This is not necessarily based on the diagnosis on the prescription, but on a new physical examination carried out on site to determine the patient's ability to stand and walk as well as a muscle function test. This is done anyway if the patient has been given a prescription for a custom-made orthosis.
The orthotist then issues a recommended prescription with a detailed description. Instead of the initial foot lifter orthosis, they will for example recommend a "custom-made lower leg orthosis made of fibre-reinforced composite material with dynamic system ankle joint for dorsiflexion assist" in case of a weakness of the dorsiflexors.
