Background or Problem/ Issue:
Contracture management can be done in different ways but they are not always effective and painless. The purpose of LLPS contracture treatment with a dynamic non-weightbearing orthosis is to obtain an increase of ROM and so to be able to achieve fixed goals such as better gait pattern, specific daily activities, hygienic matters or personal objectives with minor inconveniences and pain. In order to use active gait orthosis (AFO KAFO) in the most effective way, PROM in ankle and knee are required. Prevention and treating contractures are therefore very needed
Method or What you did?
The included persons with contractures, 2 male and 2 female adults, on which the dynamic joints were applied have neurological and orthopaedic knee and ankle contractures. A flat coil spring gives the requested linear force onto the joints to work following LLPS-principles. Each orthosis is custom made, designed following the need and is fitted at first without force to check comfort and to achieve the correct wearing time. AROM and PROM in knee and/or ankle were measured with a standard goniometer in the beginning of the treatment and weekly after delivery of the orthosis to check the progress. The force has only been increased if there was no improvement in ROM. The necessity of PROM in the ankle has been shown very needed to avoid compensation during gait and in order to decide for the right AFO or KAFO to walk as efficient as possible.
Results or Outcomes:
In a treating time of two months (wearing time 6 to 8 hours a day, minimum 5 days a week, force following evolution up to approximately 3.5 Nm) we could measure a gain of end range of passive knee extension up to 14°, which is a considerable improvement. This method was used complementary to the manual therapy (High Load Brief Stretch) that the patients already had before starting the LLPS treatment.
Conclusions or Practice Implications:
The dynamic contracture treatment following LLPS can be an effective and painless way of treating correctable contractures if the wearing time, the compliance, the comfortable orthotic design and accurate follow-up has been set up. The increasement in PROM in ankle and knee is the key to obtain a correct and most adapted orthotic solution.
Flora is passionate about the combination of technical orthopaedics and physical therapy. Graduated as a CPO, she continued studying Physical. After many years of working as a CPO, she works now as a specialist in Neuro-Orthotics by Basko Healthcare providing clinical and technical support during assessment, technical implementation and rehabilitation.