Orthotics is the use of braces (called calipers in parts of the world with British influence) and splints (orthoses) to biomechanically assist in supporting and stabilizing parts of the body affected by paralyzed and/or weak muscles (Bunch, 1985). Orthotics, grouped by a description of the area in which they provide support, are usually divided into three categories: lower extremity, upper extremity, and spinal. For example, in lower extremity orthotics, foot orthoses (FO) support and align the foot, ankle-foot orthoses (AFO) support and align the foot and ankle. Knee orthoses (KO) protect and support the knee joint. An orthotic device designed to support the whole lower extremity is called a knee-ankle-foot orthosis (KAFO). Upper extremity and spinal orthotics have similar classifications.
Increased pain, tripping, falling, dropping objects, and muscle loss are an alert to problems in the joints and muscles of the extremities (Redford, 1980). Many polio survivors who discarded their braces in earlier years, through therapy and sheer will, are in need of support once again. Bracing of joints and muscle groups can reduce pain; can prevent tripping and falling; may prevent further development of a joint deformity; and may conserve energy by making activities, such as walking, more efficient.
Communication among the polio survivor, the referring physician, and the orthotist is imperative to design the best possible brace. Today’s braces are often constructed of lightweight plastics and metals with fixed (locked) and/or free (movable) joints, not of leather and steel. The referring physician prescribes the general type of orthosis, including core components such as fixed or movable joints, or metal or plastic fabrication. The physician’s notes must include the diagnosis, estimated length of time needed, and the functional goals of the orthosis. Many physicians currently lack the training and expertise to determine the best orthoses for an individual. The orthotist fabricates a design based on the prescription, including information from a gait analysis and information about the individual’s home, work status, and physical activities.
In general, one must have a physician’s prescription to be reimbursed for orthoses by any insurance company, including Medicare and Medicaid. Many states do not have certification laws for practicing orthotists, but many are certified by professional trade organizations after a minimum of four to five years of study and training. The two national credentialing agencies in North America are American Board of Certification for Orthotics, Prosthetics, and Pedorthics (ABC) and Board of Certification (BOC). Each of the certifying organizations has a directory listing their credentialed facilities and practitioners that the general public can access from their websites, www.abcop.org and www.bocusa.org.
Having to use a brace should not be viewed as defeat, but instead as making a lifestyle change that will provide added stability and safer, more efficient, and less painful mobility, thus enhancing continued independence.
For further information
Human Gait Institute (https://humangaitinstitute.org/)
Bracing (Orthotic Care) for Polio Survivors (https://youtu.be/K9HaJhafT30)