This PPT was made to teach about the Orhtotic management of stroke for Mobility purpose when i was working in Bangladesh .And design was done by considering the sponsors for the programme. If this PPT is useful please go ahed and i am happy if you use this information for teaching....Madesh

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ORTHOTIC MANAGEMENT OF STROKE FOR
IMPROVEMENT OF MOBILITY
By
MADESHANAIKA (P & O)
Consultant
School of Prosthetics and Orthotics, BHPI,CRP

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KNOWLEDGE CHECK
Q1. What is stroke ? And its causes.
Q2. Which part of the brain gets damage in stroke ?
Q3. If which part of brain damages then speech gets affected?
Q4. Stroke is LMNL or UMNL? How will you asses ?
Q5. Why if left part of brain affects the right half of the body
paralyses?
Q6. Is there sensation problem in stroke?
Q7. What is the scenario in Bangladesh any idea?

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CONTENTS
1. ABOUT STROKE GLOBALLY AND IN BANGLADESH
2. NEURO-MUSCULAR FUNCTIONAL LOSSES IN STROKE (Related to orthotic
prescription)
3. ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING MOBILITY
4. THE AIM OF THE ORTHOSES
5. THE BIOMECHANICAL FUNCTIONS OF AFO
6. CONCLUSION
7. QUESTIONS
8. REFERENCE

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1. ABOUT STROKE GLOBALLY AND IN BANGLADESH
I. Around 15 million people worldwide suffer from stroke every year
(WHO 2003)
II. In Bangladesh Stroke is the third leading cause of death after
coronary heart disease
III. The World Health Organization ranks Bangladesh's mortality rate
due to stroke as number 84 in the world
IV. In Bangladesh hypertension is the main cause of ischemic and
hemorrhagic stroke
V. Two non-governmental organizations BRAC and the CRP are
actively involved in primary stroke prevention strategies

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2. NEURO-MUSCULAR FUNCTIONAL LOSSES IN STROKE
(Related to orthotic prescription)
I. Most stroke survivors regain the ability to walk with deviation
II. Walking after stroke has been identified as top priority for
rehabilitation
III. People who have had a stroke have a low level of ambulatory
activity
IV. The gait improve in stroke after six months reach only 40% to 50%
of matched healthy people

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2. NEURO-MUSCULAR FUNCTIONAL LOSSES IN STROKE
(Related to orthotic prescription)….continue
V. Foot frequently adopts plantar‐flexed
position in swing and stance due to
increased plantar flexor tone.
VI. PF resists forward rolling of the tibia over
the ankle joint leading to knee
hyperextension
VII. The ground reaction force (GRF) passes in
front of the knee leads to instability and
excessive flexion moment of the hip during
the late stages of the stance phase
Effect of PF to knee
and Hip

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3.ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING
MOBILITY
I. The management for stroke can be operative (Surgical) or non-
operative (PT,OT or orthoses)
II. Mainly for minimizing the gait deviation orthosis is used
III. To promote walking ability Ankle Foot Orthoses (AFOs) are
frequently prescribed
Ankle Foot Orthosis (AFO’s)

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3.ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING
MOBILITY….continue
IV. AFO’s designed with sufficient mechanical lever arms to control
the ankle complex directly and to influence the knee joint
indirectly
V. The orthosis either it can be prefabricated or custom made
Short lever arm AFO Long lever arm AFO

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3.ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING
MOBILITY…..continue
VI. The prefabricate are often used temporarily, such as during
early mobilization
VII. Custom‐made orthoses are usually prescribed for more complex
gait abnormalities associated with stroke
VIII. Custom‐made orthoses are have more effect and commonly
used because it is extremely beneficial
IX. Custom-made orthosis commonly used in developed countries
Custom
madeAFO’s

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3.ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING
MOBILITY…..continue
The different types of custom made orthosis are
A. The posterior leaf spring AFO
B. The solid AFO
C. The hinged or articulated AFO
D. The dorsiflexion assist AFO
E. The plantar flexion stop AFO
F. The energy return or ground reaction AFO
The prescription based on the deficits experienced by each
individual and the goals need to achieve.

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3.ORTHOTIC MANAGEMENT FOR STROKE FOR IMPROVING
MOBILITY…..continue
A. Posterior leaf spring AFO B. solid AFO C. The hinged or articulated AFO
D. Dorsiflexion assist AFO
F. Energy return and Ground reaction AFOE. Plantar flexion stop AFO

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,
Orthotic management for upper extremity ???

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,
UPPER EXTREMITY
ORTHOSIS FOR
STROKE

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4. AIM OF THE ORTHOSES
The main aims of the orthosis for the treatment of stroke are
1. To maintain or correct body segment alignment
2. To assist /resist joint motion during different phases of gait
3. Protect from external stimuli - Restore Mobility
4. Minimizes risk of deformities

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5.THE BIOMECHANICAL FUNCTIONS OF THE AFO
I. AFOs prevents PF in swing phase and improves ground
clearance this is achieved by the three‐point force system
II. And reduces the risk of falling
Three point force system for
preventing PF

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5.THE BIOMECHANICAL FUNCTIONS OF THE AFO….continue
III. AFOs not only alter the biomechanics at ankle joint also
indirectly change the hip and knee alignment by realigning the
tibia to a more normal position of approximately 10° forward
inclination
80
0
Ankle joint alignment in AFO
for stroke patients

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5. THE BIOMECHANICAL FUNCTIONS OF THE AFO…continue
IV. During the stance phase, the GRF is positioned posterior to the
knee thereby positively influencing the hip and knee stability—
Kinematic chain
GRF
Effect of GRF over knee and hip due to ankle joint
alignment in 10 degree DF

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6.CONCLUSION
1. Stroke is one of the major global health problem
2. Most stroke survivors regain the ability to walk with deviation
3. To promote walking ability Ankle Foot Orthoses (AFOs) are frequently
prescribed
4. AFO by three point pressure system for controlling PF and helps
mobility
5. AFO can be custom-made or pre fabricated and most commonly the
Custom made are used
6. AFO designs can vary depends on impairment and the set goals
7. AFO aligned approx 10 degree tibia forward inclination for achieving
the knee and hip stability

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7.QUESTIONS

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8.REFERENCE
1. WHO Countries Database. Bangladesh: urban health profile. Available at
http://www.who.or.jp/uhcprofiles/Bangladesh.pdf (accessed 13August 2018).
2. World Health Rankings. Available at http://www.Worldlifeexpectancy.Com/Bangladesh-
stroke (accessed 13August 2018).
3. WHO Countries Database. Bangladesh: urban health profile. Available at
http://www.searo.who.int/LinkFiles/WHO_Country_Cooperation_Strategy_-
_Bangladesh_Annex-2.pdf (accessed 13 August 2018)
4. 4.Cochrane database of systematic review ankle foot orthosis for walking in stroke
rehabilitation. Cochrane Systematic Review - Intervention - Protocol Version published: 04
August 2014 (accessed 14 August 2018) available at
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011249/full

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THANK YOU FOR LISTENING