Strokes or cerebrovascular accidents (CVA) happen when the blood supply to an area of the brain is interrupted and the brain cells in that region are damaged or even die. Ischemic strokes are the most common form of stroke.
Common problems encountered after a stroke include difficulties with speech, cognitive, emotional and visual issues, as well as more physical and balance-related difficulties.
Although some people will have a complete recovery, two-thirds of people who suffer a stroke will have some form of long term problem (lasting more than one year) and this can often involve a person’s ability to walk. When a stroke has an impact on mobility, it will tend to affect only one side of the body, as usually only one side of the area of the brain is damaged. Often, a person will be left with weakness and or spasticity in their affected side. They can also have problems with coordinating their movement.

A SCI can occur as a result of trauma, such as a road traffic accident, severe assault, or fall from a great height. Diseases such as polio or spina bifida will also cause spinal injury. Depending on the severity of the injury, a person may make a full recovery or become completely paralyzed.

The amount a stroke affects someone is determined by the size and position of the original brain injury. If there is significant weakness and spasticity, mobility and gait will be severely affected. The loss of balance due to poor proprioception and the inability to feel where their feet are will cause increased problems with standing, walking and, sometimes, even sitting. If left untreated the rehabilitation process is harder to manage and it is more difficult to achieve improvements.

One of the main problems associated with long-term stroke rehabilitation is the contracture of muscles due to spasticity. This can lead to painful deformities of both the lower and upper limbs. For example, they can prevent people from being able to stand or open their hands. Another concern is the patterns of movements that people adopt to manage their condition. Bad habits can form and these are then difficult to unlearn.

Assessing an individual following a stroke requires a neurological examination. This includes: analyzing joint ranges of movement; joint stability; muscle strength; spasticity; standing posture/alignment; and a gait/walking assessment.

A wide variety of upper and lower limb orthotic devices are used successfully by people encountering the physical effects of stroke. These can be used during rehabilitation in the year or more, following the stroke in conjunction with physiotherapy in the post-rehabilitation period. The orthotics are used to help support one part of the lower limb while strength and movement are returning to the muscles near them. These must be adapted and matched to the exact needs of the user since muscle control can change rapidly and complications such as swelling can also quickly change. Secondly, spasticity or muscle imbalance can result in poor joint positioning and a shortening of one or more muscles. Typically, part of the calf muscle becomes shorter, forcing the toes downward and making the ankle give way to the outside. This shortening effect can be prevented by using a properly-formed resting splint. Shortening that has already occurred may sometimes be improved through the use of a dynamic contracture orthosis, which acts like a spring to apply a constant stretch on the affected muscles.
Ultimately our goal is to optimize the patient’s gait so that it looks as normal as possible. More and more we are using a particular orthosis to do this, it is called the Neuro Swing. It is designed with an ankle joint that allows the patient some freedom of movement and it can be fine-tuned incredibly accurately in our gait lab. More traditional AFOs have the drawback of blocking good movement along with the bad.