INNOVATION IN REHABILITATION AFTER SPINAL CORD INJURY: ORTHOTICS

Another area of importance to spinal cord injury is orthotics, the design and making of braces and splints. Many people with spinal cord injury can benefit from appropriate bracing and splinting of the limbs and trunk. Bracing is very important for preserving stability of the spine after it is injured, keeping it in the proper alignment. For individuals with paraplegia, lower extremity bracing often allows walking with crutches. Upper extremity splinting can greatly enhance hand function in people with quadriplegia. Of particular note is the wrist-driven flexor hinge splint (also called a tenodesis splint), which uses wrist extensor muscles to give power for gripping objects between the thumb and fingers (with a pinch-type grip). {Extensor muscles contract to straighten a limb; flexor muscles contract to bend it.) New materials for braces and splints are under development. As these materials improve, braces become lighter and sturdier, making them more durable and more efficient.
Powered orthotics – motorized braces and splints – are also being developed, which are particularly important in combination with FES. As we noted above, FES is sometimes impractical because of the great number of muscles involved in controlling the movement of a particular joint. Some laboratories are working on systems that combine FES and powered braces. For example, one approach to restoring the ability to walk in people with paraplegia is the use of FES to provide control of the knees and ankles, a rigid spinal brace to control the trunk, and a powered joint to control the hip.
Bracing of the hip is a major challenge in orthotics. The human hip has enormous flexibility, with freedom of motion in many directions. It also undergoes a great deal of physical stress during normal daily activities. The design of an external, mechanical joint that can support the hip of individuals with paraplegia is therefore a challenge. The standard approach has been to use a metal joint on the side of each hip (the lateral sides), with motion in at least one axis of rotation. However, this device takes up too much space and makes sitting in a normal chair or in a typical wheelchair difficult, and the use of this brace is therefore impractical. Most individuals with paraplegia need to be able to switch easily and quickly between walking (with crutches and braces) and using a wheelchair. A promising approach to this problem is the development of a joint that sits medially (between the thighs) instead of laterally (at the side of the hip). A single midline metal joint positioned below the groin can substitute for both hip joints, providing a tremendous advantage for stability in the upright position and making walking much easier.
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