Orthoses

Orthoses, also known as casts, braces, or splints, include any device that is used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body. As with any treatment, before selecting the appropriate orthotic device, it is important to identify the functional limitations caused by spasticity, including weakness or increased activation of the agonist muscles, with or without co-contraction of antagonist muscles. The primary goals in treating spasticity with orthoses include reducing tone, increasing or maintaining range of motion, and preventing the breakdown of skin, such as the breakdown that can develop on the palm of the hand when the fist is continuously clenched. A variety of orthotic devices are available, including recently developed orthoses that provide not only correct positioning, but also deep pressure and warmth to the tissue.

The way that a particular orthoses is "named" is based upon the part of the body on which it is used. For example, an ankle-foot orthosis may be used on the lower leg, and a wrist-hand orthosis is used on the lower arm. In addition, orthoses are described by their intended biomechanical function and whether they are dynamic (which, by virtue of their moving parts, allow movement) or static (meaning that they keep the body part in a fixed position). Finally, orthoses can be designed that include features that either allow for assisted movement, such as incorporating springs, rubber bands, or coils, or that restrict movement. Variable orthoses have a mechanism to adjust control of the function, and others have the ability to "hold" or fix the position with use of a lock.

Serial inhibitory casting involves the gradual stretching of a limb to provide "stress relaxation" to the muscle, thereby increasing the range of motion and preventing contracture or relieving a contracture that has already developed. A temporary hard cast is placed on the affected arm or leg so that it is 5 degrees less than the maximum range that can be achieved without triggering spasticity. The cast is removed every three to five days, the limb is stretched slightly further, and then another cast is applied. This process is continued until maximum positioning of the joint is achieved. At that time, a different type of cast may be constructed that can be removed as needed. This is called a clamshell, or bivalve, cast. Constant watchfulness is required with the use of casts to prevent rubbing or the breakdown of skin and pressure sores.

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