Overview of orthoses

Orthoses and braces are commonly used in rehabilitation, though somewhat less so than in years past. [This is due in part to cost cutting, limited clinical expertise, and reduced time in rehab.] There is also a general feeling among many users that orthoses are cumbersome and appear too bionic or “disabled” looking.

An orthosis might be used for positioning a hand, arm, or leg, or to magnify or enhance function. Orthoses can be as simple as a splint or as a complex as a functional electrical stimulation (FES) brace for ambulation in paraplegics.

Here are some of the types of orthoses available:

Wrist-hand orthosis

Wrist-hand orthosis (WHO) transfers force from an active wrist to paralyzed fingers. This offers a grasping function for those with cervical injuries (generally between C4-C7). The WHO, also called a tenodesis splint, has been modified and simplified over the years, sometimes with the addition of batteries for power.

Ankle-foot orthosis

Ankle-foot orthosis (AFO) is commonly used in people who have experienced strokes, multiple sclerosis, and incomplete spinal cord injury to assist the ankle and allow the foot to clear the ground during the swing phase of walking. Most models have a molded heel cup that extends behind the calf.

Knee-ankle-foot orthosis

Knee-ankle-foot orthosis (KAFO) allows someone living with paralysis (usually L3 and above) to stabilize the knee and ankle. While it can be very hard work, people using KAFOs, even those with no hip flexion, can take steps by swinging their legs while supported by forearm crutches. There are many types of KAFOs, including plastic and metal braces.

Reciprocating gait orthosis

Reciprocating gait orthosis (RGO), which originated in Canada for children with spina bifida, consist of a pair of KAFOs with solid ankles, locked knee joints, and legs and thigh straps. Each leg of the brace is attached to a pelvic unit with a hip joint, supporting hip flexion and extension. A steel cable assembly joins the two hip joints to limit step length.

By rotating the torso, the user shifts the weight to the forward leg; this permits the opposite leg to move forward. This kind of walking is stable and balanced, but slow and requires a great deal of energy. Clinicians have added FES to the RGO to assist walking.

Parastep

A parastep is a “neuroprothesis,” a device that affects both the structure of the body (as a brace) and the nervous system (to stimulate damaged nerves). It is a portable FES system that facilitates reciprocal walking by stimulating leg muscles on cue. The movement is a bit robotic, but independent and functional for short periods of time.

Most people with spinal cord injuries between T4 and T12 can use the Sigmedics Parastep, which requires a physical therapy regime of 32 training sessions. The device is covered by Medicare for qualified users.

Exoskeleton

Exoskeletons and the role they are playing in both the rehabilitative care and home life of people living with paralysis have become an important emerging technology. Essentially, exoskeletons are battery powered bionic legs with small motors on the joints.

In addition to offering psychological benefits (e.g., being able to look at another standing or walking person in the eye), there may be health benefits including better bone density and reduced pain. There is anecdotal evidence that robotic walking also helps bowel and bladder function.

Exoskeleton manufacturers

Over 300 Ekso Bionics robotic exoskeletons are in use in rehabilitation centers around the globe; their use must be supervised in a clinical setting. Ekso Robotic Exoskeletons are not currently approved for personal use in the United States.

The Hybrid Assistive Limb (HAL), developed by Japanese robot maker Cyberdyne, is one of the newer exoskeletons on the market designed exclusively for use in a clinical setting.

The ReWalk Personal System was the first exoskeleton device approved by the Food and Drug Administration (in 2014) for use in the home and in the community. According to the company, the ReWalk provides user-initiated mobility through the integration of a wearable brace support, a computer-based control system, and motion sensors.

ReWalk affords people living with paraplegia the opportunity to both stand and walk independently, but the cost can be prohibitive for some. A recent article claimed the price of owning one of these devices is close to $85,000.

Resources

If you are looking for more information on walking systems and braces or have a specific question, our Information Specialists are available Monday through Friday from 9:00 am to8:00 pm ET at 800-539-7309.

Additionally, the Reeve Foundation maintains walking systems and braces fact sheets with additional resources from trusted Reeve Foundation sources. Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.