What is a stroke?

A stroke (also apoplexy; cerebral infarction) is an acute circulatory disorder of the arteries that supply the brain with blood. Worldwide, strokes are considered the second most common cause of death. The causes are manifold; the main risk factors include high blood pressure, atrial fibrillation, diabetes mellitus, obesity and nicotine consumption. The risk of suffering a stroke increases enormously with age, and men are affected more frequently than women.

Two forms of stroke are distinguished:

Ischemic stroke: This is the most common form of stroke. Due to a circulatory disturbance, individual areas of the brain are undersupplied. This leads to the death of cells and the destruction of subsequent tissue.

Hemorrhagic stroke: This involves acute cerebral hemorrhage. The most common cause is long-standing high blood pressure, which leads to vascular wall changes in the arteries in the brain and thus to bursting or rupture. The escaping blood increases the intracranial pressure and the tissue is not supplied with sufficient oxygen.

What are the symptoms of a stroke?

The symptoms are manifold, depending on the affected supply area of an artery in the brain, they can vary in severity. A stroke is characterized by sudden onset of neurological deficits. These include, for example, hemiplegia, numbness, speech disorders, word-finding disorders, visual disturbances, impaired consciousness, gait and balance disorders and states of confusion. But more non-specific symptoms such as severe headaches, dizziness, epileptic seizures and vomiting can also be signs of a stroke.

How is a stroke treated?

Stroke is a medical emergency and must be treated immediately. Because the tissue in the brain is sensitive, treatment options are limited to a few hours after the onset of symptoms. A computed tomography scan helps to distinguish between an ischemic and a hemorrhagic stroke. After that, the goal is to halt the progression of tissue loss in the brain. The blood clot blocking a vessel can either be dissolved by medication or removed mechanically with a catheter. Brain hemorrhages sometimes require surgery and/or monitoring in an intensive care unit.

What are the consequences of a stroke?

Depending on the severity and timing of treatment, symptoms may regress or remain permanent. The spectrum of persistent impairments ranges from minor fine motor disorders to complete paralysis of the legs and/or arms. For those affected and their relatives, a stroke is a drastic experience that often leads to a complete change of life. In order to restore physical functions such as balance, stance and gait as well as movement sequences as best as possible, the earliest possible rehabilitation is required. This is intended to help patients either relearn lost functions or find ways to cope with an existing restriction. In addition to regular physiotherapy and occupational therapy, orthoses are used to improve the gait pattern and thus counteract falls and malpositions.

Why is an orthosis useful after a stroke?

Orthoses are regularly used in patients who have had a stroke with permanent limitations. Often a so-called foot lift weakness occurs, i.e. the inability to pull the tip of the foot towards the body. However, this movement is crucial for a safe and fluent gait. Affected persons often get stuck with the tip of their foot and stumble. To compensate for the paralysis and lift the leg completely, a compensatory movement is made in the hip. As a result, poor posture occurs, which leads to back pain and other complaints.

The fitting of an orthosis helps affected persons to train walking and standing and thus to regain more independence and mobility. It is advantageous to use the orthosis as early as possible to prevent consequential damage and malpositions in good time.

What is the mode of action of an orthosis?

An orthosis is professionally fitted and adapted to the individual needs of the person affected. Complementary to continuous physiotherapy, it supports people who have suffered a stroke and have difficulty walking and standing.

This form of orthosis primarily involves the ankle and foot and works on multiple levels:

  • The paralyzed calf muscles are actively supported to gain more security when standing and walking
  • The paralyzed shin muscles are actively supported to prevent falls due to stumbling
  • Various spring units help to support and stabilize the balance
  • Walking becomes less strenuous because the focus is no longer on each individual step

Whether an orthosis makes sense is discussed in a detailed consultation. Therapists, doctors and orthopedic mechanics are the appropriate contacts for selecting the right aids and working out individual solutions.

Conclusion: An orthosis improves the gait pattern after a stroke

A custom-made orthosis helps sufferers feel more secure on their feet again after a stroke. This is crucial to avoid falls and to regain self-confidence.

Especially in combination with consistent physiotherapy, it is often possible to walk and stand safely again after a stroke. The greater safety provided by wearing an orthosis helps those affected to have more confidence in everyday life.

Therapists, doctors and orthopedic technicians are the appropriate contacts for selecting the right aids. After all, it is an individual situation that requires appropriate solutions. The goal is that walking is less strenuous because the entire attention is no longer on each individual step.

[1]        Daryabor, A., Arazpour, M., Aminian, G., 2018. Effect of different designs of ankle-foot orthoses on gait in patients with stroke: A systematic review. Gait Posture 62, 268–279. https://doi.org/10.1016/j.gaitpost.2018.03.026

[2]        de Paula, G.V., da Silva, T.R., de Souza, J.T., Luvizutto, G.J., Bazan, S.G.Z., Modolo, G.P., Winckler, F.C., de Oliveira Antunes, L.C., Martin, L.C., da Costa, R.D.M., Bazan, R., 2019. Effect of ankle-foot orthosis on functional mobility and dynamic balance of patients after stroke. Medicine (Baltimore) 98, e17317. https://doi.org/10.1097/MD.0000000000017317

[3]        Katan, M., Luft, A., 2018. Global Burden of Stroke. Semin Neurol 38, 208–211. https://doi.org/10.1055/s-0038-1649503

[4]        Saini, V., Guada, L., Yavagal, D.R., 2021. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology 97, S6–S16. https://doi.org/10.1212/WNL.0000000000012781

[5]        Unnithan, A.K.A., M Das, J., Mehta, P., 2022. Hemorrhagic Stroke, in: StatPearls. StatPearls Publishing, Treasure Island (FL).

[6]        Winstein, C.J., Stein, J., Arena, R., Bates, B., Cherney, L.R., Cramer, S.C., Deruyter, F., Eng, J.J., Fisher, B., Harvey, R.L., Lang, C.E., MacKay-Lyons, M., Ottenbacher, K.J., Pugh, S., Reeves, M.J., Richards, L.G., Stiers, W., Zorowitz, R.D., American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research, 2016. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 47, e98–e169. https://doi.org/10.1161/STR.0000000000000098

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