Excerpt from the
Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors©
Orthotics is the use of braces and splints (orthoses) to biomechanically assist in supporting and stabilizing parts of the body affected by paralyzed and/or weak muscles (Bunch, 1985). Orthotics, grouped by a description of the area in which they provide support, are usually divided into three categories: lower extremity, upper extremity, and spinal. For example, in lower extremity orthotics, foot orthoses (FO) support and align the foot. Knee orthoses (KO) protect and support the knee joint. An orthotic device designed to support the whole lower extremity is called a knee-ankle-foot orthosis (KAFO). Upper extremity and spinal orthotics have similar classifications.
Increased pain, tripping, falling, dropping objects, and muscle loss are an alert to problems in the joints and muscles of the extremities (Redford, 1980). Many polio survivors who discarded their braces in earlier years, through therapy and sheer will, are in need of support once again. Bracing of joints and muscle groups can reduce pain; can prevent tripping and falling; may prevent further development of a joint deformity; and may conserve energy by making activities, such as walking, more efficient.
Communication among the polio survivor, the referring physician, and the orthotist is imperative to design the best possible brace. Today's braces are often constructed of lightweight plastics and metals with fixed (locked) and/or free (movable) joints, not of leather and steel. The referring physician prescribes the general type of orthosis, including core components such as fixed or movable joints, or metal or plastic fabrication. The physician also includes the diagnosis and the functional goals of the orthosis. The orthotist fabricates a design based on the prescription, including information from a gait analysis and information about the individual's home, work status, and physical activities.
In general, one must have a physician's prescription to be reimbursed for orthoses by any insurance company, including Medicare and Medicaid. Most states do not have certification laws for practicing orthotists, but many are certified by professional trade organizations after a minimum of two years of study and training.
Having to use a brace should not be viewed as defeat, but as making a lifestyle change that will provide added stability and safer, more efficient, and less painful mobility, thus enhancing continued independence.