Who can benefit from a Neuro Biomechanical Assessment?
Biomechanical changes in walking commonly occur as a result of a number of neurological conditions which alter the way in which the way body functions. Our Orthotists at our biomechanics and orthotics clinic in Hamilton, near Glasgow in Scotland have specialist knowledge in the management of these conditions, and can provide assessment and knowledge on how orthotics can assist with:
Various neurological conditions can have a dramatic effect on how the nervous system effects normal biomechanics.
The reason for this is that the signals from the brain are either interrupted or are altered in some way, which in turn has an effect on muscle control during movement or walking.
The altered biomechanics can have an effect on gait and leaves some people struggling to walk safely or efficiently. A neurological biomechanical assessment, looks specifically at this area and how to restore a biomechanical pattern which is safer and more efficient.
Following a stroke the movements of the body can be affected often on one side in particular (hemiplegia). The issues for patients following stroke are often related to increased tone or spaticity of the muscles meaning it can be difficult t control movements of the body.
In particular the arm and leg can be affected where the arm tends to be bent at the elbow and wrist and pulled up toward the body. The leg often in walking tends to have difficulty as the foot points downwards (foot drop) due to spasticity. Normal biomechanics is lost as the foot cannot clear the ground when swinging through, and when weightbearing, the forefoot make contact first and the knee leans back (knee hyperextension).
Ankle foot orthotics (AFO's) are designed to re-position the foot in both swing and stance phase, helpi
ng the foot move in a more controlled fashion. It is important that the Orthotist has a good understanding of biomechanics and that custom made ankle foot orthotics are used to control the biomechanics very precisely.
Cerebal Palsy refers to a group of conditions which present in children at or around birth. In general terms the issues can be similar to a stroke however can present in a greater variety of different ways. Movement of the legs and arms can be affected and often spasticity or increased tone is also present.
The big difference between CP and stroke is that children with cerebral palsy have the added complication of growth and development coupled with managing spasticity.
The same biomechanical issues are present as in stroke but the Orthotist, must also consider the effect of growth which further complicates the orthotic management. Any Orthotist needs to have a good understanding of child development, before treating patients.
Ankle foot orthotics (AFO's) and Dynamic AFO's (DAFO's) are used in a variety of different ways to treat and help improve movement and prevent deformity particualrly as children grow.
Polio often causes flaccid paralysis and as such often muscle wekaness is present. The most common issues are foot drop, and knee control are the main issues for orthotics. Ankle foot orthotics (AFO) and Knee ankle foot orthotics (KAFO's) are often used to allow patients with the affects of polio to walk about more easily.
Like polio, flaccid paralysis is usually presnt to a greater or lesser degree dependant on the level of the spine affected. The other difference is that sensation of the limbs are likely to be compromised meaning any orthotics must be an excellent fit on the leg to help facilitate walking with orthotics.
What happens at an assessment
Much of the general biomechanical assessment, detailed below, is relevant within assessing patients with neurological conditions. The big differences are related to changes in muscle tone that take place with many of these conditions. Increased tone (spasticity) or flaccid paralysis often causes problems with movement and an understanding of this is required to understand the primary reason for any altered biomechanics.
Defining the Problem
The most important part of the biomechanical assessment is listening to the patient to understand the problem. It is vital that we understand the issue you have come to see us about from your persective.
Often other clincians are keen to give patients their view of the problem when really they are not the person living with it. Instead we need to hear it from your side to understand how your problem impacts on you.
We take a history of the current and previous issues you may have as well as a full medical history to inform what may be important factors to consider before starting our assessment. Equally, we need to understand what the patient is expecting from us.
Static Alignment & Range of Motion
Once we have have taken a history we assess your body alignment including, your feet/ankles. legs, knees, hips, spine and shoulders usually standing to check for any alignment issues. We then also assess the alignment and movement of your joints when moved (passive and active movement) to check against normal limits.
Any signs of potential alignment issues, muscle weakness or imbalances are recorded and discussed with you as the assessment takes place.
Sometimes it easier if you bring shorts or leggings, however it is not always necessary dependant on where your issues are
Dynamic Alignment & Video Gait Analysis
Sometimes the problem you have with the way you walk (your gait) is not always obvious to the human eye. This is why after the assessment of your alignment we look to see what happens when you move.
This in essence a way of confirming our findings from the static aligment and range of movement assesment. your gait is analysed using video gait analysis equipment to allow us to look in more detail at exactly what happens when you walk or run.
Often with biomechanical issues you will see compensatory movements or "trick" movements that your body adopts (without you being aware of it) to try to overcome your underlying problem. Video gait analysis as part of the assessment helps identify these.
Patient Feedback, Diagnosis & Prescription
The final part of the process is feeding back the findings of the biomechanical assessment through slow motion video gait analysis and the assessment findings.
A full and honest view of the possible treatment we can offer you, or alternatively we will advise on the possibility of us referring you to other members of our team for treatment.
For any orthotics/insoles that we may prescribe we make these on site and discuss your options as to how these may may be made to best fit your needs.