Orthoses and ambulation in hemiplegia: a ten year retrospective study

Of the patients with hemiplegia who had undergone active rehabilitation at the Institute of Rehabilitation Medicine (IRM), New York University Medical Center, from the years 1968 through 1977, 843 were reviewed for functional ambulatory status on admission and at discharge, type of orthotic devices used, time elapsed from onset to admission for rehabilitation, and length of stay at IRM, to determine whether a consistent change had occurred in prescribing lower extremity orthoses for patients with hemiplegia, and if so, to assess the impact of such changes on the ambulation status. Of the 843 patients reviewed, 773 (91%) were partial or nonambulators on admission. Of these, 62% of the nonambulators and 66% of the partial ambulators improved significantly. A consistent decline in the use of metal orthoses, especially of long-leg orthoses, together with an increase in the use of plastic-knee ankle-foot orthoses was demonstrated. A 20% decline in prescription of lower extremity orthoses of all kinds was also observed. The rate of neuromuscular return as mwasured by attainment of functional gait has remained stable, and the proportion of numbers of patients attaining functional gait also was unchanged.