COVER STORY
Need To Know: • The past 20 years have brought a number of advances to the field of lower-limb orthotics, and clinicians are finding new ways to improve the quality of life for patients who previously could not benefit from bracing. • One small but significant group of patients who could benefit are those who have inclusion-body myositis (IBM), a progressive disease with no cure that slowly weakens muscles and leads to decreased motor function and increased morbidity. Some clinicians are fitting them with lightweight orthoses—primarily stance control knee-ankle-foot orthoses (SCOs)—to help prevent trips and falls and prolong safe ambulation. • As physiatrists have gotten more involved in the management of myositis, the value of orthotic intervention for some patients is becoming clear. People are becoming aware that there may be a means to stabilize their lower extremities to increase ambulation. • Research on the efficacy of orthotic intervention for progressive myopathies is still in its infancy, however. One expert hypothesizes that the severity of the disease will determine which SCOs will be most beneficial for different patient populations. • Keen evaluation skills are important. Clinicians need to measure range of motion and muscle strength, assess center of mass, and use gait observation. For component selection, it is important to match the component performance to the physical limitations of the patient. • While bracing will not be effective or recommended for every patient with IBM, orthotists should strive to become more educated about the disease and be aware of how orthotic intervention may help patients in the early stages.
T
HE PAST 20 YEARS have brought
a number of advances to the field of lower-limb orthotics, including new materials, such as carbon fiber composites, and increased tensile strength and energy-storing capabilities. These advances have led to the development and manufacturing of advanced, but lightweight, components that have been used to improve stability and increase ambulation for several types of patients. As these orthoses become more commonplace, and more readily reimbursed, clinicians are finding new ways to improve the quality of life for patients who previously could not benefit from bracing. Patients who have inclusion-body myositis (IBM) are one small, but
significant, group that may benefit from these advances. IBM is “the most common myopathy in adults over the age of 50 years,” says Rahila Ansari, MD, MS, an assistant professor of neurology and neuromuscular subspecialist at Case Western University and the Department of Veterans Affairs. For patients with IBM, weakness is slowly progressive and leads to decreased motor function and increased morbidity. Weakness initially affects the quadriceps, and due to the role of the quadriceps in knee stabilization during foot strike, a weakened quadriceps results in falls. As the disease progresses, weakness also is noted in the finger flexors and ankle dorsiflexors; eventually, most skeletal muscles are affected. O&P ALMANAC | JANUARY 2016
21