Orthotic Solutions For MS And ALS Patients In Texas

Multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) are related neuromuscular diseases that afflict patients with progressive muscle weakness in the lower extremities, accompanied by coordination and balance challenges. While the progression of the two disorders is distinctly different, both produce mobility challenges that can be ameliorated with focused orthotic support.

MS affects an estimated 2.5 million people worldwide. Diagnosis usually occurs between ages 20 and 50, more often in women. In MS, the body’s own immune cells attack the nervous system causing inflammation, which damages the myelin protective sheath surrounding nerve cells. This process disrupts brain communication to the body, resulting in muscle deterioration. Other MS symptoms include memory and cognitive problems, extreme fatigue, numbness and tremors.

ALS is a progressive disorder that attacks nerve cells in the brain and spinal cord controlling voluntary muscle movement. As these neurons waste away, they can no longer transmit signals to actuate the muscles they normally control. ALS typically strikes between ages 40 and 60, more often in men. Besides weakness in the legs and arms, initial symptoms include twitching and speech, swallowing and writing difficulty. As the disease progresses, chest muscles atrophy as well, ultimately resulting in respiratory failure.

While MS and ALS have many common features, they are different in one important respect: Though multiple sclerosis is chronic and incurable, life expectancy can be normal or near normal. With assistive devices, many MS patients continue to walk and function at work with minimal disability for 20 or more years. By comparison, the ALS path of progression is continual and straight; life expectancy is typically three-to-five years, although 25 percent of patients live longer than five years after diagnosis.

Because lower-extremity muscle weakness manifesting in drop foot is common to ALS and MS patients, orthotic support is frequently prescribed in both instances to stabilize the foot and provide a safer and more efficient gait.

In drop foot the leg muscles are unable to achieve reliable forefoot ground clearance; tripping and falling are common. Patients may try to compensate with an exaggerated high-stepping gait pattern, which is both awkward and tiring. An orthotic device, generally some form of ankle-foot orthosis (AFO), provides a much superior solution.

Orthotic Treatment Options

Posterior leaf spring AFO — In general, our approach with any orthosis is to provide the lightest and least-complex device that will get the job done. In the early stages of MS and ALS, that objective is generally best delivered by a custom-molded posterior leaf spring AFO, a simple L-shaped brace that provides necessary support primarily behind the ankle and under the foot and adds a degree of dorsiflexion assist. Width and thickness are customized to reflect the strength and weight of the patient. With its thin profile and light weight, this AFO enjoys a high level of patient acceptance.

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Articulated AFO — This design, featuring medial and lateral hinge joints closely aligned with the anatomical ankle joint and trimlines encompassing the sides of the leg as well as the back, provides added support for patients demonstrating drop foot along with medial and/or lateral instability. The articulated AFO can also help control knee hyperextension resulting from quadriceps weakness. The disadvantage of the this design is that it is more bulky and difficult to conceal, an important consideration for some patients

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Solid-Ankle AFO — This rigid construction promotes stability in all planes by preventing both dorsiflexion and plantar flexion. It is an appropriate choice when ankle motion must be controlled, as in the presence of ankle or knee instability or when ankle spasticity requires counter-resistance. Addition of an anterior panel creates a floor reaction during weight-bearing to apply an effective knee extension moment, providing added safety for patients with advanced muscle weakness. With its bulk and rigidity, the solid-ankle design is the least-tolerated AFO among this patient population.

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KAFO — When controlling the entire leg is required, a knee-ankle-foot orthosis can be applied. This long leg brace effectively prevents knee hyperextension by maintaining close contact both below and above the knee. A knee locking mechanism can be included as needed for added stability.

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FES Systems — In recent years, a non-traditional approach to controlling drop foot and limited knee hyperextension has emerged, which can benefit early stage MS and ALS patients. Functional electrical stimulation devices such as the WalkAide and the Bioness L300 direct electrical current to the peroneal nerve to trigger ankle dorsiflexor contraction timed to the gait cycle. FES devices are not widely approved for insurance reimbursement at this time.

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Orthotic prescription for MS and ALS patients begins with an individualized gait assessment followed by careful measurements and/or casting for creating the most intimate, effective orthosis possible. While we realize both diseases are progressive in nature and likely will require heavier and more technically rigorous orthoses down the road, we also understand that “bracing for the future” will only hasten the need for those more advanced devices. Therefore, we generally design AFOs to reflect existing and near-future conditions and anticipated needs.

Over time, MS and ALS patients tend to receive several braces of varying degrees of support and control, giving them a choice based on their planned activities and how they feel on a given day. MS patients in particular have good days and bad days, making the availability of different levels of orthotic support a true advantage.

For additional information about orthotic management for MS and ALS patients and the different types of AFOs, we invite you to call our office. We are located in Beaumont, Nederland and Jasper, Texas.