Medical devices for stroke survivors - Homepage — Ottobock UK · 2017-09-19 · Medical devices for stroke survivors. 4 What happens during a stroke? ... of a stroke are paralysis

Information for end-users

Stepping forwardMedical devices for stroke survivors

4 What happens during a stroke?

6 What comes next?

8 Typical consequences of a stroke

Contents

Ottobock | Stepping forward 3

"It was always important for me to live independently and I'm grateful that now I can again."

Kathrin will never forget 29th January 2000. She was only 14 when she was overcome by a headache on the way to football training.

Then she felt nauseous. This was followed by a tingling feeling on the left side of her body. Her coach called an ambulance. The diagnosis: a stroke as a result of a tear in her carotid artery. Kathrin had three operations to remove a large part of the right half of her brain. Then she was in a coma for almost three weeks.

After that, rehabilitation began for Kathrin. Over the course of a year, Kathrin had to re-learn everything; she made progress and experienced repeated successes. Some problems with walking remained however, as a result of the stroke, as she could not lift her left foot properly. Doctors at Göttingen University Hospital recommended ActiGait. The neuroimplant considerably improved her ability to walk. Kathrin was mobile again and soon achieved her greatest wish: at 26, she was able to get a job, and today works in the office at a newspaper.

KathrinSuffered a stroke at age 14

4 Ottobock | Stepping forward

What happens during a stroke?

Most of those who suffer a stroke are over the age of 50. But younger people can be affected too, sometimes even children like Kathrin.

There are two main causes of a stroke: inadequate blood supply (ischaemia) and internal bleeding (haemorrhage). With ischaemia, the brain is not supplied with sufficient blood for a short period – this is the most frequent cause of a stroke. It is caused by a blood clot or calcification that blocks a blood vessel. A haemor-rhage occurs when a cerebral vessel tears and blood enters brain tissue. This puts pressure on the surrounding areas.

In both cases, the constant supply of blood to the brain is interrupted. Cells are no longer supplied with sufficient oxygen and nutrients. This causes damage to the brain so it is vital that treatment is delivered as soon as possible.

But even if treatment is given very quickly, two thirds of stroke survivors sustain some damage. The good news is that the brain is capable of regenerating. Slightly damaged cells can be partially, or in a best-case scenario, completely restored. With specific training, other healthy nerve cells can also assume their function. This is called neuroplasticity.


With the support of a good rehabilitation team you can make good progress. Some 70% of those who have suffered a stroke are able to live relatively indepen-dently three months later. Every step along the way is a small victory.

Three months after a stroke

• 25% of stroke survivors still cannot walk• 66% of stroke survivors have difficulty walking• 33% of stroke survivors can’t move their affected arm yet• 50% of stroke survivors have impaired dexterity


A stroke can change your life from one moment to the next. Your everyday routine changes, and suddenly your focus is relearning existing skills. The most common consequences of a stroke are paralysis on one side of the body and impaired sensation in the arms and legs. Then come speech, swallowing and vision problems. Perception and your sense of balance are often impaired.

If you have physical impairments, your rehabilitation team will advise you as to what medical devices are most suitable for you. Some can facilitate training in the early rehabilita-tion phase, while other devices help you return to your normal routine later on. Take control of your everyday life and rehabilitation and accept the help that’s on offer – from your rehabilitation team, family members or in the form of medical devices.

Rehabilitation and managing your daily routineMedical devices are designed to help you be more active, more independent in your daily life, and continue to develop dexterity and muscle strength. Many devices also relieve pain and protect against uncontrolled movement.

What happens next?

"Following a stroke, it’s important to work on becoming active again."

Daniel Gelbart, Commercial Manager, Orthotics & Neurorehabilitation, Ottobock UK

“It’s important that stroke survivors are fitted with the products best suited to their particular requirements – orthoses, products that provide functional electrical stimulation, or a wheelchair,” says Daniel Gelbart, Ottobock UK’s Commercial Manager for Orthotics and Neurorehabilitation. Daniel was an Orthotist and Orthopaedic Technician based in Switzerland before joining Ottobock in a number of international roles. “Our products enjoy a high level patient compliance because they fit well and are made of top quality materi-als,” he says. “This is essential, as stroke survivors’ symptoms can often be long-term.”

For me, getting out and about is the best form of rehabilitation!

Gerhard, 57

“We were skiing when the accident happened. My wife had already gone down into the valley with part of our family, whereas my sister-in-law and I were still on the slopes. All of a sudden, I fell. My sister-in-law tried to help me get up, but I couldn't. Then everything went black. The doctors later diagnosed a brain haemorrhage. I was taken to hospital and was in a kind of vegetative state for almost three months. When I woke up, I noticed that I was paralysed on my right side. At first, I could get around only with a wheelchair. I learned how to walk again in rehab, but I couldn’t lift my toes. The first time I wore MyGait, I was really surprised by the feeling. All of a sudden, I could move my foot properly again.”


Shoulder

Hand

Knee

Foot

Typical consequences of a stroke

Often one side of the body is completely or partially paralysed and has sensory deficits. The following medical devices were devel-oped especially for stroke patients. They help you train movement patterns and make everyday life easier for you.

Stroke patients typically experience impairment of mobility in the shoulder, hand, knee and foot.


When one shoulder is paralysed, it hangs lower than the opposite side. Often it rotates inwards and the arm is slightly flexed. The shoulder may even be partially dislocated. If this happens, you are in pain and your mobility is even more limited.

Omo Neurexaplus

The Omo Neurexaplus stabilises and supports your shoulder in a natural position. The arm is extended and rotated slightly outwards.

• Healthy shoulder

• Partially dislocated shoulder

Position the shoulderFor a natural posture

Benefits at a glance• Relieves pain• Stabilises the arm against stiffness (spasticity)• Improves posture• Has a positive effect on balance and gait• Facilitates gait training• Does not restrict arm movements• Soft, temperature-regulating material is pleasant to wear• Slim design for wearing under clothing• Easy to put on and take off


Support the hand For a better grip and to relieve the joint

When forearm function is impaired, the hand is also affected. The wrist joint and fingers may droop. These wrist supports secure your hand either in a certain position or hold it so that it is easier to use the fingers and grasp things.

The Manu Neurexa is a wrist support that enables you to grasp better. This helps you in occupa-tional therapy. Better positioning and posture of the hand can optimise existing grip strength.

The Manu Immobil Long ensures that your wrist and finger joints are immobilised. The orthosis is particularly useful at night when you wish to position your hand as painlessly as possible.

Manu Neurexa Manu Immobil Long

• Neutral position of the hand

• Drop hand

Benefits at a glance• Ensures a natural hand position• Promotes activity and restores awareness of your hand• Relieves pain• Soft, temperature-regulating material is pleasant to wear• Facilitates training of the hand and fingers in occupa-

tional therapy

Benefits at a glance• Immobilises hand and fingers• Breathable padding is comfortable to wear• Prevents pressure points and overlapping fingers• Easy to apply with the other hand• Individual adaptation is possible


When leg muscles are paralysed, you may perceive instability in your leg or knee. You unconsciously overextend your knee when you put weight on it. Hyperextension is intended to compensate for lost muscle

Benefits at a glance• Stabilises the knee and prevents hyperextension• Easily integrated into gait training• Promotes activity• Increases awareness of the leg• Repositions the knee cap (patella) to relieve pain• Prevents involuntary movements• Soft, temperature-regulating material is pleasant to wear

functionality and to secure the knee. However, this compensatory movement interferes with learning to walk naturally again.

Genu Neurexa

The Genu Neurexa knee orthosis prevents hyperextension of the knee joint. It supports your knee while allowing it to bend when walking.

• Hyperextended knee• Walking with a healthy knee

Guide the kneeSmoother movement


The goal is to move more smoothly. By avoid-ing compensatory movements such as hip hike, you put less strain on your body. You will notice that walking is less tiring because it requires less concentration.

For more information see: www.dropfoot.co.uk

• Walking with a healthy foot • Posture with drop foot

Lift the footLook straight ahead

Do you find it difficult to point your toes upwards, or to keep the sole of your foot parallel to the floor? Then you probably suffer from drop foot, which is commonly accompa-nies hemiplegia - paralysis of one side of the body - following a stroke. Drop foot prevents a safe, normal gait. When the leg is swung through, the foot is too close to the ground and you can easily trip. Stroke survivors with drop foot often “hike” or raise their hip on that side, to lift the foot off the floor. But this compensa-tory movement leads to further malposition that can cause back pain.A number of devices can prevent the toes from pointing downwards, while at the same time preventing the foot from twisting. Selecting one depends on what product your physical condition allows you to use. Please talk to your doctor, physiotherapist or orthotist. It is also important to be able to use the device comfortably.


Plastic AFOThe plastic ankle foot orthosis is particularly light-weight. It was developed for temporary use in the first phase of rehabilitation.

Ankle foot orthosis made of plastic Malleo Neurexapro

WalkOn® product rangeWalkOn orthoses are suitable for drop foot sufferers who want to be active. They facilitate walking on uneven ground and support climbing stairs and ramps. Carbon fibre makes these orthoses extremely durable yet lightweight. The padding is soft, and is made from a tempera-ture regulating material.

Benefits at a glance• In addition to lifting the foot,

it also supports the knee• High dynamic energy return

when walking

Benefits at a glance• For the treatment of

supination (i.e. when the foot turns inwards) with the onset of spasticity, or stiffness of the foot

Benefits at a glance• Suitable for temporary use

or for shorter distances

Benefits at a glance• Lifts the foot and stabilises

the ankle joint• Moderate dynamic energy

return when walking

WalkOn® and WalkOn® Trimable

Benefits at a glance• Allows flexibility in the ankle

and knee while also lifting the foot

• More pliable material than in the other orthoses of the product family

• Low dynamic energy return when walking

WalkOn® FlexWalkOn® Reaction and WalkOn® Reactionplus

Support the foot with Ankle Foot Orthoses (also called AFOs)AFOs support the leg muscles. They position the foot so that it can be lifted when walking.

Malleo Neurexapro

The Malleo Neurexapro is used to prevent the foot turning in (known as supination) caused by stiffness (spasticity).


Activate the foot with electrical stimulation

• MyGait

• ActiGait

Functional electrical stimulation (FES) allows those nerves that the central nervous system no longer controls, to be activated once again. The intensity of the electri-cal impulse is fine-tuned to each patient’s requirements and is delivered either exter-nally (MyGait) or via a partially-implanted device (ActiGait). Both systems activate the common peroneal nerve that is responsible for dorsiflexion, or lifting the foot.

The nerve sends the signal to the muscles in the lower leg, which then lifts the foot; a positive effect of this is that you are there-fore exercising your muscles. Certain condi-tions must be present for FES to be used, which must be determined by a qualified physiotherapist for each potential end-user.

Visit www.dropfoot.co.uk to find out more about FES to treat drop foot.


MyGait is a surface stimulator held in a cuff that fits around your calf. You wear a heel switch on the foot in a special inconspicuous sock that fits around your heel. Every time you take a step, the heel switch sends a wireless signal to the stimulator in the cuff. The stimulator then sends stimuli to the nerve and the foot is lifted at just the right time - in the swing-through phase of your gait cycle. The MyGait can even stimulate an additional muscle group, for example at the knee or hip. This provides additional support while walking.

ActiGait is a world first: the stimulator is implanted under the skin in an operation. Like the MyGait, a small heel switch in a special inconspicu-ous heel sock sends the signal needed to lift the foot. It transmits the signal to a control unit that you wear at your hip, for example on a belt. An antenna sends the signal to the implant and the nerve is activated. ActiGait can not only lift the foot, it can also partially correct the position of the foot when walking.

Patients report the following benefits• Gait becomes faster and smoother• Makes it possible to walk greater distances• Walking requires less concentration• Easy to put on with one hand• Second muscle group can be stimulated• Can be used from an early stage of rehabilitation

Patients report the following benefits• Gait becomes faster and smoother• Makes it possible to walk greater distances• Walking requires less concentration• Permanent solution, no daily application of a cuff required• Suitable for those who experience skin irritation as a result of surface stimulation

(e.g. with the MyGait)

MyGait ActiGait


In January 1998, Lida, then 33 years old and a single mother of two, suffered a devastating stroke. After five months in hospital, Lida returned home. But with a drop foot and unable to walk unaided, she found it difficult to get used to her new life. “I was fitted with a really large foot brace, so I had to wear a boot two sizes bigger than my normal shoes” she recalls.Lida was forced to give up her job as a property lawyer, and her parents, who had emigrated, returned to England to help look after her children. Then, in December 2011, Lida was invited to trial ActiGait FES implant.

“I was so excited, it was the answer I’d been waiting for,” she says. After having the implant surgically inserted into her thigh, Lida immediately became used to using AcitGait. She says, “at home it took about three seconds to switch on, and it stayed working appropriately every day. Since then I haven’t looked back, I can walk effortlessly. ActiGait became part of my life.” Lida has recently started a new job. She says: “I’m not back to how I was before, but that’s never going to happen, at least I’m back as close as I can be and I couldn’t really ask for more.”

Lida:Stroke at age 33


“I’m proud that I can live independently.”


Other mobility aidsMake everyday life easier

After a stroke or severe hemiplegia, other mobility aids can provide additional sup-port, particularly in the early phases of rehabilitation. The lightweight Start M3 Hemi has special features that make the daily lives of stroke survivors easier.

Benefits at a glance• Low seat to floor height facilitates propulsion with one foot• Wider foot room available for more freedom of

movement• Easy to operate with one-hand control and one-hand

activated wheel lock (optional)• Foldable to a convenient size• Multiple combination and equipment options

Options

• Channel forearm support

• One-hand operation

• Anti-tipper

Start M3 Hemi


Otto Bock Healthcare PLC 32 Parsonage Road, Englefield Green, Egham, Surrey TW20 0LD T +44 (0) 1784 744900 · F +44 (0) 1784 744901 [email protected] · www.ottobock.co.uk · www.dropfoot.co.uk

Please contact us if you have any further questions or would like more information.

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Medical devices for stroke survivors - Homepage — Ottobock UK · 2017-09-19 · Medical devices for stroke survivors. 4 What happens during a stroke? ... of a stroke are paralysis