Orthotics play an important role in inpatient rehabilitation by supporting movement, improving alignment and helping patients regain independence after an injury or illness. In inpatient rehabilitation, these devices are often used alongside physical and occupational therapy to restore mobility, improve safety and support long-term recovery. Understanding how orthotics work and who may benefit from them can help patients and caregivers feel more confident throughout the rehabilitation process.
How orthotics support rehabilitation and recovery
Whether used short term or long term, orthotics can help patients regain independence and improve quality of life during inpatient rehabilitation.
After an injury, illness or surgery, you or a loved one may have limited mobility. When that happens, limb correction and assistive devices can support mobility and independence.
Orthotics are supportive devices that improve limb function by assisting weakened muscles, accommodating abnormal movement patterns and correcting musculoskeletal alignment. They are commonly used to support feet, ankles, knees and spine. By helping the body move in safer and more efficient ways, orthotics can help alleviate pain or discomfort.
Who may benefit from orthotics after injury or illness
Orthotics can be helpful for people recovering from conditions that affect mobility and function. Conditions that may benefit from orthotics include:
- Diabetes
- Spinal cord injury
- Multiple sclerosis
- Brain injury
- Stroke
- Other complex disabilities
What are the types of orthotics?
There are several different types of orthotics available, depending on a patient’s needs, goals and diagnosis.
“There are several different types of orthotics available to assist patients,” said Corrine Fritcher, a physical therapist at Encompass Health Valley of the Sun Rehabilitation Hospital. “These range from diabetic shoes to custom inserts that a podiatrist may prescribe an individual with diabetes. These custom-made devices assist with multiple muscle groups to aid alignment and mobility. Even small improvements in alignment with an orthotic can lead to significant improvements in gait mobility.”
General categories of orthotics
Orthotics typically fall into two categories:
- Functional orthotics: Custom-made shoe inserts that support foot alignment and mobility
- Accommodative orthotics: Over-the-counter devices that support limb positioning and mobility
Lower-limb orthotics used in rehabilitation
Within these categories, different orthotics support different parts of the body affecting your mobility. They include:
- Ankle-foot orthotics: Addresses foot drop by supporting both the foot and ankle to help control the range of motion and the ankle joint
- Knee-ankle orthotics: Support lower extremity control (knee and ankle) by offloading pressure and helping individuals to move independently
- Hip-knee-ankle-foot orthotics: Support the hip, knee, ankle and foot for individuals with significant lower limb weakness or paralysis
“Ankle-foot orthotics are commonly prescribed to an individual following a central nerve injury such as a stroke or peripheral nerve injury — where a specific nerve has been damaged in an accident,” Fritcher said. “There are several custom-made and off-the-shelf ankle-foot orthotics that assist with lifting the foot correctly, allowing an individual to be able to take quality steps, return to walking safely and increase independence.”
Knee-ankle-foot and hip-knee-ankle-foot orthotics are more commonly used in individuals with incomplete spinal cord injury or neuromuscular diseases. These orthotic devices are prescribed and custom-made to optimize safe mobility.
Why orthotics matter in rehabilitation
After a serious illness or injury, your doctor may recommend inpatient rehabilitation to help you get back to everyday activities and live as independently as possible. If your mobility has been impacted, a physical therapist could recommend orthotics, which play a vital role in rehabilitation and recovery. Orthotics provide a range of benefits, including:
- Improving safety during transfers and ambulation
- Preventing further deterioration from disuse of muscles
- Supporting healing and tissue protection
- Improving mobility and independence
Orthotics can empower you to increase mobility and independence when used temporarily during inpatient rehabilitation or long term. Physical and occupational therapists will work together to train you in using the proper devices to help you regain as much mobility as possible.
Using orthotics as part of a rehabilitation care team
In inpatient rehabilitation, patients are supported by a care team that may include rehabilitation physicians, nurses, physical therapists, occupational therapists and case managers.
Your care team works together to:
- Evaluate your mobility and functional needs
- Determine whether orthotics may be helpful
- Ensure proper fit and comfort
- Train you and your caregivers on safe use
- Plan for continued care after discharge
Whether helping someone walk again after a stroke or supporting mobility for those with chronic conditions, orthotics can play a critical role in your care at an inpatient rehabilitation hospital.
What is dysphagia?
Like aphasia, it can be caused by neurological conditions such as brain injuries and stroke, but it also can stem from muscle disorders, certain cancers and blockages/strictures in the throat.
Depending on the cause, dysphagia can be temporary or long-term.
Conditions commonly associated with dysphagia include:
- Parkinson’s disease and multiple sclerosis
- Neck and throat cancers
- Late-stage Alzheimer’s disease and other dementias
- Cervical neck surgeries
Stages of dysphagia
There are three phases of swallowing that are impacted with dysphagia:
- Oral: This is the process of chewing food and mixing it with saliva to form a bolus in order for it to be moved from the front of the mouth to the back of the mouth. A person with dysphagia in this phase could have trouble breaking down the food enough to properly move it to the back of the mouth to trigger the swallowing reflex. This stage is also where tongue weakness or decreased sensation may impact the ability to clear food from the sides of the mouth causing it to pocket in the cheeks.
- Pharyngeal: This is where the swallowing reflex begins, and pharyngeal muscles push food down the throat to the esophagus. The epiglottis (a cartilage) inverts to protect the airway and sends the bolus towards the esophagus. This is when the upper esophageal sphincter opens to allow food to travel into the esophagus. A person with dysphagia in this phase might feel like the food is “entering the wrong pipe,” Delashaw said, because the muscles in the pharynx and/or larynx are not operating properly to prevent food or liquids from entering the airway.
- Esophageal: This is when the bolus is taken from the upper esophageal sphincter that has opened, allowing it to enter the esophagus. Peristalsis (muscle contractions) carries the bolus from the upper esophagus towards the stomach. In this phase, a person with dysphagia may feel like food is stuck in their throat or chest.
Symptoms of dysphagia
Dysphagia symptoms could include:
- Coughing or choking during or shortly after eating or drinking
- Heartburn or indigestion
- Feeling that food is stuck in the throat or chest
- Painful swallowing
- Regurgitation
- Food sitting in the mouth or being pocketed in the cheeks
- Unexplained weight loss
- Reduced desire to eat
Diagnosing dysphagia
Dysphagia is diagnosed by a healthcare provider. Speech-language pathologists diagnose dysphagia with a comprehensive oral exam and swallowing examination, which should include swallowing tests such as a FEES or MBS exam.
- FEES: FEES stands for fiberoptic endoscopic evaluation of swallowing. This is an exam where a speech-language pathologist inserts a small thin scope with a camera through the nose and allows visualization of the throat, larynx and vocal cords to assess swallow function as you eat and drink certain foods.
- MBS: During a modified barium swallow study, a speech-language pathologist will give you food and liquids covered in a small amount of barium. As you swallow, X-rays are performed to view your swallow in real-time.
Treatment of dysphagia
After a dysphagia diagnosis, a speech-language pathologist can help determine what consistency of food and liquids is safest to eliminate risk of choking or aspiration. They can also provide therapy and exercises to help strengthen the muscles used during the different stages of swallowing.
Treatment should always involve a discussion with the individual to determine their wishes regarding oral intake and development of dysphagia treatment.
“If difficulty is noted in the oral phase, we can design an exercise program to target movement for the muscles used when breaking down the food,” Delashaw said. “Say you had a stroke that impacted lip muscles, and you can’t hold food in your mouth. We’re going to work on increasing the control and strength of the lip muscles, so you do not lose liquids or foods out of the mouth.”
In addition to exercises, Delashaw said neuromuscular electrical stimulation could also be used to increase muscle awareness in the different stages of dysphagia.
In the esophageal stage, your speech-language pathologist could suggest obtaining a referral from your primary care doctor to a gastroenterologist for further evaluation.
Recovery from dysphagia
Depending on the diagnosis and related conditions, dysphagia could improve over time. If swallowing difficulty is related to a neurological condition, inpatient rehabilitation could help develop adaptive techniques and diet plans to meet your needs and quality of life standards.
The multidisciplinary approach in this setting also allows for other symptoms related to your condition to be addressed through intensive therapy. In addition to working with a speech-language pathologist, your therapy team would also include a physical therapist and occupational therapist to address mobility and strength as well as activities of daily living and quality of life.
