Orthotic devices after stroke and other non-progressive brain lesions

Abstract

BACKGROUND Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking. OBJECTIVES To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions. SEARCH STRATEGY In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field. SELECTION CRITERIA We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. MAIN RESULTS We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials. AUTHORS' CONCLUSIONS A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.