What is an orthosis?

The term orthosis contains the ancient Greek word “ortho”, which can be translated as “upright”. Orthoses are medical aids used to bring extremities or the trunk into an “upright” position that have been weakened or altered by an illness.

Paralysis (paresis) or increased muscle tension (spasticity) can lead to instability of the feet, legs, hands, neck and trunk, each of which requires an orthosis for support. A simple translation for the word orthosis is the term “orthopaedic splint”. This term already makes it clear that orthoses aim to stabilize and maintain weakened or spastic regions of the body.

In ALS, a foot lifter orthosis (peroneal orthosis) is most commonly used to compensate for the weakness of the foot lifter muscles and reduce the gait impairment caused by a “drop foot”. Other orthoses are used to stabilize the position of the head in the event of weakness of the cervical muscles (cervical orthosis). Weakness or spasticity of the hand muscles can lead to the development of hand flexor contractures (“claw hand”), which can be prevented by a positioning orthosis of the forearm and hands. Weakness of the back muscles can lead to trunk instability, which in turn leads to the need for a trunk orthosis.

In principle, orthoses must be ordered and prescribed by a doctor and are reimbursable by health insurance. Orthoses are produced, fitted and tested in orthopaedic workshops and specialized medical supply stores. Individual adaptation to the patient’s body and treatment objective is crucial for the acceptance and usability of the orthosis. In the case of orthoses, a distinction must be made between prefabricated medical products (delivery of a prefabricated product from an orthosis manufacturer and fitting by the medical supply retailer on site) and customized products (usually based on a plaster cast of the limb or other individual body measurements). The selection, manufacture and fitting of orthoses (especially in the case of custom-made products) requires a high level of experience and skill on the part of the medical supply retailer providing the product.

Within the medical supply store, qualified orthopaedic technicians are entrusted with the provision of orthoses. It is advantageous if the respective medical supply stores have experience in the care of ALS patients in order to take the individual progression of the disease into account when making orthoses. The challenge with a progressive disease such as ALS is to estimate the future progression of muscle weakness and spasticity and to “plan for” this when making the orthosis. This is to prevent an orthosis from no longer being suitable (due to the progression of the disease) when the aid is delivered. Due to the special demands placed on the supply of orthoses, it is advantageous to make use of specialized medical supply stores in the ambulance partner supply network.