August 2018

CMT Patients Experience Improved Gait, Balance with AFO Usage

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Use of orthoses can help improve the gait and balance of patients with Charcot-Marie-Tooth (CMT) disease, but patients don’t always follow recommendations for their use, a review study has found. The study, “The Role of Orthotic Service in Modern Rehabilitation of Patients with Charcot-Marie-Tooth Disease,” was published in the July issue of Journal of Biosciences and Medicine.

Researchers analyzed current literature to determine the effectiveness of orthotic management in habilitation of CMT patients. Several studies found that orthotic usage was associated with an improvement across various domains including walking balance and performance, preventing the foot from falling and reducing the frequency of tripping, and improvement in restoring bone-joint interactions. However, some studies did not find any association between orthoses and improvement in patients, indicating the need for further research.

Next, researchers investigated the influence of orthotic usage on balance and gait, two issues linked to severe impairment in CMT patients. One study indicated that the use of orthoses was associated with increased gait velocity, particularly in patients who wore polypropylene and silicone orthoses. Another study found that wearing AFOs led to improved balance and gait performance, particularly when the orthoses compensate for specific muscle deficits. Additionally, these researchers found that AFOs help reduce both foot drop and compensatory movements while walking for this patient population. The authors concluded that the orthotic usage is associated with improving gait and balance in CMT patients.

Researchers also investigated adherence to orthoses and found that patient compliance was low. In one study, only 5 out of 25 patients who received recommendations to use orthoses actually used them. And 3 of those 5 people “hated” them.

The studies would appear to suggest that noncompliance stems from inadequate education by the physician. When meeting with patients, it is important for the physician to help patients gain an understanding of orthoses and form adequate expectations of their use. The authors also discussed the need to identify which orthoses are best for patients at different stages of their disease. Another issue is the availability of orthoses in different countries. Patients in some countries don’t have access to orthoses, and many don’t even know about their use. However, the authors wrote, “the situation is changing for the better” as more specialized internet resources are being developed to provide information for these patients.

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