Bracing: Critical to Neuro Recovery
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- čas přidán 30. 06. 2024
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Your info has really helped me recover post stroke. From not being able to walk or use my arm at all to now playing pick up basketball with my 12 year old nephew. I wanted to give up and go to a nursing home in the beginning but I kept fighting after watching all your videos that gave me inspiration and hope. I work hard everyday. I appreciate everything you do for us stroke survivors and I'm always looking forward to your next video. I can't wait to share my recovery story with all the stroke survivors.
Hi Tyson! Thank you for sharing your story! I am so glad you are continuing to fight and win!!! I know that others will be inspired by this!
Please, how long did you have a stroke? And how long have been doing exercise ( which ones); so you can from no walking to pịck up a ball...my husband got a stroke 3 & a haft already, but he has walked back yet.. appreciate.
Inspirng😅
Thank you for this inspiration!!!💞
Pls tell us more about ur life with strobe Tyson I think like u nursing home ready to give up led hand no movement or can do anything bearly can walk help me out Tyson tepp lo l me more on ur recovery back to hand movements and walker great help god bless u hugs and blessings
Never seen someone have ever explained/Teaching at this level.full of knowledge video.
I am thankful to doctor and the whole team behind this channel, really appreciate guys you are doing a great job helping people around the Globe.
My 10 years old son suffering from post strock side effects and these videos will help me alot to treat him in better shape.
Lots of love from Pakistan 🙏
Happy Holidays Dr. Tobias to you and Family. And thanks for all you do. God bless
Thank you for your generosity in sharing with us!
I have an appointment tomorrow with an Orthotist to try an AFO again, last time the calf spasticity wouldn’t allow it, my heel lifted right out of my shoe. Fingers crossed!
I appreciate the info and the series on braces. I know you often mention braces in videos, so it’s good to hear a more in-depth discussion. Thanks!
Just dropping a note you are real awesome Dr. Tara Tobias! Thank you so much.❤
Loved your energy in this video!!!! I`m excited going forward!!!
Thank you very much for your help today as usual the info was most helpful Was considering a Swedish knee cage , only because my custom afo was creating a sore on the rear of my calf but after your excellent overview of afo, I realize now that I need to perhaps get a new afo and start wearing it again! I probably do not need the knee cage. Because of the rampant covid ,I do not leave the house for therapist and I am told that I do not qualify for therapy at home. I have purchased most of the items for home therapy that you have recommended, including the mat table that is very good. Your assessment of ssaebo complete at least for me, I have several items for my arm that I can not don myself and my last therapist was not familiar with this brace.I live in a small town In Illinois, and unfair the therapist are not very experienced. So thank you again for your help. Always excellent advice. You are the Wonder Woman of rehab.
I find that toe spacers have helped my toe spacisity greatly. It helps keep my toes from tightening when I step
Thank you for this video! I’ve been using off the shelf foot drop straps as a stubborn attempt to avoid further limiting my choice of footwear. Your explanation of the type of movement patterns that would benefit from an articulated AFO fits me to a T. I’m slowly coming to terms with my MS and still hide it from many people but I realize I’m only inhibiting myself by not using the right assistive tool.
Thanks for sharing Veronica! Many of my patients with MS share a similar feeling regarding bracing. Generally speaking, bracing does not have to be black and white. Maybe you only wear it when you are walking longer distances and continue to use the foot drop strap at work and/or when you want to be more "discrete" 😊 Remember, this can just be one tool in an entire tool kit. I hope that helps!
I am very impressed with your presentation and information.
I have CMT and am using a noodle on my right foot and after a hip fix I’m thinking I’m going to need a left one. I really appreciated your going through all the over the counter ones as I think you saved me a lot of money. I have bilateral drop foot ,knee and ankle pronation as well. Will be looking into orthotics and braces. Not looking forward to wearing them but no-choice if I want to keep walking.
Loved this video!!!! Finally I understood what I really have to look for
Merry Christmas to you snd your family doc
Your videos are really motivating . Also , give us hope that yes , we can improve. We will get fit and fine soon .
Merry Christmas ! And thank you
Thanks for sharing this video, 👍. Very true
great informations, thank you !
I have a brace similar to the Saebo stretching bracelet, I use it occasionally because it is difficult to put on because of the spasticity of the hand, but it helps me because of the position of the raised wrist because it reduces my spasticity. Thanks for the explanations. Merry Christmas.
Thank you. Very informative.
Thank you Tara Tobias for all videoes helping us all hope you have a good Christmas with family and friends
Hi Carol! Same to you 😊
Fantastic video...I put my AFO away years ago-thinking that it would not help because of my inability to walk (due to weakness).
I am doing the exercises you have taught and will certainly use my AFO going forward.
You are a true blessing!
Merry Christmas to you and your family!
Hi Kathy! Thanks for watching and for sharing your story. Merry Christmas to you as well!!
Your information has really helped my mother's recovery, I was able to get a customized afo brace for after going back and forth with her Physician. Thank you!
Hello Doc Tibia. Happy Christmas and a happy new year
Dr. T, the device you mentioned at 18:01 is the SaeboReach (the upper arm piece) & the SaeboFlex (the forearm/hand piece). The SaeboStretch is a resting splint (shaped similarly to the SaeboFlex albeit, it's not dynamic (aka functional). After my second TBI, the Reach, Flex, & the Stretch were recommended for me, yet I had (and still have severe spasticity which has only been somewhat managed with Botox). The first few years of using the Reach & Flex in conjunction were semi-productive; I could feel the muscles of the arm being worked, yet not anymore after 12-13 years of trying to use them. The last time I used my Flex, (you're right it's hard to get on & not comfortable to wear anymore) only the index finger & thumb moved in a pinching motion instead of all 5 fingers & over the years, I was CONSTANTLY taking these in to address fitting issues as well as functionality issues. While Saebo adverts considerable recovery with these, in my experience, using just these alone won't cut it. The best that can be said of my recovery (so far) is that I can extend the elbow of my own volition, yet while I don't have a club fist anymore, I'd hardly consider my affected hand/arm functional. Perhaps using a bunch of the biofeedback devices (Saebo Stim mini, Saebo Mirror Box, etc.) will yield better results. So, I think I'd have to agree with your assessment. Caveat emptor.
Thank you so much doc..
You are So helpful.
Tank you. This was helpful!
Thank you! I feel lost when it comes to bracing. Especially like hearing your opinion that OTC AFO’s do not help with a spastic ankle/foot. I can now say that with confidence! (I hate for someone to spend money on something that doesn’t benefit them.)
Thanks doc!
Very timely video for me. My left leg foot drop needs mechanical help!
I agree with most everything you say here, but the Saebo glove is and has improved the function of my fingers drastically. The muscles that close the fingers worked fine, but the muscles to open the fingers didn’t move. Wearing the glove and repeatedly as you say picking up and releasing items is helping to get those muscle groups to fire together again. And I can put it on myself without issue.
Scott Marsh
You're right about The Walking aid with spasticity it's bad. I used it for a year or bad foot drop and it cramped my muscles up even more in my calf. Watch all these videos tonight see if I can't figure something out that you're recommended. Thank you
I was on ecmo 5 weeks flat on my back. I was in the hospital for close to 100 days. Yes flat on my back. Rehab for 1 month. I cannot balance or walk. I have zero control over feet ankles I have foot drop. No one is helping me so I bought afo's off of Amazon. I had buckled knees but it's much much better. I'm going to start some of these exercises.
Agreed, Saebo glove is extremely difficult to get it on. My wife can close her fingers but has no active movement to open them. Only wore this glove twice.
Billies footwear is an amazing company for prope who need to use AFO’s or can only use one hand/arm to put. They can accommodate getting to different sizes and they can look part spiffy too.
thats a lot of info and good on you too stand up to a few tools. I chatted to some people that got saebo gloves saying just that. There is probably a really small window where they would work, like a lot of tools. But often people probably try it too early and try to battle spasticity with it. Desperation and lack of info does make people easy targets, willing to buy anything that will magically solve things.
Thank you for another fantastic and informative video. I really appreciate you sharing your thoughts on these aftermarket off the shelf braces. I have a custom as articulating AFO from Hanger clinic. It works well for me, I just wish I could get to the place I can walk without it.. I'm wondering if you have any thoughts on the products from Flint Rehab?
Hi Fred! Thanks for sharing more of your story related to this issue of bracing! Flint rehab has tons of products. Many of which I am not familiar with.
My ankle and leg spasticity decreases considerably when I wear insoles that support my high arch. I wish PTs would offer this tip to patients. A podriast finally brought it up 2 years after my stroke and it has made a world of difference. I use the pinnacle max support insole.
Good..Thank you mam 💞
I wear a ‘off the shelf’ AFO on my left lower leg; but for me the only reason now is to have something that I can grab onto with my right hand to be able to pull my lower leg backwards when sitting. It does nothing to help me with walking;I can flex the quads(straighten the left leg, but currently cannot bend the left leg backwards at the knee; unless I grab the AFO part just below my knee.
I just posted a few of your videos on a group I'm involved with sohopefully you'll have a lot of new visitors coming
Your videos are excellent! I always hear foot drop and pointing down of the foot mine claws up don"t know if that fits in the same category. Have been to 12 doctors and each one points to spine and others point to foot. Seeing a nuro muscular doctor next but very frustrated and confused and in a lot of pain. Thanks
Sigh because of you I wear my AFO a couple of days a week. But I'm scared to use on stairs, driving or walking long distances. It makes my left leg uninvolved leg hurt - overcompensation.
I’ve had plantar fasciitis and seems to feel heavy at times. And they gave it to me 24 years later.
Your videos are very helpful. I don’t have a problem with my foot dropping or pointing. I do have a problem with my ankle rotating in. Is my AFO helpful to correct this?
🏆🏆🏆👍🇺🇲🙏
Merry Christmas
🎅🤶❄️🎁⛄🎄
Thank you for sharing
Dr have you ever heard of the Turbo Med Extern
AFO . I have used this afo for 4 years now and it works very well . This brace it sits out side the shoe which doesn't irritate the foot. The Turbo Med also has a strap to help with the foot rolling out. I may try this as I have a little bit of a roll out thank for your posts very informative
I'm thinking about getting turbomed classic. How happy are you with the brace?
Hey Tara! Thank you so mich for all of your videos & information! You have givin me sooo many answers and UNDERSTAND of myself!! So Thank you for that!!
My question would be could i have both drop foot and spasticity? I have ms had to re-learn to walk. I hyperextend both knees, worse in the left. Could i have both drop foot and spasticity?
GREAT TOPIC DR. TOBIAS but can you explain to us the difference between, NEURO FATIGUE, and regular fatigue?
4yrs post hemorrhagic stroke, im 56yo, i never got back what alot of others did, it wasnt for lack of therapy either, its aweful to suffer with no independence
I'm at a point where my leg knee is strengthening greatly. I wear a swedish knee cage with a knee height AFO but knee has grown much stronger and I would like to lower the AFO for strengthening the weak ham string and quad. The AFO seems to push the knee in a hyperextened position inadvertently.
I’m having a problem with my AFO chafing my foot. It use to fit perfectly, I didn’t have a problems with it. But now, it’s rubbing on my foot. It rubbed the skin off making it bleed. Now my foot is sore to walk on. I did some research about it and it’s something to do with my tendons
will a custom brace break the skin or create pressure soars in the skin? My mother is currently not walking and the PT said the brace could do that so they won't get her a brace.
I have flop foot, I've had nerve conduction test and a brain/spine scan. All normal so no known cause!
I’ve been a full time grocery delivery driver for a while and my issue turned into something worse this month. My right leg will circumduct and toes point down due to spasticity and I can’t stop dragging and swinging out until I stop or sit down. I hope meds will help, because it sounds like the braces are supposed to stay on all day. I just wish I was walking how I was last month.😕😣
I have a lot of trouble putting on my AFO myself and getting it into my shoe. It also limits my foot movement. Maybe this is its intent but at times it’s a significant limitation.
is something like a knee cage permanent? or are there exercises to get rid of that need?
Ration e stem devices, what are some good exercises using testem for spastic hand/anrm and foot?
Can u combine custom and off the shelf?.....
They made me a custom afo due to foot coming inward and combined it with a knee stabilizer to keep the knee from subluxation back and giving out forward.
I love my afo definitely but I wish he would have given me the one that goes in front of the shin too instead of stabilizer. Is there a shin piece that I can combine to replace the bulky/hot knee stabilizer?
That blue hand splint is not the saebo stretch, (The stretch is a night splint for the hand to keep it flat), it's the saeboflex. The SaeboFlex is not intended to be used throughout the day or functionally. It is only for exercise/retraining purposes - you follow a specific saebo program of grasp and release that you do with the guidance of an OT. It is for people with little to no hand extension, so you definitely need someone to help. I did the saebo flex when I couldn't open my hand at all, could not grab anything and it was great at helping my brain retrain itself. I have taken a break from it doing other OT exercises but might continue with the saeboglove (also has a designed program for it) since I now have active movement in my hand (Which is what its for -for someone who has movement). I would highly recommend the flex if you can't open your hand...but it is very intense... did 200-400 reps of grasp and release a day.
you are correct. Thanks for correcting the names on the Saebo products.
What do you think is best brace for the spasticity arm and wrist. Please help!!
I had a massive stroke three yesterday ago to my Right side of Brain. I guess a bleeder. This affected my left side. I learned to do many things on my own except walk. I depend on a Healthcare with a Rehab. I Only get therapy when Medicare let's me. I try to a lot of Therapy on my own, but it gets me nowhere. My knee still buckles and now my foot is pointing inward which making things worse. The facility has Resortive program, but the Nurses are always busy, so I get frustrated. I only have a AFO that works with my ankle. Would an AFO up to the knee be better?
I'm trying to find the brand you would recommend in a swedish knee cage? I'm currently using a walker, but hoping the knee cage can possibly help me walk without a walker possibly.
The amazing thing if I think it’s your vibrary sometimes we come up with our own therapies that are therapists and rehab never thought of like with my case I suffered from left side neglect so one things I learned to do when I came home was actually played chess on my Tablet and the Chinese tile game Mahjong because that would trade me to remember I had to look to my left defined the matches and also worked on my memory remembering where the offset matching price was
Yes! The BEST exercises are the ones you come up with. First, they have more meaning. Second they are more enjoyable. Third, it forces someone to gain more understanding about the problem they are trying to solve :) Thanks for sharing your "go-to exercises"!
I've tried the Saebo glove. I would not recommend it if you have opening hand issues. Fingers are hard to extend to put on the brace and rubber bands one-handed aren't easy to use unless you have consistent help, such as a therapist. hard to use at home on your own. May I ask, my hand is relaxed at night so I'm not bracing however I have challenges during the day with the index finger extension and thumb turning inward, both while I pick up coins or brush my teeth. Are the finger and thumb related in movement?
Thanks for sharing your experience! This will help others in making their decision :)
I wear AFO's but I still have A LOT of valgus in my right knee, is their any type of AFO and is their a certain angle to put the AFO in? The KAFO would not be functional for me to put them on independently. When I was a kid I wore HKAFO braces. I have spastic CP. I live completely independently. I currently have an awesome PT and orthopedic surgeon. I am very motivated to stay as independent as long as possible!
Is there a method of bracing or splinting for toes? I have severe spasticity in my left foot ( I’m almost 4 years post stroke) this causes my toes to curl very tightly and point down and in. I stretch but it doesn’t help for very long.
Question for you: my mom had a massive stroke in May of 2020. My question is she has a involuntary Co in down and to the side. Her left side is the week side. They're doing RNA therapy. Here's my true question what can my mom used on that feet to make it right again. Not involently droop to the side or have control have control of her feet. Right now she said it's still nursing and facility and I want to for her to speed it up a little bit and have usage of her feet and her left side. Would a a f o help her? Right now they have for her feet heel protectors the heavy one and keeps her feet up straight
Tara are You planning to do some vid. in the Pool ? Generally exercise in the Hydro Pool ? or only on the Dry Land ?
Hi Simon! I am not a huge fan of the pool - post stroke. Do to the buoyancy, you do not get good Weight bearing on the legs which can interfere and/or worsen spasticity. Additionally - in my opinion - the buoyancy also suppresses appropriate balance response reactions, and creates a proprioceptive awareness that does not transfer well to dry land. That being said, I have not incorporated aquatics into a rehab plan in nearly 15 years so take what I say with a grain of salt.
Dr. Tobias, I have a MS diagnosis. I have foot drop and a hyperextended knee, with a weak hamstring. I do swing my leg out because my hamstring is weak and my knee is straight. I use a AFO, can I also use the Swedish knee cage simultaneously?
This is an excellent question! Generally speaking, I would start with adjusting the AFO. There are certain adjustments including a different joint at the articulation can help prevent the knee hyperextension. If that does not work, than yes, I have several patients who need to use both.
@@rehabhqofficial thank you for responding.
Dr, my left leg is going straight. Shape of my leg is changing. Please suggest what kind of brace i should go in for
i have tried googling where to buy articulated AFO. any suggestions. have spastic ankle
Hello Dr, I want to consult for one of my family member. Please suggest the way forward. I am from India.
Would an articulated AFO be suitable for foot that rolls. I am hoping to progress to an articulated AFO . Your views would be appreciated
My "Hanger" PT. Could not find the sweet spot (Muscle activation) for Bio-ness or Walk-aide for my Footdrop. We even tried marking my leg to line up the electrodes to fire. I wear an AFO now and a Saebo "Over the counter" for Footdrop.
Dr. T. What do you recommend I do? 5 years out from a ischemic stroke my Rt. side is affected.
That is a common problems with the walk aide and the bioness. In this case, I typically do not recommend it :)
I wish I had old school Forrest Gump braces. I endure so much instability that it is hard for me to re-engage normal movement and proprioception av be muscle memory.
But I'm in a constant state of fear and over compensating.
I dream of forest gump polio braces - originally used to support weak bodies as they grew stronger after polio.
Hi- I went to see my orthotist today and the braces he recommended for me were the sprystep or turbomed extern. He also thinks I’m a good candidate for the walk aid device. I’m so confused on what to do..help!
Hi Dr Tobias. I have used the Saebo Reach for the last year, and my OT and I attribute much of my increased range of motion and movement in my affect arm to it. You're not just supposed to wear it, your supposed to practice and retrain the neuro pathways/muscles. I'm fortunate to be able to put it on myself, though it took some getting used to the process. In my anecdotal experience it has provided benefits well beyond the $650 cost, and I still use it to this day. I think of all the things I've used and spent money on over the last 2 years, it's one of the very few that was worth the money.
Thanks for your input!
Don’t be so hard on yourself. Take a moment, sit back and reflect on your life, at the grief that softened you, at the heartache that wisened you, at the suffering that strengthened you. Despite everything you still grow, be proud of that. Acknowledge every quiet, small, unseen act of courage, that brought you to now. The gradual reopening of your heart after it was broken, the awakening into a difficult but necessary healing....and the moving away from self doubt
How do I stop limping and walk normally after wearing a Swedish knee brace for months after a stroke and covid? Please help me with this. Thank you
I have a stiff leg with knee not bending easily and is without good control. Using several gaits when walking with left foot swinging out. I have had a brain injury that I am aware of. I don't know whst happened except that I had an ankle break diagnoses incorrectly in 2004 and was given a boot and did not have surgery for 4 months for complete break in 2 places. Was put in cast then. I think I fall in foot drop, neuro damage symptoms. My orthopedic foot specialists does not have answer. My left foot was pronated slightly as a child but after break it became severe. What kind of doctor should use. Limited in Shreveport LA.
you haven't talked about the xturn afo??
Yep good but a KAFO with a C-Brace works for SCI patients!
I have not seen much of your vidio s but I like the idea I had an mva where I lost anterior tibialis tendon so I had drop foot syndrome and then they did ttc fusion which left me with equinus deformity so have difficulty walking so can you help me thank you
There is something called neuroswing afos what do you think about it for slight spastestic foot ?
Thanks Tara.So glad I found your channel.
Where can I get an AFO?
Hi Dr. Tara,
I am wearing my 3rd AFO and my foot is supinating causing falls. In addition, I have pain in my hip and lower back. Any suggestions would be appreciated.
Hi Taylor! My suggestion is find a new orthotist. There are several components of an AFO that can be adjusted correct the foot issue. And yes, if the foot is left to supinate, in some cases, it can cause hip and low back pain.
@@rehabhqofficial Thank you so much for responding.
do you know any physio therapist like you in toronto
Will braces help with late onset hereditary spastic paraplegia?
I can take un assisted steps, but its not consistent yet
Hi, Doctor
I would like to request you to please answer this question,
My 10 years old Son having ADEM and now he's going through the pos ADEM side effects, like he's not able to walk, he's not able to speak, even he can't sit by himself without any support.
As we are doing treatment and he's taking medication, but still we need your assistance to understand which rehabilitation process or exercise can improve his walking possiblity and speaking issues.
Your response will be appreciated.
Thank you
Thank you for your response! ADEM is so different for each person and really requires an entire multidisciplinary team to create the best plan for your son. Generally speaking, it is best to make sure he is getting out of bed everyday and sitting in chair (with assistance), and passive range of motion exercises for all his joints (a parent or caregiver is moving his arms and legs). Also, that he has a good therapy team around him to make sure he is standing everyday (with a standing frame and/or other equipment) and working on improving his overall mobility, speech, and functional independence. I hope that helps!
@@rehabhqofficial Thank you so much dear,
We will start this practice and I hope it will help.
The one of most worried thing about him that he is not able to handle his Head.
Appreciate your response 😊
My AFO is something like medal
I have dystonia in my foot, and I wear a brace but it doesn’t really help as it doesn’t stop my foot pulling down.
Hi Sam! Thanks for sharing your story! Dystonia and bracing is tricky and it takes a ton of patience trying different things before you find something that works.
@@rehabhqofficial what sort of brace would you recommend. I do have the allard Toeoff 2 and walk on Trimable
i was taken off my custom AFO. because of calf muscle atrophy.
What about smart step foot brance.. can I use for feet tendon stifnees??
I do not think that brace is rigid enough if you have spasticity. I hope that helps!
I want to consult with you and start the treatment from you but I am not able to contact you and not getting response to your phone number on the website
Also not getting response for my online submitted inquiry.
How can I contact you please help me..!
I use neuro ifrah😊
is involuntary movement the same as spasticity or abnormal synergy movement the same as an abnormal involuntary movement?
Hi Reynaldo. This is an excellent question! Spasticity and an abnormal synergy pattern or two different things. In most cases after a stroke someone will present with both. Spasticity is specific to one muscle group whereas an abnormal synergy pattern is where groups of muscles link up abnormally. I hope that answers your question
Hello ma'am, I have cidp, can you please put video about physiotherapy for cidp disease
Thanks for watching and for sharing! Generally speaking, anything I have about foot drop would be a good place to start. Also, generally speaking, the carbon brace typically works better than a heavy plastic brace for CIDP. I hope that helps!
Hi,I got stroke my right body in month I can walk slowly but still week vain is alive but still shaking when I walk and my foot also
when would an articulated AFO be unsuitable if at all?
There are some situations where a solid AFO is better. It is best to work with a PT and an orthotist together.
I have just discovered the xtern AFO from turbomed. I tested on the other day and it felt pretty awesome. I’ve been wearing them for 36 yrs. Check them out