Brain Injury Orthotics in London
Brain injury covers an unusually wide range of presentations. A traumatic injury from a road collision, a fall or an assault, and an acquired injury from a bleed, an infection or a period without oxygen, can all leave very different patterns of movement difficulty behind them.
Our consultant orthotists assess adults and children after brain injury at four London clinics, and are experienced in working within rehabilitation teams and case managed packages of care.
How Brain Injury Affects Movement
The physical consequences relevant to orthotic care commonly include:
- Weakness or paralysis, which may affect one side, both legs, or a less predictable distribution
- Spasticity and raised tone, sometimes severe enough to hold a limb in a fixed position
- Poor coordination and difficulty placing a limb accurately
- Impaired balance, with a raised risk of falls
- Contracture developing where a joint has been held in one position for a prolonged period
- Altered sensation, so pressure and discomfort may not be reported reliably
Alongside these sit cognitive, communication and behavioural changes, and those matter for orthotics more than people expect.
Why Brain Injury Orthotics Needs a Different Approach
A device is only as good as the wearing of it. Where memory, attention, insight or communication are affected, the simplest workable design usually beats the most technically sophisticated one. Straightforward fastenings, an obvious right way round and a device that is comfortable enough not to be removed all carry real weight.
Family members, carers and support workers are often the people putting the device on and checking the skin underneath it, so they need to be part of the fitting appointment rather than briefed afterwards.
Fatigue and reduced tolerance also mean assessments sometimes need to be paced differently, and we plan for that.
Spasticity, Tone and Timing
Tone after brain injury is rarely static. It can change with position, effort, temperature, discomfort and time since injury, and it responds to treatments delivered elsewhere in the team.
Where botulinum toxin injections or a course of serial casting are planned, the timing of orthotic provision matters. Fitting a device immediately before an intervention that will change limb position risks producing something that no longer fits. We will ask what else is scheduled and coordinate with the team accordingly.
What Happens at Your Assessment
Assessment covers joint range, tone, muscle activity, skin integrity, sitting and standing posture, and walking where that is applicable. Where walking is not yet the goal, the focus shifts towards positioning, comfort, protecting range of movement and making handling easier for those providing care.
We will want to understand the rehabilitation goals already agreed with the wider team, so that what we prescribe supports them rather than pulling in a different direction.
Orthoses Used After Brain Injury
- Ankle foot orthoses across the full range of designs, from rigid through hinged to dynamic, according to how much control is required
- Ground reaction ankle foot orthoses, where knee control is limited during stance
- Knee ankle foot orthoses, where support is needed across the knee, ankle and the foot
- Wrist and hand orthoses , used for positioning, skin protection, comfort and in some cases functional assistance
- Head and neck orthoses, where head control or neck position needs support
- Spinal bracing, where trunk posture requires support
- Custom footwear and insoles, to accommodate deformities, manage pressure or pain and improve fit
Skin Integrity and Tolerance
Where sensation is reduced or where someone cannot easily report discomfort, skin checking becomes a shared responsibility rather than something left to the person wearing the device. Redness that does not settle, any break in the skin and any change in how a device is being tolerated all need acting on quickly.
We cover this in detail at fitting with whoever will be involved day to day, and set a wearing schedule that builds up gradually rather than starting at full time. Where tolerance is limited, a device that is worn for shorter periods reliably is worth more than one that is abandoned after a week.
Case Managed and Medico-legal Clients
A significant proportion of our brain injury work comes through case managers and solicitors. We understand what is needed in that setting, including comprehensive written assessments, clear clinical reasoning behind each recommendation and documentation that stands up to scrutiny.
We integrate into existing multidisciplinary teams and can offer travel arrangements where attending a clinic is impractical.
Common Questions
How soon after an injury should orthotics be considered?
There is no single answer. Early input often focuses on positioning and maintaining range, while later input tends to focus on walking and function. The right timing is best judged alongside the rehabilitation team.
Can you help if walking is not currently realistic?
Yes. Positioning, comfort, protecting joint range and making care easier are all valid orthotic goals in their own right.
What if the injury was a long time ago?
Assessment remains worthwhile. Needs change over years, and devices provided during early rehabilitation are frequently no longer the right ones.
Do you provide reports for case managers and solicitors?
Yes. Detailed written assessment and recommendation reports are a routine part of this work.
Can you see someone at home or in a rehabilitation unit?
Travel options are available for case managed clients. Please contact us to discuss what is possible in your situation.