The need for multidisciplinary team

The need for multidisciplinary team
(MDT) working is anecdotally evident in
the management of stroke. NICE (2013)
guidelines recommend that the core
stroke team should comprise of consultant
physicians, nurses, physiotherapists,
occupational therapists, speech and language
therapists, clinical psychologists,
rehabilitation assistants and social workers.
In addition to this core team,
patients should have access to other
health professionals as required, including
orthotists.
The need for the MDT and the
inclusion of orthotists in stroke
rehabilitation teams is noted in the best
practice statement (Bowers, 2009), which
also states that AFO use should be
considered as soon as the patient is
medically stable. NICE (2013) guidelines
also state that once orthotic intervention
has been decided on, regular MDT and
patient/family discussions should be
arranged to ensure a holistic approach is
taken. NICE (2013) also recommends
that the goals of treatment should be
clearly recorded in the patient’s notes.
None of the studies regarding upper
limb treatment looked into MDT
working specifically; however, the
aforementioned evidence indicates that
orthotic management requires treatment
by an MDT with a focus on joint
position following inpatient discharge.
The use of the orthosis, including time
worn, specific donning/doffing
instructions with clear guidance and the
need for the orthosis must be
documented thoroughly in the patient
notes with the orthotist’s contact details.
It is valuable for orthotists to ensure that
all nursing staff are familiar with the
type of orthosis provided and highlight
any new styles/features which could
Carbon fibre AFOs A lightweight prefabricated
alternative to other
off-the-shelf AFOs
• Isolated
dorsiflexor
weakness
• Patient require
lightweight
orthosis
• High tone
• Contractures
• Jobs which involve
kneeling etc
• Heavy users—
most
have weight limitations
• High price compared
wiyh other
pre-fabricated AFOs
Can be pre-fabricated or custom-made
Drop foot splint with
ankle wrap
Lightweight option
that uses strong
elastic to pull the
foot up
Isolated
dorsiflexor
weakness
• High tone
• Severe medio-lateral
instability
• Uncontrolled oedema
• Poor skin integrity
Stock product in a range of sizes available
from Blatchford Clinical Services and Ossur
30 BJNN/Stroke Association/European Stroke Organisation Supplement April 2015
© 2015 MA Healthcare Ltd
prevent the orthosis being used and thus
compromise patient improvement.