1
Q
Definition of Orthosis
A
A static or dynamic EXTERNALLY APPLIED DEVICE
2
Q
What are orthosis used for?
A
(IMPROVE FUNCTION!!)
- prevent deformity
- Correct deformity
- support segment for WB = Unload
- Assist movement, facilitate movement, limit movement
- Decrease pain or discomfort
- Improve posture/ alignment
- Immobilize
- Provide feedback
- Improve cosmesis
3
Q
Indications for orthoses
A
- Impaired (posture, muscle performance, joint mobility, motor function, sensory integrity, peripheral nerve integrity, integumentary integrity)
- Acute conditions. (Trauma, post-surgery)
- Chronic conditions (Musculoskeletal, neuromuscular)
- Prophylactic
- No age or practice limitation
4
Q
What does brace orthosis
A
Resists or directs force
5
Q
Two types of orthosis
A
Brace or splint
6
Q
What does a splint do?
A
Maintained or attains a position
7
Q
How are orthoses named?
A
By body part/ joint encompassing
8
Q
What are prefabricated also called and what are they used for?
A
Custom- fitted
- mid-mod joint involvement
- temp use
- diagnostic procedure
- do NOT fit or function as well as custom made
9
Q
Custom made orthosis
A
- mod-severe joint involvement
- extended or permanent use
- Give individual fit & max function
- MORE pricey
10
Q
Material used for orthoses
A
-Thermoplastic, metals , carbon fiber
11
Q
Thermoplastic
A
-Light weight, easy to clean, total contact (distributes pressure over larger area), can wear different shoes w/ plastic
12
Q
What does total contact provide in orthoses
A
Distributes pressure over large area
13
Q
Metals for orthoses
A
- Steel, aluminum, titanium
- stronger
- SOme heavier; bulkier
- more maintenance; oil joint
- limited shoe wear
14
Q
Carbon fiber orthoses
A
Greater elasticity
Lighter
15
Q
Principles of design (6)
A
- distribute pressure (p= f/a)
- Length of force arm (think resistance)
- Control ground reaction force (GRF)
- Control degrees of freedom
- 3 point pressure
- 4 point pressure
16
Q
when the control ground force is in front of the knee….
A
knee ext
17
Q
when the control ground force is behind the knee….
A
knee flex
18
Q
why would you want to control degree of freedom ?
A
its allows the brain to focus on a smaller amount of motion . (brace controls virus/valgus in knee; brain worries about flex/ext)
19
Q
why is it common for functional knee braces to be 4 point pressure
A
so that there is no pressure on the patella
20
Q
orthotic solution for gene recurvatum
A
- 3 point system/ manipulate GRF
- usually done with AFO to prevent PF
- Swedish knee cage also used to prevent knee ext
21
Q
3 point pressure systems using concave/ convex?
A
2 points on concave
1 point on convex
22
Q
How would you set up a WC with a 3 point pressure system to reverse decorticate posturing ?
A
Tilt in space WC
-butt, back, gravity
23
Q
foot lifts
A
correct limb length discrepancies
- SI disfunction
- Opposite limb of KAFO to help make clearing orthoses easier
24
Q
Heel lifts
A
reduce achilles tendon stress (achilles tendinitis)
25
Heel cups
Redistribute fat pad to improve shock absorption
| -Heel spurs & plantar fasciitis
26
foot orthoses arch supports
rigid pes planus
27
rigid and semirigid corrective foot orthotics normalize?
abnormal subtalar and tarsal-metatarsal joint mechanics
28
example of AO
aircast
- controls talocrural joint
- accommodates swelling
29
examples of AFO
swedeO (fabric)
sure step
langer total control
30
CAM walker
- immobilizes ankle joint
- no unloading of distal structures
- rocker bottom
- Removable and adjusts to volume changes
- accommodates swelling
31
articulated AFO can allow for
energy conservation
| -springs allow for a more continuous gait
32
what are parts for articulated AFO?
DF/PF stops, dual channel (springs and stoppers)
33
AFO with plastic in back helps with
controls PF. (knee hyper ext)
34
AFO with plastic in front help with
controlling DF (knee flex )
35
AFO with plastic in front controls?
tribal advancement and helps maintain knee ext during mid stance
36
what is important to note about knee immobilizers?
- the deg. on the flex/ext stop is rarely accurate.
| - important to educate pt. on proper donning (axis on joint line)
37
4 point pressure KO systems are ?
single axis or polycentric joints
38
4 point pressure KO systems are suppose to limit
- genu recurvatum
- anterior tibial translation
- varus/ valgus forces
- rotation ?
- Enhance proprioception (mostly)
39
Unloading knee brace use what to do what?
3 point pressure systems to redistribute WB
40
examples of when to use an unloading knee brace?
Genu valgum
genu varum
knee OA
41
what are neoprene sleve with buttress and T-strap orthosis used for?
altering patellar tracking
42
what are infra patellar straps used for?
decrease strain on patellar tendon by decreasing patella-patellar tendon angle
43
what are the different types of KAFO knee locks?
bail lock
drop lock
ratcheting locks
44
with a KAFO where is the weight bearing ?
through the ischium comparable to a quadrilateral TF prosthesis socket
-It unloads proximal tibia and femoral condyle
45
Extension assist KAFO, what does it do?
elastic webbing controls heel rise in MidSt and increases knee extension in TSw
46
with a stance control KAFO PF produces what force at the knee?
extension force
47
with a stance control KAFO DF does what at the knee?
releases the extension force
48
a stance control KAFO are helpful for?
fatiguing diseases like MS and CMT
49
why can stance control KAFO be problematic
hard/ heavy to swing leg to advance
| -when DF all weight is on the heel
50
Name a sequelae of stroke that would contraindicate a stance control AFO
Stroke or TBI where there is PF tone and cannot DF to unlock the knee
51
what type of pt would a HKAFO be good for?
CP or SCI but have to be very strong to be able to be able to hold self up and swing both leg forward
52
HpO are usually seen on
kids to maintain hip ABD
53
post op hip abduction orthosis are used for?
pt with dementia who will not follow precautions or challenging hip surgeries
54
LSHO limit?
hip adduction, flexion, and IR
55
hip spica (spika) LSHO are?
to immobilize the hip completely,
| not east to don/ doff
56
which LSHO orthoses controls forces at the hip most effectively ?
Hip Spica (spika)
57
which LSHO exert larger pressure at its edges?
post op hip ABD orthosis
58
what are RGO?
reciprocal gait orthoses (HKAFO)
| -ext, unload, spring forward
59
What are the pavlik harness used for?
- to treat reducible developmental hip dysplasia in children less than 6 months old
- draws femurs into flexion and abduction
60
what are the pavlik harness not appropriate for?
for fixed tetatologic islocations of the hip
61
what is the scottish rite brace used for
- weight bearing and hip abd.
| - W/B in abd improves development of femoral head
62
what disease uses the scottish rite? and what is the disease?
legg calve perthes disease
| -it is a degenerative disease of the hip causes osteopenia and necrosis of femoral head
63
what do splinting/casting for contractures prevention do?
long duration , low load passive stretch
64
what is an active splint for contracture prevention ?
dyna splint
| -good for synergies, hypertone, and spasticity
65
What is a passive adjustable splint for contracture prevention
RCAI
| -set an angle and it stays
66
what is a passive splint for contracture prevention ?
mult-podus boot
- Used alot for patient with low arousal.
- neutral alignment with DF and IR/ER.
- off loads the calcaneus
67
can cast be used for splinting to prevent contracture ?
yes. not commonly used. more often seen in inpatient
68
examples of post op shoes ?
- cast shoes (can be dangerous when ambulating)
| - wedge shoes (eliminates forefoot WB (forefoot offloading shoes)) good for diabetic patients with ulcer
69
how should you evaluate a patient for LE orthosis
- Evaluate in standing, w/o external support as appropriate
- Evaluate walking, w/o support if appropriate
- want to be able to see/visulizing AT LEAST feet, knees and ankles
- Viewing iliac crest and lumbar spine can also be helpful
- ANT, POST, LAT VIEWS!
70
what test should be performed when evaluating a pt for LE orthosis?
- MMT (k ext, PF/DF)
- ROM (K ext (0 deg)/flex, DF(0-5 deg))
- Sensation (protective, proprioception, kinesthesia, somatosensory) for balance
71
How to test proprioception for balance?
have patient close their eyes.
- If patient has good balance and then poor balance when eyes are closed they rely on eye sight for balance.
- for these patients an orthoses should not effect balance.
72
before providing a patient with an orthosis what should you do?
trial walking with a temporary interventions.
| -heel lifts, toe lifts straps, DF wraps or straps (use an ace bandage), off the shelf orthoses
73
What are some considerations for LE orthosis (6)
- check for slipping, alignment
- Evaluate donning/ doffing (independence/ caregiver)
- Pressure areas, skin care (skin may get red in beginning)
- Care giver education
- Monitor for wt loss or gain ( 10lb change orthosis/ 5 lb prosthesis)
- ROM
Prosthetics & Orthotics
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