Orthotics

Question 1

What is an orthosis?

Answer 1

• Used interchangeably with splints and braces
• A device that is applied to part of the body for the purpose of protecting that part or assisting in the restoration or improvement of function

Question 2

What are low-heat thermoplastic materials?

Answer 2

• A combination of elastic, plastics, and rubberlike components
• Used for splinting
• Softens in temperatures between 135-180
• Need to choose material based on purpose of splint and desired properties of material

Question 3

What is memory when referring to orthotic material?

Answer 3

• The degree to which the material is able to return to its original shape once molded and then reheated

Question 4

What does drapability/conformability mean when referring to orthotic material?

Answer 4

• The way the material conforms to the shape of the hand
• Materials with high drapability work best with gentle handling since they conform easily to the arches or bony prominences by just placing the material on the patient
• Requires light touch since it works well with gravity

Question 5

What is elastic or flexible orthosis material like?

Answer 5

• It has a springy feel
• The material stretches but springs back
• Can be more heavy handed when working with this material
• Less conformable but has memory

Question 6

What is bonding when referring to orthotic materials?

Answer 6

• Materials can coated or uncoated
• Coated materials will not stick to one another unless the coating is removed by scraping it off or using a bonding removal agent such as acetone
• Bonded materials are needed in order to make dynamic outriggers
• Uncoated materials will stick to itself. This can be good because it can save time but is a difficult material to work with when a new splinter

Question 7

What are performance characteristics of orthosis materials?

Answer 7

• Conformability
• Flexibility
• Durability
• Rigidity
• Perforations

Question 8

What can be made with minimum resistance orthosis material?

Answer 8

• Hand splints for tendon injuries
• Injury/area that requires low resistance to stretch
• However, small splints may require material with a higher resistance to stretch when splinting against gravity or for spasticity
• Polyform

Question 9

What can be made with moderate resistance orthosis material?

Answer 9

• Medium-sized splints and orthotics
• Hand splints, elbow splints, neck collar, knee splints
• Polyflex

Question 10

What can be made with maximum resistance orthosis material?

Answer 10

• Back braces, foot drop splints, leg braces, and spasticity splints
• Helps reduce tone
• Ezeform

Question 11

What are common tools needed when creating an orthosis?

Answer 11

• Super shears
• Nylon spatula: better than tongs
• Heat gun: good for bonding and fine tuning
• Curved scissors
• Strapping material: foam has some give/stretch
• Strap pads
• Hook material: with and without adhesive. Does not stretch

Question 12

What are static splints and what are they used for?

Answer 12

• A splint that is molded to the hand to maintain the tissue in one position
• No moveable parts
• Ex: resting hand splint, CMC static splint, ulnar gutter splint, anti-spasticity ball splint, thumb hole wrist cock-up splint (wrist neutral splint)
• Help relieve pain: helps drain edema and keeps extremity safe in anatomical position
• Helps maintain joint alignment
• Prevents adaptive shortening of soft tissue
• Corrects soft tissue contracture
• Immobilizes a joint or limb following trauma

Question 13

What is a resting hand splint?

Answer 13

• A static splint
• Used to treat RA, carpal tunnel syndrome, fractures, hand burns (modified into intrinsic plus position), tendonitis, hemiplegia
• MCP joints and skin are in a lengthened and stretched position
• 70-90 degrees of MCP flesion and IPs straight

Question 14

What are buddy straps?

Answer 14

• Used to protect injured finger by keeping affected and neighboring finger together
• Helps with mobility
• Can be used with finger dislocation and fracture
• Encourages flexion

Question 15

What are common liners that are used with orthotics?

Answer 15

• Fleecy Web/foam lining, Stockinette (helps absorb heat and can be washed), and Terry Foam

Question 16

What is a dynamic splint?

Answer 16

• Splint applies force and movement to joint(s)
• Must have three parts: a splint base, an outrigger, and a dynamic traction force
• Used to improve function and motion

Question 17

When are dynamic splints used?

Answer 17

• Can be substitute for lost muscle function
• Can assist weakened muscles
• Can correct deformity
• Can minimize adhesion formation
• Helps move affected areas earlier in recovery process

Question 18

What is a dorsal blocking splint?

Answer 18

• No longer used because contractures can result
• Was used for tendon injuries
• Provided dynamic traction for flexion tendon repairs

Question 19

What do static progressive splints do and when might they be used?

Answer 19

• They are similar to dynamic splints but there are no moveable components
• They apply low-load to joint while maintaining the tissue at its maximum length
• Worn for extended periods of time so that the tissues can adapt and “grow” to new length.
• Increase ROM and correct soft tissue contractures
• Serial static splints
• Ex: static progressive splints, static progressive finger flexion splint, static progressive finger extension splint, dynamic wrist splint. Phoenix Wrist Hinge,

Question 20

What are goals of splinting?

Answer 20

• To protect or support injured, weakened, or repaired joints and soft tissue
• To immobilize or restrict joint ROM. Ex: carpal tunnel syndrome, cubital tunnel syndrom, dequervain’s tenosnovitis
• To correct or prevent joint deformity. Ex: arthritic ulnar deviation
• To substitute for weak or absent muscle function. Ex: radial nerve splint
• To inhibit abnormal muscle tone. Ex: stroke
• To increase ROM. Ex: static progressive splints

Question 21

What are anatomical landmarks that are important to keep in mind when splinting?

Answer 21

• Creases of hand: splinting should clear the creases of mobile joints in order to allow full movement of joint
• Arches of the hand: custom made splints should maintain/support the arches of the hand. Arches maximize amount of surface contact with an object and enhances stability and increases sensory input
• Longitudinal arch: maintained by activity in the hand’s intrinsic muscles. Should be a flexible arch
• Proximal transverse arch: a stable bony arch that forms the posterior border of the carpal tunnel. Should be a rigid arch and located at the level of the carpometacarpal joints with the keystone being the capitate
• Distal transverse arch: formed by the metacarpal heads. Combination of “radial” stability and “ulnar” mobility. It should be a flexible arch at the level of the metacarpophalangeal joints with the keystone being the 2nd and 3rd metacarpals. The 1st, 4th, and 5th metacarpals rotate around the 2nd and 3rd metacarpals to either flatten or increase the arch

Question 22

What should be considered when making an orthotic?

Answer 22

• The normal axis of motion should be maintained
• Try not to splint unaffected joints
• When possible, allow contact of palmar surface of palm and digits with the environment to permit greater sensory discrimination

Question 23

What is the resting hand splint position?

Answer 23

• 10-20 degrees of wrist extension
• Neutral wrist
• Flexion and abduction of the thumb
• 15-20 degrees of MCP flexion

Question 24

Where should fingers point to when flexed?

Answer 24

• Towards the scaphoid bone

Question 25

Where should hooks be attached in order to obtain optimal leverage?

Answer 25

- Proximal and central aspect of the nail

Question 26

How can the strength of a material be increased?

Answer 26

- By adding contours to the material

Question 27

What is the rule of area of force when making orthotics?

Answer 27

- By increasing the area of force applied on skin, it will reduce the amount of pressure in area - Forearm trough should be 2/3 forearm length - Thumb or forearm troughs should 1/2 the circumference - Rolled edges reduce pressure

Question 28

What precautions should be taken with orthotics in order to reduce chances of injury?

Answer 28

- Round corners to avoid sharp points - Remember areas of impaired sensation - Use padding over bony prominences before splinting. Padding afterward will increase pressure - The pt should wear the splint for approximately 20-30 minutes. Then it should be removed and checked for red areas. Red areas should not last for more than 20 minutes after splint removal

Question 29

What are common areas of injury due to pressure?

Answer 29

- Ulnar styloid: can use theraputty to create negative space when making splint - Metacarpal joints - Tips/pads of fingers for pts that have tone

Question 30

What are other splinting precautions to educate pts on?

Answer 30

- Time: when can pt wear splint (bathing?), for how long, how often is it tightened? - Edema: sign that splint may be too tight, could be agitating a nerve, or strap is on too tight (you should be able to fit one finger under straps) - Moisture: macerations may result, keep splint clean - Circulation: look at color and capillary refill - Tingling/numbness: straps may be too tight, digital nerves can become irritated and feel like the finger is falling asleep - Temperature of materials: do not want material to get too hot - Additional splinting materials: rubberbands and monofilaments can snap/break, what should the pt do if this happens?

Question 31

What are important points to make when educating pts on orthotic care?

Answer 31

- Explain purpose of the orthotic - Pts need to know that heat may melt or change the shape of the orthotic - Pts should be discouraged from making self-adjustments - Clean orthotic with mild soap and water - only if pt is allowed to come out of splint - Provide pt with a contact phone number in case of problems or questions

Question 32

What should be included in orthotic documentation?

Answer 32

- Type of splint, anatomical position, and purpose of splint - Pt education: wearing schedule, splint care, precautions, HEP Follow Up Visits: - Any changes/modifications to design or schedule - Patient's wearing tolerance and compliance - Efficacy of splint

Question 33

How are orthotics billed?

Answer 33

- L-Codes | - Facility must be a DME provider, otherwise must bill under orthotic management and training 97760

Question 34

What are important things to remember when making an orthotic?

Answer 34

- Use gravity whenever possible - Use palmer surface of hand and digits and not fingertips when molding material - Use lotion on the material to keep it from sticking to itself and to reduce fingerprints - Heat the adhesive on the velcro to make it stick better and not peel up - Round edges of straps and velcro hook