1) Intro Lecture/Vocab & LE Orthosis Flashcards
1
Q
What is an orthotic?
A
A static or dynamic externally applied device used to improve pt fxn
2
Q
What are all of the things that orthotics do?
A
- Prevent & correct deformity
- Support segment for WB (unload)
- Assist, facilitate, or limit movement
- Decr pain or discomfort
- Improve posture/alignment
- Immobilize
- Provide feedback
- Improve cosmesis
3
Q
What are the indications for orthotics?
A
Impaired:
- Posture
- Muscle performance
- Jt mobility or integrity
- Motor fxn
- Sensation
- Peripheral nerve integrity
- Integumentary integrity
- Acute conditions (post-trauma or surgery)
- Chronic conditions (neuro & msk)
- Prophylactic
4
Q
Are there age or practice setting limitations for orthotics?
A
No
5
Q
Who does the team approach encompass?
A
- Pt & caregiver
- PT
- OT
- Orthotist
- Physician (Physiatrist)
- Social Worker
- Vocational Counselor
6
Q
What are the two types of orthoses?
A
Brace & Splint
7
Q
What is a brace?
A
Designed to resist or direct force long term or permanently
8
Q
What is a splint?
A
Designed to maintain or attain a position on a temporary basis
9
Q
What terms are used for orthotic nomenclature?
A
- Body part/jt
- Function terms
- Special characteristics or hardware
- Trademark names
10
Q
How do you name orthoses?
A
Based on what jt’s they cross
11
Q
FO
A
Foot Orthotic
12
Q
AO
A
Ankle Orthotic
13
Q
KO
A
Knee Orthotic
14
Q
HpO
A
Hip Orthotic
15
Q
AFO
A
Ankle Foot Orthotic
16
Q
KAFO
A
Knee Ankle Foot Orthotic
17
Q
HKAFO
A
Hip-Knee-Ankle-Foot Orthotic
18
Q
LSHKAFO
A
Lumbo-Sacral-Hip-Knee-Ankle-Foot Orthotic
19
Q
SIO
A
Sacro-Illiac Orthotic
20
Q
CO
A
Cervical Orthotic
21
Q
CTO
A
Cervical-Thoracic Orthotic
22
Q
LSO
A
Lumbo-Sacral Orthotic
23
Q
TSLO
A
Thoracic-Lumbo-Sacral Orthotic
24
Q
CTLSO
A
Cervical-Thoracic-Lumbo-Sacral Orthotic
25
HCTO
Head-Cervical-Thoracic Orthotic
26
HO
Hand Orthotic
27
EO
Elbow Orthotic
28
SO
Shoulder Orthotic
29
WHO
Wrist-Hand Orthotic
30
EWO
Elbow-Wrist Orthotic
31
SEO
Shoulder-Elbow Orthotic
32
SEWO
Shoulder-Elbow-Wrist Orthotic
33
SEWHO
Shoulder-Elbow-Wrist-Hand Orthotic
34
What is a pre-fabricated orthotic?
Custom-fit aka "off the shelf"
35
What are the indications for prefab orthotics?
* Mild-mod jt involvement
* Temporary use
* To figure out if a custom-made orthotic would be effective
36
What are the indications for custom-made orthotics?
* Mod-severe jt involvement
* Extended/permanent use
37
Which orthotic fits and fxn's better: Prefab or custom-made?
Custom-made
38
What are the different materials that orthotics can be made out of?
* Thermoplastic
* Metals (Steel, aluminum, titanium)
* Carbon fiber
39
What is the benefit of using metal to make an orthotic?
It's strong
40
What do metal orthotics lack, who can this benefit, and why?
Lacks metal
Good for pt's w/conditions such as lymphedema bc it leaves space for swelling
41
What are the cons of using a metal orthotic?
* Can be heavy and bulky
* Requires maintenance-oil jt's
* Limited footwear options
42
What is good about carbon fiber orthotics?
* Greater elasticity → Allows for energy return
* Lighter
43
What are the benefits of thermoplastic orthotics?
* Light
* Easy to clean
* Total contact
* Can wear a variety of shoes
44
What does the material an orthotic is made of effect?
Fxn of the device
45
What does total contact mean in regards to an orthotic?
Pressure will be distributed over a large area
46
In a pt w/strong PF & inv hypertonicity, which AFO would exert the largest edge pressure?
\*
47
Which AFO would best control PF Hypertonicity?
\*
48
Explain ground reaction force
\*
49
Explain example of controlling degrees of freedom
Can put an orthotic on legs bilaterally to allow pt to focus on spine movement
50
In a 3 point pressure system, how are the points distributed?
1 point on the convexity, 2 points on the concavity
51
Give an example of when a 4-point pressure system could be used and why
* Used to control knee flexion
* 4th point prevents pressure on the patella
52
What things need to be taken into consideration for designing an orthotic?
* Pressure distribution
* Force arm
* GRF
* Pressure System
* Control of DoF's
53
What type of orthotic could be used for genu recurvatum?
Swedish Knee Cage
54
Where would the points go on a 3-point system?
\*
\*
55
How would you set up a wheelchair w/a 3-point pressure system to reverse decorticate posturing?
Tilt w/c in space and use gravity as the point of pressure on the convexity
56
Foot Lift
Used to correct limb length discrepancies, SIJ dysfxn. or in conjunction w/KAFO
57
What is this?
Foot Lift
58
Heel Lift
Used to reduce achilles tendon stres
59
What is this?
Heel Lift
60
Heel Cup
Redistributes fat pad to improve shock absorption, especially in cases of heel spurs or chronic plantar fasciitis
61
What is this?
Heel Cup
62
What do rigid & semi-rigid corrective foot orthotics do?
Normalize abn subtalar & TMT mechanics
63
What FO would you use for a pt w/achilles tendinitis?
Heel Lift
64
What FO would you use for pt w/plantar fasciitis?
Heel cup
65
What FO would you use for a pt w/ a 1/4" limb length discrepancy?
Foot Lift
66
What does an aircast do & which pt's are commonly given this?
* Controls talo-crural jt
* Pt's w/inversion sprains
67
True or False: An aircast accomodates for swelling?
True
68
What is one limitation of AFO's?
They limit proprioception
69
What is this?
SwedeO
70
What is this?
Surestep
71
What does a surestep do?
Controls inv/ev
72
What is this?
\*
Langer Total Control
73
What is a langer total control AFO used for?
Instability
74
What does a CAM walker do?
Immobilizes the ankle
75
True or False: CAM walkers do not unload distal structures?
True
76
How do patellar tendon weight-bearing AFO's work?
They reduce WB through the metatarsals, TCJ, & STJ by putting pressure through the patellar tendon via a lip
77
What is this?
Patellar Tendon Weight-Bearing AFO
78
What would you use an articulated/jointed AFO for?
To normalize a pt's gait
79
Because articulated/jointed AFO's normalize gait mechanics, what else does it do?
Decr energy cost of ambulation
80
What does Ground Reaction/Floor Reaction AFO do?
* Controls tibial advancement → Helps maintain knee extension during midstance
* Compensates for weak PF's
* **Controls the knee through the ankle**
81
What is the problem w/knee immobilizers?
The numbers on the flexion/extension stop are never accurate so you need to use a goni & teach pt about alignment for donning
82
What do KO's limit?
* Genu recurvatum
* Anterior tibial translation
* Varus/Valgus Forces
* Rotation
* **Enhance proprioception**
83
What are knee unloading braces used for?
OA
* Buys the pt a little bit of time before needing a knee replacement
84
What pt population are knee unloading braces not too effective for?
Active pt's
85
What type of pressure system do knee unloading braces use?
3 point
86
What does a T-strap orthosis do?
Alters patellar tracking
87
What do infrapatellar straps do?
Decr strain on patellar tendon by decr patella-patellar tendon angle
88
What can ratcheting lock KAFO's be used for
* Hamstring spasticity
* Low-load, long duration stretch
89
What do weightbearing KAFO's do & how?
Unloads the proximal tibia & femoral condyles by having pt wb through their isch tubes (there's a lip on the device that the pt kind of sits on)
90
What does extension assist KAFO do?
Controls heel rise in midstance and increases knee extension in terminal swing
91
Why do stance control KAFO's get tiring to use?
Bc they restrict knee flexion
92
What sequelae of CVA would contraindicate a stance control AFO & why?
Synergy → Pt won't be able to PF enough to extend knee
93
How do stance control AFO's work?
1) PF produces an extension force at the knee
## Footnote
2) DF releases extension force during swing
94
What are HpO's used for?
Congenital hip issues → Keeps the pt in abdution
95
What do LSHO's do?
Limit adduction. flexion, & IR
96
What is the difference between a post-op hip abduction orthosis & a spika?
Post-op hip abduction orthosis cues & Spika maintains
97
What conditions can RGO's be helpful for & what do they do?
SCI & CP → Facilitates gait
98
RGO
Reciprocal Gait Orthotic
99
What is a pavlik harness used for & how does it work?
To tx reducible developmental hip dysplasia in kids \<6mo by drawing the femur into flexion & abduction
100
What is a pavlik harness not appropriate for?
Fixed teratologic hip dislocations
101
What does a Scottish Rite brace do?
Facilitates WB in abduction for pt's w/Perthe's Disease
102
Explain serial casting?
Cast stretch in 1 position, leave it on for a few days, take it off & recast again in new range
103
How does an RCAI passive adjustable splint work?
Set an angle & it holds the pt there
104
Is a dynasplint passive or active?
Active
105
Is an RCAI splint passive or active?
Passive Adjustable
106
What is a multi-podus boot?
For pt's who were in one position for an extended period of time
107
Is a multipodus boot active or passive?
Passive
108
What is a wedge shoe?
Eliminates forefoot WB (aka unweights the met heads)
109
Who are wedge shoes good for?
Pt's w/DM
110
Process for evaluating a pt for an LE orthosis
* Eval standing w/out external support as appropriate
* Look at at least the feet, knees, and ankles
* Iliac crests & L/S is also helpful
* View from all angles
* MMT & ROM for K ext, PF, & DF
* Sensation (Protective, Proprioceptive, Kinesthesia, & Balance)
111
After giving a pt an LE orthosis, what needs to be checked?
* Alignment & slippage
* Donning/doffing
* Pressure areas & skin care
* Pt ed
* Monitor for weight loss/gain
* **ROM**
112
113
After giving a pt an orthosis, if you notice some skin redness should you go crazy & why?
Not necessarily → Sometimes it takes some time for a pt's skin to get used to the device
114
