Chapter thirteen: Principles and components of Upper limb Orthoses

Question 1

What is the clinical application of the static WHO?

Answer 1

supports the wrist joint, maintains the functional architecture of the hands, and prevents wrist hand deformities.

Question 2

What patient population benefits from static WHOs?

Answer 2

Patients with severe weakness or paralysis of the wrist and hand musculature.
Without it, patients are susceptible to developing the “clawhand” deformity.
Indicated as a positional orthosis for C1-5 quadriplegics with zero wrist extensors and an intrinsic minus hand.

Question 3

What are the most common attachments used with the static WHO?

Answer 3

MCP extension stop and Ip extension assist.

Question 4

What does the MCp extension stop and IP extension assist help prevent?

Answer 4

The clawhand deformity

Question 5

What is the clinical application of the static Hand Orthosis (HdO)

Answer 5

It maintains the functional position of the hand and prevents development of deformities.

Question 6

Which attachments can be used with the static HdO?

Answer 6

All the attachments that could be used with the static WHO

Question 7

Which patient population benefits from a static HdO

Answer 7

Patient’s with weakness or paralysis of the hand intrinsic musculature and strong wrist extensors.
Without the orthosis, these patients are at risk for developing a flat hand with the thumb carpometacarpal joint in extension.
The C7 neurosegmental level quadriplegic exhibits this weakness.

Question 8

What is the clinical application of static elbow orthoses?

Answer 8

They reduce soft tissue contractures.

Question 9

With elbow contractures, the arm and forearm must be restricted to what?

Answer 9

Pure rotation with minimum translation to avoid joint subluxation or dislocation.

Question 10

What patient population benefits from static EO?

Answer 10

Patient’s with elbow contractures.
Patient’s with spinal cord injury that require full ROM of the elbow for alleviating ischial sitting pressure, propelling a manual wheelchair, or bringing the hand to the face.
Patient who were immobilized after trauma.

Question 11

What is the clinical application of the shoulder-elbow orthosis?

Answer 11

Support of a painful shoulder or traumatized brachial plexus injured limb with an orthosis.

Question 12

What is the most common SEO?

Answer 12

A sling

Question 13

What is another type of SEO?

Answer 13

Abduction orthosis, anchored on the hip

Ex: gunslinger

Question 14

What patient population benefits from SEOs?

Answer 14

The brachial plexus-injured patient

Question 15

What is the clinical application of the shoulder-elbow-wrist orthosis?

Answer 15

They are used to protect soft tissues or to prevent contracture of soft tissues. Occasionally they are used to correct an existing deformity.

Question 16

What is an example of a SEWO?

Answer 16

The airplane orthosis also known as the shoulder stabilizer.

Question 17

What does the airplane orthosis or shoulder stabilizer do?

Answer 17

it externally rotates the glenohumeral joint, this puts the internal rotators on stretch, and the tension on the deltoid and rotator cuff is relieved, which are desired after surgery.

Question 18

What patient population benefits from SEWO?

Answer 18

Airplane orthosis is and excellent orthosis after rotator cuff repairs, anterioposterior capsular repairs, and postmanipulation.
It is prescribed for axillary burns to prevent contracture and reduce contracture.

Question 19

What is the clinical application of functional WHO and HdO?

Answer 19

The attachment of utensils and other items in order to make ADLs easier.

Question 20

When are functional WHO and HdO indicated?

Answer 20

When patients have rigid deformities in the hand and finger joints and prehension is not feasible.

Question 21

What does WAWHO stand for?

Answer 21

Wrist-action wrist-hand orthosis

Question 22

What is the clincial application of the WAWHO?

Answer 22

A positional and therapeutic orthosis. It maintains the functional position of the hand and prevents wrist and hand deformities.
It functions to protect and assist weak wrist extensors with mechanical wrist motion stops.

Question 23

What patient population are WAWHOs indicated for?

Answer 23

Patients with weak (2 or 3) wrist extensors and paralyzed hand muscles.
Patients who have potential for wrist extensor musculature return.

Question 24

What are the clinical applications of dynamic EO?

Answer 24

Use immediately after trauma or surgery. They usually consist of joints that have adjustable ROM.

Question 25

What patient population benefits from dynamic EO?

Answer 25

After cast removal for stable fractures.
Postoperatively as an adjunct to internal fixation
Elbow disloaction mangement
Strains
Sprains
Muscle trauma

Question 26

What is the clinical application of the ratchet WHO?

Answer 26

It is the functional prehension orthosis.
It allows patients to grasp and relase objects by using external power.
It is manually controlled and substitutes for finger flexor and extensor muscles that are less than grade 3.
Patient’s with C5 quadriplegia may benefit.

Question 27

What is an alternative to the ratchet WHO?

Answer 27

The electric-powered prehension unit (EPPU). It uses a rechargeable battery pack that closes the hand

Question 28

What patient population benefits from a ratchet WHO and EPPU?

Answer 28

C5 quadriplegia

Patients with paralysis or severe weakness of the hand and wrist musculature.

Question 29

What musculature must be present to operate a ratchet WHO?

Answer 29

3+ strength in shoulder flexion, abduction, external rotation , and internal rotation.

Question 30

What other factors must be checked for a patient to use a ratchet WHO?

Answer 30

Endurance
ROM
Spasticity
Sensation
Patient motivation and social support

Question 31

What does WDWHO stand for?

Answer 31

Wrist-driven WHO

Question 32

What is another name for WDWHO?

Answer 32

Flexor hinge WHO

Question 33

What is the clinical application of WDWHO?

Answer 33

A dynamic prehension orthosis for transferring power from the wrist extensors to the fingers. Active wrist extension provides grasp, and gravity-assisted wrist flexion enables the patient to open the hand.

Question 34

What patient population benefits from WDWHO?

Answer 34

Individuals with paralysis or severe weakness of the hand. Wrist extensor strength must be at least grade 3+ and proximal strength must be functional.
Patients with C6 or C7 quadriplegia benefit.

Question 35

What is the clinical application of the mobile arm support (MAS)?

Answer 35

It supports the weight of the arm and provides assistance to the shoulder and elbow motions through a linkage of bearing joints. Joint ROM can be maintained with a MAS

Question 36

What are the basic components of the MAS?

Answer 36

Wheelchair mounting bracket,
Proximal arm
Distal arm
The forearm trough

Question 37

What patient population benefits from MAS?

Answer 37

Patients who have severe arm paralysis such as due to Muscular dystrophy, poliomyelitis, cervical spinal cord lesion, Guillain-Barre syndrome, and amyotrophic lateral sclerosis

Question 38

What are the arm muscle criteria for the use of MAS?

Answer 38

Absent or weak elbow flexion
Absent or weak shoulder flexion and abduction
Absent or weak external rotation
limited endurance for sustained upper limb activity.

Question 39

What is usually added to a functional EO?

Answer 39

An elastic device with a locking mechanism to assist elbow flexion with multiple angular lock points.

Question 40

What patient population benefits from functional EO?

Answer 40

Individuals with selective loss of elbow flexion secondary to a brachial plexus injury or congenital deficit.

Question 41

What is the clinical application of the resting WHO?

Answer 41

It maintains the arches of the hand, keeps the thumb abducted and flexed, maintains the wrist in a functional position.

Question 42

What patient population benefits from a resting WHO?

Answer 42

Patient swith paralyzed musculature, and to reduce hypertonicity by abducting the fingers.
Can add in scar formation in a burn patient.

Question 43

What is the clinical application of the HO with thumb adduction stop?

Answer 43

It positions the thumb in opposition and maintains the thumb web space.

Question 44

What patient population benefits from the HO with thunmb adduction stop?

Answer 44

Acute intervention in a painful hand or in cases where a thumb contracture is threatening.
A burn victim with palmar hand trauma or the arthritic patient with tender joints

Question 45

What is the clinical application of the HO with MCP extension stop?

Answer 45

To prevent MCP hyperextension due to intrinsic weakness of the hand which often rests in a posture that encourages MCP hyperextension.

Question 46

What patient population benefits from HO with MCp extension stop?

Answer 46

Patients with median and radial nerve injury cuases weakening of the transverse arch.

Question 47

What is the clinical application of the dynamic dorsal WHO?

Answer 47

It provides a quickk clincial means for positioning the hand and assisting wrist and MCP extension.

Question 48

what are the components of the dynamic dorsal WHO?

Answer 48

The dorsal forearm piece
The palmar piece
The MCP extension assist.

Question 49

What patient population benefits from the dynamic dorsal WHO?

Answer 49

Patients with radial nerve injury resulting in weakness of wrist and MCp extension.

Question 50

A patient presents after 1 month of use his WDWHO. The patient was able to use the brace for ADL activities, but was unable to begin self-catheterization. What should be done to change the brace?

Answer 50

Compromise finger opening for a tighter pinch by having the orthotist shorten the tenodesis bar and have the therapist provide additional training.