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Gait > FINAL EXAM: Orthotics > Flashcards

FINAL EXAM: Orthotics Flashcards

1
Q

Reasons for needing PF STOP

A

to help foot clearance during swing phase!

  • PF severe spasticity
  • Absent proprioception (affects foot placement during stance)
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2
Q

Reasons for needing DF STOP

A

PF <+ to 4/5 (weak PF)
- knee buckling at stance phase OR
- knee hyperextension at stance phase
(would usually still recommend even with hyperext compensation due to variability)

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3
Q

Explain why you need DF stop for PF weakness during MSt

A

during MSt, ankle goes from 5 deg PF to 5 deg PF and is eccentrically controlled by PF (mostly soleus), if there is PF weakness the knee will buckle
(there would be excessive DF and compensatory increased knee flexion)

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4
Q

Reasons for needing DF ASSIST

A

DF <= to 4/5

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5
Q

What phases of gait will DF ASSIST help with

A

IC (isometric)
LR (eccentric)
ISw (TA weak - concentric)
TSw (isometric)

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6
Q

List SOFT and RIGID spinal orthoses

A

SO / ISO
LSO
TLSO

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7
Q

List SEMI RIGID and RIGID spinal orthoses

A

COs
CTOs

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8
Q

What is the main purpose of soft orthosis

A

protect body part by preventing/restricting movement

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9
Q

Soft trunk LSOs have ______ stays secured with canvas, neoprene and or velcro

A

VERTICAL (not horizontal)

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10
Q

Benefits of Soft LSOs

A

May increase IAP to decrease axial loading; may act to remind client to splint or protect self (kinesthetic reminder)

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11
Q

TLSOs benefits and detriments

A

+ may increase IAP to decrease axial loading
+ may act as splint to protect self

  • may be confortable at axilla w kyphosis
  • may limit ventilation
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12
Q

what are the 3 MAJOR PURPOSES of rigid orthoses

A
  1. correct or prevent deformity by restricting or altering motion (fixed should be accommodated or supported, flexible may be corrected or prevented from progressing)
  2. compensate for weakness and/or deformity
  3. protect a body part by preventing/restricting movement
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13
Q

Rigid trunk LSO Knight Spinal Orthosis is _____ control
What lever system is it?

A

FEL
First Class Lever

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14
Q

Chair back orthosis is ___ control
ClamShell Body Jacket is _____ control

A

FE
FELR

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15
Q

Benefits/detriments of rigid trunk TLSO

A

+limit motion in sagittal and coronal planes and rotation
- skin irritation/maceration
- prolonged wearing may lead to muscle wasting

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16
Q

Rigid TLSO (flexion control) indications, benefits, uses

A
  • stable spinal compression fx (w/o osteoporosis)
  • postural kyphosis
    Benefits: limit motion in sagittal plane

used to protect post trauma surgery to prevent flexion

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17
Q

Jewett and CASH are examples of:

A

Rigid TLSOs with FLEXION control only

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18
Q

How long do you need to wear brace for scoliosis

A

at least 12 hours, as much as possible until child reaches skeletal maturity

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19
Q

Magnitude of curve for scoliosis
< ____ deg = NO bracing
___ to ____ deg and still growing = bracing
> ____ deg and done growing = surgery

A

25
25-45
45

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20
Q

What is needed when curve apex is above T6 for scoliosis?

A

ann attachment (sternal or subclavicular out trigger)

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21
Q

thinnest thermoplastic (polypropylene) design, asymmetrical design, 3D correctional brace

A

WCR Braces

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22
Q

type of force application of BOSTON TLSO for scoliosis

A

passive and active

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23
Q

5 criteria for consideration when rx a scoliosis brace

A
  1. cobb angle and curve hx
  2. onset of menses girl, voice boys
  3. age
  4. Risser sign (bony maturation)
  5. prev treatments
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24
Q

5 critical points for parents to improve brace correction

A
  1. monitor growth/height in standing and sitting positions
  2. report growth of 1”
  3. dont get complacent w good in brace correction and not f/u with orthotist for 6-9 months
  4. critical f/u on brace at 9/12/15 months
    report any sig changes in clinical presentation
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25
Q

night only wear braces for scoliosis

A

charleston bending brace CBB (emphasize unbending)
Providence nocturnal brace (emphasize re rotation)

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26
Q

Night only braces are limited to…

A

L or TL curves, 25-35 deg

8-10 hours a day, at least 5 hours

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27
Q

Spinal orthoses for osteoporosis benefits

A
  • facilitate recruitment of back ext m
  • increase joint percention to encourage ext
  • reduce back pain
  • increase gait speed
  • w back ext exercise training
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28
Q

Spinomed Backpack type TLSO is used for…
and to facilitate…

A

osteoporosis and compression fx

facilitate active correction of excessive kyphosis

29
Q

Weighted Kypho-Orthosis effects:

A

both groups improved, intervention more than control

30
Q

total contact body jacket is _____ control and a TLSO

A

FELR

31
Q

COs: soft collars vs semi rigid collars

A

soft: do NOT significantly limit c spine motion
semi rigid: moderately limit midde c spine (c3-5) and used after trauma/surgery

32
Q

CTOs limit…

A

mid and lower cervical flexion/extension, lateral flexion and rotation
thoracic extensions can be removed post surgery to allow more motion

33
Q

CTOs: post type orthoses mostly effecting limiting _____
less effective limiting______

A

C1-3 flexion
extension

34
Q

CTOs: Halo vests

A

most restrictive, invasive and heavy

35
Q

Pinless noninvasive halo are used…

A

peds
torticolis release, C1-2 rotary subluxation reduction, post immobilization tumor removal, C2 otonoid fx fixation

36
Q

Miami J collar VS Aspen collar VS 2 post VS 4 post

A

flexion / extension:

16/32
18/43
-1/38
-1/22

37
Q

how do you size for a collar?

A

vertical chin to shoulder distance
(highest point of trap to tip of chin)

38
Q

how do orthotics address impairments/orthotic functions?

A

Insufficient limb movement due to m weakness (assist with movement to compensate)

Abnormal or excessive movement (limit excessive motion to protect joint)

deformity, excessive movement instability, local pain
(correct or prevent deformities)

39
Q

Goal of AOs

A

restrict INV and EV (ankle sprains, M/L support)

40
Q

Classification of AFOs: purpose and indication

A
  1. Prefabricated 2. Custom Fabricated

resist PF (pf soft stop)
indication: drop foot, mild PF spasticity

41
Q

what determines AFO full length foot plate vs 3/4 length?

A

strength of spasticity

42
Q

Indications for conventional AFOs

A
  • large or heavy duty individuals
  • fluctuation edema
  • heat/pressure sensitivity
  • change in volume anticipated
43
Q

Springs vs pins

A

springs: PF resist, DF assist
pins: PF stop DF stop

44
Q

Sagittal plane ankle joint control:
Why would you use ankle (PF) stop

A

help with foot clearance during swing phase (excessive pf spasticity)

45
Q

Sagittal plane ankle joint control:
Why would you use DF assist

A

substitute for weak or paralyzed DF muscles

46
Q

DF vs PF stop

A

DF: facilitate stability in stance
PF stop: assist foot clearance

47
Q

What would you use for IV/EV control in the frontal plane?

Varus/IV control:

A

T strap
- lateral strap attached and fastened around medial upright

48
Q

Posterior leaf spring indications and function

A

treat the feet with mild spasticity and no contractures

function: assist DF during swing to compensate for weak DF, control varus/valgus (with a high trimline)

49
Q

Anterior ground reaction AFO facilitates….
what phase of gait does it enhance stability in ?
what does it compensate for?

A

knee extension moment at midstance and enhances stability at stance phase (encourages knee ext by resisting tibia forward progression)
compensated for weakness at ankle or knee buckling

50
Q

how do you prevent knee buckling at stance phase?

A

Anterior ground reaction AFO
- DF stop
- shift GRF ant to knee
- enhance knee control during stance phase

51
Q

Articulating (hinged/hybrid) AFO functions and indication and considerations

A
  1. control excessive PF in swing phase and midstance
  2. allow DF in mid and terminal swing
  • indicated when solid AFO is too rigid/restraining
  • must have sufficient PF strength to prevent buckling, avoid too much DF
52
Q

Neural sleeve mechanism, indication, diagnoses

A

functional E STIM, impaired DF with intact PNS
CP, Stroke, MS

53
Q

AFO summary:
DF stop during stance indications:

A

PF weakness <= 4

weak quads (excessive DF, knee buckle at stance)or(excessive PF, mild knee hyperextension at stance)

54
Q

AFO summary:
DF assist during swing indications:

A

DF weakness DF <=4
drop foot

55
Q

AFO summary:
PF stop for initial stance

A

PF spasticity
PF contracture
absent DF

56
Q

types of knee orthoses

A

rehab knee orthoses
functional ACL PCL
functional OA unweighting
patellofemoral

57
Q

function of rehab knee orthoses

A

after surgery early rehab repair ligaments
control knee motion, minimize excessive loads on healing tissues, adjusted to fit fluctuating edema

58
Q

functional PCL ACL knee orthoses are designed to

A

control movement of tibia on femur, control ML and rotational stability (4 point stabilization system)

59
Q

Knee orthoses for OA for pts who….
purpose:

A

demonstrate increased loading on medial compartment of knee
unload medial compartment (3 point force system)

60
Q

indication and purpose for KO for Patellofemoral pain

A

patellar tracking problems, chondromalacia, patellar tendonitis

purpose: prevent/control patellar subluxation or disloaction

61
Q

KAFO indications

A

excessive movement at knee during stance phase that cannot be controlled with AFO!
- knee instability in sagittal plave (buckle or hyperext during stance)
- instability in coronal place (varus/valgus moment)
- weak quads <3+ MMT unilateral

loss of proprioception
joint laxity

62
Q

KAFO: single axis drop lock vs variable knee position vs limited range drop lock

A

single axis drop lock: no motion during stance
limited range: allows 30 deg flexion in locked position
can manually lock in standing and unlock when sit down!

63
Q

posterior offset KAFO increases knee stability in stance by…
may be effective if…

A
  1. moving GRF to front of knee to prevent buckling, wont effect swing
  2. if the individual has good control of hips and trunk
64
Q

Unweighting KAFOs are used in conjuction with…

A

surgical repair to protect and immobilize
(femoral component shaped IC socket–theoretically to WB proximally)

65
Q

HKAFO indication

A

excessive movement at hip and knee during stance that cannot be controlled by KAFO

66
Q

normally, pts with HKAFO would also need…

A

UE AD

  • energy demand, household vs community ambulation considerations
67
Q

RGO vs HKAFO with hip guidance

A
  1. one directional movement, alternative to hip guidance wirth twister joint, for L2 to T5 lesion, need walker
  2. hip guidance with twister joint: allows guided rotation at hip, saved energy, fixed knee joint, L2 to T5, can use to quadricanes
68
Q

Practical considerations for HKAFOs

A

energy expenditure high
inefficient walking speed
mobility and balance in walking
funciton in walking
(low compliance)

69
Q

DONNING/DOFFING HKAFO

A

layer stocking.clothinf if needed
assure proper alignment of anatomical and mechanical joints
no pressure on bony prominences
strapping how tight?
weaing schedule: depend on purpose, increasing and decreaing time (PT education)

Gait (2 decks)

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