Intro to Orthosis Flashcards
What is an orthosis?
any device added to the body to stabilize or immobilize a body part, prevent deformity, protect against injury, or assist with function
What does an orthotist do?
Specializes in the design, fabrication, fitting, alignment adjustment of orthoses
What are the 4 basic goals of orthoses?
- Maintenance or correction of body segment alignment
- Assistance or resistance to joint motion
- Axial loading of the orthosis & therefore relief of distal weight bearing forces
- Protection against physical insult
LE orthoses consist of:
FO - foot orthosis AFO - ankle foot orthosis KO - knee orthosis KAFO - knee ankle foot orthosis HKAFO - hip knee ankle foot orthosis HO - hip orthosis
The “ideal” orthosis has what 3 things?
- Function
- Comfort
- Cosmesis
What does function consist of?
- Meets the individuals mobility needs and goals
- Maximizes stance phase stability
- Minimizes abnormal alignment
- Minimally compromises swing clearance
- Effectively pre-positions the limb for initial contact
- Is energy efficient with the individual’s preferred assistive device
What does comfort consist of?
- Can be worn for long periods without damaging skin or causing pain
- Can be easily donned and doffed
What does cosmesis consist of?
Meets the individual’s need to fit in with peers
An accommodative FO is used when…
foot cannot attain neutral (it can shim the gap to the fixed position
A corrective FO is used to…
help the foot attain a neutral position
A FO mechanism of action is either _______ or _______.
unloading compromised tissue or may provide total contact
What are the 2 most commonly prescribes external shoe modification?
A rocker sole and a SACH heel
T/F : The rocker soles have shown to have the capacity to mimic the forefoot joint, aid in roll off, and simulate forefoot dorsiflexion.
True
- (study on slide 9)
What are metatarsal bars?
Flat surface placed behind the metatarsal head, that are used to relieve pressure from the metatarsal heads.
Metatarsal bars are designed to help…..
metatarsalgia and relieve plantar pressure
How do metatarsal bars help meatatarsalgia and relieve plantar pressure?
Adding a wedge of firm material across the sole of the shoe just proximal to the met heads unloads the pressure from the met heads, allowing for rapid transfer from the shafts of the metatarsals to the distal end of the toes, with limited extension of the digits.
How tall are metatarsal bars usually?
1/4 inch
- this makes them a tripping hazard
How do metatarsal bars differ from rockers?
They have a much flatter plantar surface, providing a broader area of contact with the ground.
What is a DAFO?
A custom-molded orthosis that has evolved from the UCBL shoe insert to better address sagittal plane control of the ankle and foot during stance and to facilitate foot clearance in swing.
Where are the proximal trim lines of a DAFO compared to the ankle joint? Distal trim lines?
- Proximal = Superior
- Distal = encase more of forefott
The DAFO is often used in what patient population? How does it help them?
- Mild to moderate diplegic CP
- redistributes plantar pressures of spastic equinovarus from the anterior foot to the heel, perhaps by reducing overall stimulation of reflexes that would otherwise reinforce extensor hypertonicity
A DAFO provides a more stable base during stance phase which improves what aspects of gait? What overall improvements have been noted?
- swing limb clearance, stride length, cadence, and self-selected walking speed of children with diplegic cerebral palsy, nearly to that of age-matched peers without neuromotor impairment
- improved upright posture as well as enhanced ability of CP children to participate in play activities, based on perceived changes in stability, agility, and speed of movement when wearing it
What is the major complaint about the DAFO?
there is a need to frequently change socks because confinement of the foot within the plastic DAFO shell and shoe contributed to sweaty feet.
What is a UCBL (University of California Biomechanics Laboratory)?
- An orthotic intervention for subtalar joint instability
- Rigid plastic total contact design
What is a UCBL used for? How does it help?
- Hind foot / mid foot correction
- –calcaneal deformities (rearfoot valgus or varus) as well as transverse plane deformities of the midtarsal joints (forefoot abduction or adduction)—
- –used to improve functional alignment of children and adolescents with flexible pes planus, a longitudinal arch deformity— - Heel cup extends proximal to inframalleolar area and distally to the metatarsal heads
- –by “grabbing” the calcaneus and supporting the midfoot with high medial and lateral trim lines; it realigns the calcaneus, improving the angle of pull of the Achilles tendon, providing a more stable foundation for the articular surfaces of the talus, navicular, and cuboid bones—
Varus or valgus correction straps (T Straps)
Most aggressive way to control medial and lateral instability
T straps:
Medial strap buckles around the ____ upright and correct for valgus.
Lateral strap buckles around the ___ upright and corrects for varus.
lateral, medial
Unweighting AFO
May be patella tendon bearing (PTB), specific weight bearing or total surface bearing, TSB
Purpose of unweighting AFO:
Spreads total weight bearing force
Crow Walker= Charcot Restraint Orthotic Walker
Immobilizing AFO
CAM Walker
Immobilizing AFO
AFO for Fracture Management
Immobilizing AFO
Pts w/ distal tibia/ fibula, foot bone fxs, tendocalcaneus rupture, and Diabetic Foot (Charcot Foot) may need a(n) _____ AFO
immobilizing
Wearable functional electrical stimulation units, AKA “neuroprostheses” are necessary for which pts?
pts w/ impaired motor control resulting from disease or trauma of the CNS
Name 2 purposes of KOs
- Protect knee structures from loading stress
2. Correct/prevent genu valgum, varum, recurvatum
Purpose of athletic KO (2):
Preventative; may also assist w/ proprioception.
controversial
Swedish knee cage for genu recurvatum
Non-articulated KO
Knee immobilizer KO
Non-articulated KO
Disadvantage of Non-articulated KOs:
difficult to transfer with
Name two pt populations who may benefit from Drop ring locks / Pawl locks w/ Bail release system:
Elderly and SCI
