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DPT 771 - Ortho, Prosthetics & Assistive Tech > Intro to Orthosis CSV > Flashcards

Intro to Orthosis CSV Flashcards

1
Q
  • What is a UCBL orthosis?
  • Indications?
  • Contraindications?
A

UCBL (University of California Biomechanics Laboratory) is a rigid plastic total-contact orthosis designed to control hindfoot/midfoot alignment.

Indications:

Contraindications:

  • rigid deformities
  • high-tone conditions
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2
Q

What is an AFO, and what are its four main types?

A

- An AFO (Ankle Foot Orthosis) supports the ankle and foot; the most common orthosis.

- Main types include:

  • DAFO (Dynamic AFO): Flexible, energy-returning.
  • SAFO (Solid AFO): Rigid, controls severe tone or flaccidity.
  • Posterior Leaf Spring: Assists dorsiflexion, limits plantarflexion.
  • Floor Reaction AFO: Resists tibial progression, aids crouch gait.
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3
Q

What is a SMO, and what are its indications?

A

SMO (Supra Malleolar Orthosis) provides better medial-lateral control than UCBL.

Indications:

  • severe pes planus
  • mild ankle instability
  • mild to moderate CP
  • low tone

Contraindications:

  • high-tone
  • sagittal plane
  • weakness deformity (drop foot)
  • dominate toe walkers
  • equinovarus/valgus
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4
Q

When is a KAFO indicated?

A

KAFO (Knee Ankle Foot Orthosis) is used for knee/ankle instability, post-polio syndrome, SCI, and coronal plane instabilities (e.g., genu valgum/varum).

  • Contraindicated in adequate stance stability provided by AFOs alone.
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5
Q

What is an HKAFO, and why is it rarely used?

A

HKAFO (Hip Knee Ankle Foot Orthosis) provides support for severe lower-limb weakness or paralysis. It is labor-intensive to use (e.g., swing-to gait) and has high rejection rates.

  • Common in myelomeningocele or SCI patients.
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6
Q

What is the purpose of trimlines in orthoses design?

A

- Trimlines determine the orthosis’s rigidity, fit, and functional control based on the patient’s needs.

- For example, more anterior trimlines provide greater resistance to ankle motion, while smooth blending prevents irritation.

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7
Q

What are the general rules for the proximal trimline of an orthosis?

A

The proximal trimline is located ~3.8 cm below the fibular head to avoid compressing the peroneal nerve and should encircle 3/4 of the calf for stability without irritation.

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8
Q

How does the anterior trimline influence ankle motion?

A
  • Anterior trimlines located further forward increase rigidity, limiting ankle rotation.
  • Posterior trimlines allow more flexibility.
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9
Q

What are the medial and lateral foot trimline guidelines for orthoses?

A
  • Medial trimline: Extends slightly above the navicular apex.
  • Lateral trimline: Extends above the shaft of the fifth metatarsal.
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10
Q

Why are metatarsal trimlines important in foot orthoses?

A

Metatarsal trimlines align with the metatarsal heads to relieve pressure and improve weight distribution, reducing irritation and supporting functional alignment.

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11
Q

What design principles should be followed to prevent irritation at bony prominences?

A
  • Trimlines should either align with or be slightly above bony prominences to avoid pressure points.
  • Smooth contouring is essential for comfort and effectiveness.
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12
Q

What is the purpose of trimlines in orthoses design?

A
  • Trimlines determine the orthosis’s rigidity, fit, and functional control based on the patient’s needs.
  • For example, more anterior trimlines provide greater resistance to ankle motion, while smooth blending prevents irritation.
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13
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14
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15
Q

What are the medial and lateral foot trimline guidelines for orthoses?

A
  • Medial trimline: Extends slightly above the navicular apex.
  • Lateral trimline: Extends above the shaft of the fifth metatarsal.
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16
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17
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18
Q

What type of orthosis is recommended for mild to moderate foot drop?

A

- Posterior leaf spring AFO is recommended (Most common AFO/DAFO)

  • It limits plantarflexion, assisting with limb clearance during swing.

- Indications include LMN flaccid paralysis of dorsiflexors.

- Contraindications: moderate to severe spasticity or severe knee instability.

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19
Q

Which orthosis is best suited for crouch gait?

A

A floor reaction AFO (FRO) is ideal.

  • It blocks forward tibial progression, preventing knee collapse and aiding in stance stability.
  • Contraindicated in genu recurvatum, ACL deficiency, or inadequate trunk control.
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20
Q

What orthosis is used for severe pes planus or posterior tibial dysfunction?

A

UCBL or SMO are commonly used.

  • UCBL provides rigid support for hindfoot/midfoot alignment.
  • SMO offers additional medial-lateral control for mild instability.
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21
Q

Which orthosis helps relieve plantar pressure in metatarsalgia?

A
  • Metatarsal bars or pads.
  • They redistribute pressure away from the metatarsal heads, alleviating pain.
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22
Q

What is a TONE-inhibiting AFO, and when is it used?

A

A TONE-inhibiting AFO is a rigid AFO designed to reduce hypertonicity in neurological conditions.

  • Examples include anterior floor reaction AFOs or rigid SAFOs with specific strapping.
  • Indications: severe spasticity or high tone.
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23
Q

When is a bilateral metal upright AFO indicated?

A

- Indicated for patients with

  • foot drop
  • severe edema
  • neuropathic feet
  • poor sagittal plane knee control

- Contraindicated if weight and bulk are patient concerns.

24
Q

What orthosis is used for children with mild to moderate diplegic CP?

A

DAFOs (Dynamic Ankle Foot Orthoses) are ideal.

  • They limit midfoot/forefoot motion while providing a stable base for motor control during ambulation.
25
Q

What is the role of dorsiflexion-assist AFOs in gait?

A

Dorsiflexion-Assist (AFO): They assist toe clearance during swing and facilitate controlled foot-flat during stance.

  • Indicated for dorsiflexor weakness (e.g., drop foot).
  • Contraindicated in severe spasticity or altered knee control.
26
Q

Which orthosis is ideal for managing ankle instability in multiple planes?

A

A rigid SAFO (Solid Ankle Foot Orthosis).

  • Indicated for high-tone conditions, equinovarus, or moderate-severe pes planus.
  • Contraindications: not appropriate for more mild dysfunctions (mild drop foot or mild pes planus).
27
Q

What orthosis is typically used for post-polio syndrome or SCI patients with lower limb weakness?

A

A KAFO (Knee Ankle Foot Orthosis), often with bilateral metal uprights or ischial weight-bearing designs for additional support.

28
Q

What is the purpose of a SACH heel?

A

The SACH (Solid Ankle Cushioned Heel) heel mimics forefoot dorsiflexion, reduces joint excursion, and provides shock absorption during gait.

  • Commonly used in rocker soles for limited motion.
29
Q

.

A

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30
Q

What is a plantar fascia splint, and when is it used?

A

A plantar fascia splint stabilizes the arch and reduces strain on the plantar fascia, typically used for plantar fasciitis or related conditions.

31
Q

What is a dynamic stretching orthosis?

A
  • A dynamic stretching orthosis applies controlled tension to improve joint range of motion gradually.
  • Used for contractures or post-operative stiffness.
32
Q

What is the role of functional neuromuscular electrical stimulation (FNMES) in orthotic intervention?

A

Functional Neuromuscular Electrical Stimulation (FNMES) assists dorsiflexion during gait by electrically stimulating the peroneal nerve.

  • It is often used in drop foot conditions caused by stroke, MS, or TBI.
33
Q

What is the benefit of a posterior leaf spring AFO?

A
  • It assists with dorsiflexion, enabling toe clearance during swing and limiting plantarflexion.
  • Commonly used in mild to moderate foot drop.
34
Q

How do T-straps assist in orthotic interventions?

A

T-straps provide medial or lateral ankle stability by counteracting valgus (medial strap) or varus (lateral strap) forces.

35
Q

What is a BiCAAL, and what does it do?

A

BiCAAL (Bi-channel Adjustable Ankle Lock) is an ankle joint with adjustable pins or springs that allow motion assistance or restriction (e.g., plantarflexion/dorsiflexion stops or assist).

36
Q

What is a Craig-Scott orthosis?

A

A Craig-Scott orthosis is a lightweight KAFO designed for SCI patients, allowing a stable standing position with exaggerated posture and facilitating a swing-through gait with crutches.

37
Q

When is a reciprocating gait orthosis (RGO) indicated?

A

Reciprocating Gait Orthosis (RGO):

  • Used in patients with spina bifida or SCI
  • It facilitates reciprocal motion by coupling hip flexion on one side with extension on the opposite.
38
Q

What are the general steps in selecting an AFO?

A

Determine if an AFO is indicated based on:

  • ankle strength
  • proprioception
  • spasticity
  • assess need for dorsiflexion stop or assist
  • choose between articulated or non-articulated designs
39
Q

When is a dorsiflexion stop indicated in an AFO?

A
  • Indicated when plantarflexor strength ≤4 in standing or excessive dorsiflexion leads to knee flexion in stance.
  • Contraindicated with weak dorsiflexors or fused ankle joints.
40
Q

What conditions require a floor reaction AFO?

A
  • Conditions with crouch gait, quadriceps weakness, or knee instability, such as CP or post-polio syndrome.
  • Contraindicated in genu recurvatum or ACL-deficient knees.
41
Q

What is the clinical application of posterior stops in an AFO?

A

Posterior stops limit plantarflexion during swing and early stance, assisting knee flexion.

  • Indicated for foot drop or ankle instability.
  • Contraindicated in fixed plantarflexion contractures.
42
Q

What is the purpose of a dorsiflexion assist in an AFO?

A

To facilitate toe clearance during swing phase and smooth heel strike in stance.

  • Indicated for mild to moderate foot drop.
  • Contraindicated in high-tone or spastic conditions.
43
Q

When should a KAFO be prescribed instead of an AFO?

A
  • When knee instability (e.g., recurvatum, varus, or valgus) cannot be managed with an AFO alone.
  • Common in SCI or polio patients.
44
Q

What factors influence the choice between rigid and dynamic orthoses?

A

Dynamic orthoses are used for mild support and energy return (e.g., DAFO).

  • Rigid orthoses (e.g., SAFO) are for severe instability or tone management.
  • Consider patient mobility goals and tone.
45
Q

How are trimlines adjusted for stability or flexibility?

A

Anterior trimlines closer to the midline increase rigidity and stability.

  • Posterior trimlines allow greater flexibility and motion.
46
Q

What is the Rancho Los Amigos Decision Tree?

A
  • A systematic guide to selecting LE orthoses, including criteria for AFOs, joint mobility, and strength assessment.
  • Helps clinicians match orthoses to functional deficits.
47
Q

When is an unweighting AFO used?

A
  • For conditions requiring reduced weight-bearing on the foot, such as fractures or severe Charcot foot.
  • Provides support while immobilizing the ankle and offloading pressure.
48
Q

What orthosis would you recommend for a child with flexible pes planus?

A

UCBL orthosis. It provides rigid hindfoot and midfoot support, improving alignment and stability.

49
Q

A patient with mild ankle instability and low tone requires support. Which orthosis is appropriate?

A

SMO (Supra Malleolar Orthosis): Offers medial-lateral ankle stability while accommodating mild instability.

50
Q

What orthosis is recommended for severe spasticity leading to equinovarus deformity?

A

SAFO (Solid Ankle Foot Orthosis) Provides rigid support to control tone and deformity.

51
Q

A patient has drop foot but no spasticity or knee instability. What orthosis is suitable?

A

Posterior leaf spring AFO - Assists dorsiflexion for swing phase clearance.

52
Q

What is the best orthotic solution for managing crouch gait in children with CP?

A

Floor Reaction AFO - Blocks tibial progression to prevent knee collapse during stance.

53
Q

Which orthosis would you use for a patient with severe ankle edema and poor skin tolerance?

A

Bilateral metal upright AFO - It accommodates volume fluctuations and avoids skin contact.

54
Q

How would you manage an individual with knee hyperextension during stance phase?

A
  • A dorsiflexion stop in an articulated AFO or a rigid SAFO.
  • Both control knee recurvatum.
55
Q

What orthosis is recommended for severe foot deformities like Charcot foot?

A

A custom total contact AFO or Crow Walker to provide rigid immobilization and pressure redistribution.

56
Q

A patient presents with mild to moderate CP and intermittent toe walking. What is an appropriate orthosis?

A

DAFO (Dynamic Ankle Foot Orthosis) - Promotes functional alignment while allowing movement.

57
Q

What orthotic intervention would you recommend for post-polio syndrome with quadriceps weakness?

A

KAFO with knee locks or stance control joints to provide stability during ambulation.

DPT 771 - Ortho, Prosthetics & Assistive Tech (21 decks)

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