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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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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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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
What is the role of dorsiflexion-assist AFOs in gait?
**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
Which orthosis is ideal for managing ankle instability in multiple planes?
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
What orthosis is typically used for post-polio syndrome or SCI patients with lower limb weakness?
A **KAFO** (**Knee Ankle Foot Orthosis**), often with bilateral metal uprights or ischial weight-bearing designs for additional support.
28
What is the purpose of a SACH heel?
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.
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30
What is a plantar fascia splint, and when is it used?
A plantar fascia splint stabilizes the arch and reduces strain on the plantar fascia, typically used for plantar fasciitis or related conditions.
31
What is a dynamic stretching orthosis?
* A dynamic stretching orthosis applies controlled tension to improve joint range of motion gradually. * Used for contractures or post-operative stiffness.
32
What is the role of functional neuromuscular electrical stimulation (FNMES) in orthotic intervention?
**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
What is the benefit of a posterior leaf spring AFO?
* It assists with dorsiflexion, enabling toe clearance during swing and limiting plantarflexion. * Commonly used in **mild** to **moderate foot drop**.
34
How do T-straps assist in orthotic interventions?
T-straps provide medial or lateral ankle stability by counteracting valgus (medial strap) or varus (lateral strap) forces.
35
What is a BiCAAL, and what does it do?
**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
What is a Craig-Scott orthosis?
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
When is a reciprocating gait orthosis (RGO) indicated?
**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
What are the general steps in selecting an AFO?
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
When is a dorsiflexion stop indicated in an AFO?
* 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
What conditions require a floor reaction AFO?
* 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
What is the clinical application of posterior stops in an AFO?
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
What is the purpose of a dorsiflexion assist in an AFO?
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
When should a KAFO be prescribed instead of an AFO?
* When knee instability (e.g., recurvatum, varus, or valgus) cannot be managed with an AFO alone. * Common in SCI or polio patients.
44
What factors influence the choice between rigid and dynamic orthoses?
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
How are trimlines adjusted for stability or flexibility?
Anterior trimlines closer to the midline increase rigidity and stability. * Posterior trimlines allow greater flexibility and motion.
46
What is the Rancho Los Amigos Decision Tree?
* A systematic guide to selecting LE orthoses, including criteria for AFOs, joint mobility, and strength assessment. * Helps clinicians match orthoses to functional deficits.
47
When is an unweighting AFO used?
* 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
What orthosis would you recommend for a child with flexible pes planus?
UCBL orthosis. It provides rigid hindfoot and midfoot support, improving alignment and stability.
49
A patient with mild ankle instability and low tone requires support. Which orthosis is appropriate?
**SMO** (**Supra Malleolar Orthosis**): Offers medial-lateral ankle stability while accommodating mild instability.
50
What orthosis is recommended for severe spasticity leading to equinovarus deformity?
**SAFO** (**Solid Ankle Foot Orthosis**) Provides rigid support to control tone and deformity.
51
A patient has drop foot but no spasticity or knee instability. What orthosis is suitable?
**Posterior leaf spring AFO** - Assists dorsiflexion for swing phase clearance.
52
What is the best orthotic solution for managing crouch gait in children with CP?
**Floor Reaction AFO** - Blocks tibial progression to prevent knee collapse during stance.
53
Which orthosis would you use for a patient with severe ankle edema and poor skin tolerance?
**Bilateral metal upright AFO** - It accommodates volume fluctuations and avoids skin contact.
54
How would you manage an individual with knee hyperextension during stance phase?
* A dorsiflexion stop in an articulated AFO or a rigid SAFO. * Both control knee recurvatum.
55
What orthosis is recommended for severe foot deformities like Charcot foot?
A custom total contact AFO or Crow Walker to provide rigid immobilization and pressure redistribution.
56
A patient presents with mild to moderate CP and intermittent toe walking. What is an appropriate orthosis?
**DAFO** (**Dynamic Ankle Foot Orthosis**) - Promotes functional alignment while allowing movement.
57
What orthotic intervention would you recommend for post-polio syndrome with quadriceps weakness?
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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