Intro to Orthotics (1) Flashcards
what is an orthosis
external device
restricts or assists movement
transfers load to other body parts
new nomenclature
described by joint it covers and controls
LE orthotic levels
FO
SMO
AFO
KAFO
KO
HKAFO
HI
FO
foot
SMO
supra-malleolar
AFO
ankle/foot
KAFO
knee/ankle/foot
KO
knee
HKAFO
hip/knee/ankle/foot
HO
hip
what is the base of support for all orthoses
shoe
the goal of an orthosis
give as much fxn as possible w/ least deviation from normal
why’re there usually some issues w/ orthoses
gait or dysfxn created by orthotic use
additional weight of the orthosis
gait or dysfxn created by orthotic use
limited ROM
balance issues
additional weight of the orthosis
increased energy consumption
what is the fxn of the orthosis defined by
pathologic condition
dx of the patient
dx of the pt –> fxn of orthosis
why is it given
condition of the pt
orthosis fxn
more than 1 fxn often
5 fxns of an orthosis
support
create fxn
correct
protect
feedback
support –> 5 fxns
muscle weakness
bone weakness
ligamentous weakness
create fxn –> 5 fxns
enhance movements
springs or materials
correct –> 5 fxns
deformities
deformities –> correct –> 5 fxns
forces applied must be tolerable
pediatric v. adult
scoliosis is most common
protect –> 5 fxns
healing tissue
healing tissue –> protect –> 5 fxns
vulnerable tissue
prevent re-injury
feedback –> 5 fxns
facilitate muscle
enhance alignment
scoliosis O
scoliosis O –> feedback –> 5 fxns
correct curve during exercise
how do orthotics work
through force application
orthotic control system
3 point force system
3-point force systems
reduction in unwanted angular rotation
stabilization about a joint, bone or skeletal segment
3 points of force in the force system
3 forces arranged w/
1 middle force
2 opposite forces
what do the 3 forces create
a torque
the force arms for each force must be considered
best 3 point pressure system includes
2 forces equidistant from center force
forces have long lever arms
center force should be close to the joint being controlled
forces have long lever arms
greater distance from center
less force we have to apply
additional stabilizing forces
compression and distraction
compression
external support producing compressive load
distraction
immobilize and stabilize
increase lateral stability
abnormal forces
when forces become excessive they can cause damage or injury to the body
abnormal force consideration
compression
shear force
frictional force
compression –> abnormal
fxn of force per unit area
an abnormal amount produces damage
solution to abnormal compression
increase area
increase force arm
contour orthosis well
pad area
shear force –> abnormal
coplanar forces acting on the same body in the opposite direction
deep force producing destruction in nerves and blood vessels
solution of shear force
minimize movement b/w brace and body part
minimize movement b/w brace and body part –> shear force solution
align and fit brace properly
placing pressure points in tolerant areas
put something b/w brace and skin
frictional force
superficial force
skin breakdown
does not result in deeper damage
solution to frictional force
proper fit and alignment (minimize movement)
good hygiene
put something b/w brace and skin
principles of the fit are determined by
looking at the limb as a whole
look at normal static alignment and dynamic relationship
principles of fit
alignment
joint alignment
what must we consider with alignment
relationship b/w orthosis, anatomical landmarks, body contours
for fit and alignment to be proper
foot flat on the floor
anatomical and mechanical should be congruent
joints should be horizontal
orthosis should conform to anatomical contours of the body
forces should be dispersed over large area for comfort and safety
anatomical and mechanical should be congruent
unless intentionally not
forces should be dispersed over large area for comfort and safety
total contact
reliefs
build up
reliefs –> forces should be dispersed over large area for comfort and safety
boney prominences and pressure sensitive area
build ups –> forces should be dispersed over large area for comfort and safety
relieve pressure prox/dist
joint alignment
hip
knee
ankle
foot plates
hip –> joint alignment
1-2 cm above the superior apex of the greater trochanter
knee –> joint alignment
2 cm proximal to tibial plateau
ankle –> joint alignment
through the centers of the malleoli
at the level of the distal tip of lateral malleoli
foot plates –> joint alignment
full –> end of foot
3/4 plates –> proximal to MT heads
orthotic prescription is best
improve ADL
positive effect on balance
increase pt compliance
what does a prescription of an orthosis do
improves gait and WBing
increases activity level
minimized energy expenditure
most common finding w/ LE orthotic
static balance improved
LE orthotics improved
lateral stability
increase WBing
postural control
walking speed
when are pts most complaint with orthotics
increase mobility esp w/ gait
dependability of orthosis
comfort
given appropriate expectations
given appropriate expectations
pt education
how may clinicians be able to help pts optimize their mobility
asking about environmental obstacles
recommending strategies for utilization of mobility aids, depending on the activity and situation
less control v. more control
less control has less coverage and more flexible
more control has greater coverage, more rigid and closer to body
precautions
alignment considerations
spasticity
bowel bladder incontinence
how long should a pt initially wear a orthotic
30-60 min
what should a pt do before and after removal of the orthotic
inspect it and the skin
making sure there are no damage to the skin, after each time of wear
redness initially
should disappear after 15-20 min
gradually –> wearing schedule
increase wearing time by an hour then 2 hours etc.
by the end of the two week period –> wearing schedule
should be able to wear it full time
when should a pt seek our a medical provider
rubbing
blistering or skin breakdown
orthosis is damaged
swelling
new pain or change in the intensity of pain
toes become discolored or theyre difficult to move
odor or exudates from pre-existing sores
