Intro to Orthotics Flashcards
What is an orthosis
- Orthotic Devices are externally applied
devices “used to modify the structural
and functional characteristics of the
neuromuscular and/or skeletal system” - Devices used to protect some parts of the
body from potential injury
Orthoses devices can include -
- Braces
- Splints
- Serial casts
- Shoe inserts
- Helmets
- Protective and supportive taping
- Corsets
- Functional Electrical Stimulation
What are orthoses generally named for?
- Area of body they cover
- Type of material utilized- plastic, metal, soft
- Components
Healthcare professionals involved in the care of a patient who requires an orthotic intervention:
- PT
- OT
- SLP
- Orthotist
- Physician (Physiatrist)
- Nurse
- Case Manager
- Patient and Family (Caregiver)
What is an Orthotist
- An American Board Certified (ABC)
Orthotist or Prosthetist is an allied health
professional who is specifically trained and
educated to manage the provision of
comprehensive orthotic and prosthetic
care, based upon a clinical assessment and
a physician’s prescription, to restore
function and/or cosmesis
Education of an orthotist
- Educational Background- Typically requires
Masters Degree following undergraduate
degree - Certification in Orthotics (CO) or Orthotics
and Prosthetics (CPO)
Purpose/ Function of an Orthosis
- Safety
- Reduce Pain
- Provide Stability/ Prevent Deformity
- Correct aLignment
- Accommodate fixed deformity/prevent further deformity
- Enhance performance
- Provide kinesthetic feedback
Purpose/ Function of an Orthosis - Safety
- Orthosis may be required to maintain safety at joint/body part
- Maintaining alignment to allow healing; Post surgical fixation
- Allow clearance during mobility
Purpose-Function of an Orthosis - Reduce Pain
- Inflammation
- Joint Instability
Purpose/Function of an Orthosis - Provide Stability/Prevent Deformity
- Ligamentous Laxity
- Muscle imbalance/weakness
- Abnormal muscle tone
Purpose/Function of an Orthosis - Correct alignment
- Improve joint stability
- Improve biomechanical function
- Poor alignment at one joint may impact other joints
Role of an orthotist
- Expertise in components of orthotists available
- Creation of Orthotic device
- Communication with healthcare team to ensure
accuracy of need/improvement - Ongoing adjustments to orthotic as needed
How do orthotists adjust orthotics as needed?
- consideration of patient condition- is it a
progressive condition?, is it a condition the
patient may improve during therapy? - if patient requires orthosis for life,
adjustments due to changes in body size, limb
size, growth? - Wear/tear of device?
Role of PTs for orthoses determined by physician/surgeon for safety/post surgical fixation
- Determination of orders for Orthotic- OOB, when in weightbearing, walking, high level activities
- Patient ability to adequately don/doff
- Alignment, fit, use, care
- Skin management
- Function in device
Role of PT for LE Orthotics
Assessment for need for orthotic- generally utilized for safety or improved independence with ambulation; if patient needs for safety in stand pivot transfers may also be covered
Pre Orthotic Assessment for LE orthotics
- Patient demographics- weight, height, condition
- Tone
- ROM
- Strength
- Functional mobility with/without device
- Patient goals
- Swelling
- Sensation
- Anticipated activity levels
- Degree of deformity/ correction/ accommodation needed
Role of Physical Therapist in Orthotic Management
- Assessment of Orthotic Components
- Alignment, fit
- Accomplishment of goals- remediation of
impairment, functional limitations, or disabilities
with use of orthosis - Ability to use/care/don/doff device
- Skin Management/Wearing schedule
- Ability and safety with performing
mobility/functional activities
Role of Physical Therapist in Orthotic
Management - Prescription
evaluate patient’s functional abilities and participate in pre-orthotic evaluation
Role of Physical Therapist in Orthotic Management - Application
train the patient to utilize orthosis during functional activities; assess fit and function over time/use
role of PT in Orthotic Management - Fabrication
Advanced level physical therapist skill- therapists who participate in fabrication pursue post-entry level training- serial casting
Acquiring Device
- Identification of need
- Orthotic Prescription
- Management may be based on clinic/hospital
agreements OR patient’s insurance provider - Orthotic clinics vs. Orthotist coming in
Orthotic Materials
- Plastic
- Metal
- Hybrid
- Wood
- Leather
- Carbon Fiber
- FES based systems
Considerations for orthotics
strength, stiffness, durability, density, corrosion resistance, function, comfort, cosmesis, fabrication time, cost/coverage
strength
maximal external load that the material can support or sustain
stiffness
amount of bending or compression that occurs when a material is loaded
Durability
fatigue resistance- determined by the material’s ability to withstand repeated cycles of loading or unloading
Density
material’s weight per unit of volume- related to energy cost
Corrosion resistance
degree to which the material is susceptible to chemical breakdown
Function
Does it accomplish goals? Does patient see value?
Comfort
Will the patient wear it? How does it impact skin?
Cosmesis
what does it look like?
fabrication time
Orthotist generally needs a week to create-meaning if need orthotic in rehab, generally referral needs to be put in week one
Cost/Coverage
Some insurance providers have preferred vendors; Medicare will not cover orthotic if patient not returning home; Medicare will not allow patient to receive orthotic more than 2 days prior to discharge home
Fabrication options
*Pre-Fabricated- Off the shelf Options
*Custom Fit
*Custom- best for patients with specific needs, higher level needs, body size needs, and long term use
AFO custom fabrication
*Cast (usually fiberglass) of the patient’s foot is made- negative impression
*Pour plaster into the negative impression to create a positive cast of the limb
*Plastic is then wrapped on the positive cast to create AFO
Understanding forces in orthotic design
3 point presssure systems
slide 21
considerations moving forward
CKC vs OKC
GRF
Psychological Impact
*Will patient accept it?
*How will patient feel about using it in the community?
*Will the patient feel safe using it?
