Intro to Orthotics

Question 1

What is an orthosis

Answer 1

• 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

Question 2

Orthoses devices can include -

Answer 2

• Braces
• Splints
• Serial casts
• Shoe inserts
• Helmets
• Protective and supportive taping
• Corsets
• Functional Electrical Stimulation

Question 3

What are orthoses generally named for?

Answer 3

• Area of body they cover
• Type of material utilized- plastic, metal, soft
• Components

Question 4

Healthcare professionals involved in the care of a patient who requires an orthotic intervention:

Answer 4

• PT
• OT
• SLP
• Orthotist
• Physician (Physiatrist)
• Nurse
• Case Manager
• Patient and Family (Caregiver)

Question 5

What is an Orthotist

Answer 5

• 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

Question 6

Education of an orthotist

Answer 6

• Educational Background- Typically requires
  Masters Degree following undergraduate
  degree
• Certification in Orthotics (CO) or Orthotics
  and Prosthetics (CPO)

Question 7

Purpose/ Function of an Orthosis

Answer 7

1. Safety
2. Reduce Pain
3. Provide Stability/ Prevent Deformity
4. Correct aLignment
5. Accommodate fixed deformity/prevent further deformity
6. Enhance performance
7. Provide kinesthetic feedback

Question 8

Purpose/ Function of an Orthosis - Safety

Answer 8

• Orthosis may be required to maintain safety at joint/body part
• Maintaining alignment to allow healing; Post surgical fixation
• Allow clearance during mobility

Question 9

Purpose-Function of an Orthosis - Reduce Pain

Answer 9

• Inflammation
• Joint Instability

Question 10

Purpose/Function of an Orthosis - Provide Stability/Prevent Deformity

Answer 10

• Ligamentous Laxity
• Muscle imbalance/weakness
• Abnormal muscle tone

Question 11

Purpose/Function of an Orthosis - Correct alignment

Answer 11

• Improve joint stability
• Improve biomechanical function
• Poor alignment at one joint may impact other joints

Question 12

Role of an orthotist

Answer 12

• 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

Question 13

How do orthotists adjust orthotics as needed?

Answer 13

• 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?

Question 14

Role of PTs for orthoses determined by physician/surgeon for safety/post surgical fixation

Answer 14

• 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

Question 15

Role of PT for LE Orthotics

Answer 15

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

Question 16

Pre Orthotic Assessment for LE orthotics

Answer 16

• 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

Question 17

Role of Physical Therapist in Orthotic Management

Answer 17

• 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

Question 18

Role of Physical Therapist in Orthotic
Management - Prescription

Answer 18

evaluate patient’s functional abilities and participate in pre-orthotic evaluation

Question 19

Role of Physical Therapist in Orthotic Management - Application

Answer 19

train the patient to utilize orthosis during functional activities; assess fit and function over time/use

Question 20

role of PT in Orthotic Management - Fabrication

Answer 20

Advanced level physical therapist skill- therapists who participate in fabrication pursue post-entry level training- serial casting

Question 21

Acquiring Device

Answer 21

• Identification of need
• Orthotic Prescription
• Management may be based on clinic/hospital
  agreements OR patient’s insurance provider
• Orthotic clinics vs. Orthotist coming in

Question 22

Orthotic Materials

Answer 22

• Plastic
• Metal
• Hybrid
• Wood
• Leather
• Carbon Fiber
• FES based systems

Question 23

Considerations for orthotics

Answer 23

strength, stiffness, durability, density, corrosion resistance, function, comfort, cosmesis, fabrication time, cost/coverage

Question 24

strength

Answer 24

maximal external load that the material can support or sustain

Question 25

stiffness

Answer 25

amount of bending or compression that occurs when a material is loaded

Question 26

Durability

Answer 26

fatigue resistance- determined by the material’s ability to withstand repeated cycles of loading or unloading

Question 27

Density

Answer 27

material’s weight per unit of volume- related to energy cost

Question 28

Corrosion resistance

Answer 28

degree to which the material is susceptible to chemical breakdown

Question 29

Function

Answer 29

Does it accomplish goals? Does patient see value?

Question 30

Comfort

Answer 30

Will the patient wear it? How does it impact skin?

Question 31

Cosmesis

Answer 31

what does it look like?

Question 32

fabrication time

Answer 32

Orthotist generally needs a week to create-meaning if need orthotic in rehab, generally referral needs to be put in week one

Question 33

Cost/Coverage

Answer 33

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

Question 34

Fabrication options

Answer 34

*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

Question 35

AFO custom fabrication

Answer 35

*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

Question 36

Understanding forces in orthotic design

Answer 36

3 point presssure systems slide 21

Question 37

considerations moving forward

Answer 37

CKC vs OKC GRF

Question 38

Psychological Impact

Answer 38

*Will patient accept it? *How will patient feel about using it in the community? *Will the patient feel safe using it?