Intro to Orthotics (3) Flashcards
AFO orthosis
shoe
force system
non-articulated and articulated orthosis
shoe –> AFO
base of support
part of pressure system
what kind of force system does an AFO have
3 point
sometimes more than 1 pressure system
non-articulated and articulated orthosis
with or w/o an articulating joint
non-articulated AFO
AFO w/o ankle joints/covers and controls foot/ankle
general description of NA-AFO
velcro closure
calf shell/pre-tibial shell
trim line
foot plate/shoe insert
velcro closure
clinched or straight
trim line
cut edge of orthosis
foot plates
connected to the foot not the shoe
fits in shoe
arch support
foot plates allow for
better foot control
arch support –> components
support MLA
types of foot plates
full length
3/4 length
sulcus length
full length –> foot plates
heel to toe
3/4 length –> foot plates
proximal to metatarsals
sulcus length –> foot plates
across MLA/mid foot
types of non-articulated AFOs
posterior leaf spring O
PLSO w/ modified shell
carbon fiber PLSO
solid ankle
solid ankle w/ a flange
anterior floor reaction
posterior leaf spring design
narrow calf shell
3/4 footplate
velcro closure
why is a posterior leaf spring given
weak DFs
what motion does a posterior leaf spring allow
assist DF
resist PF
when does the posterior lead spring control
during HS and swing phase
posterior leaf spring is the
most common AFO
what DOESNT posterior lead spring control
M/L (subtalar joint)
clinical application –> PLS
prevent drop foot
prevent foot drop –> PLS
high steppage gait
PLS is most common for
CVA dsyfxn
neuropathy
CVA dysfxn –> PLS
minor spasticity in ankle d/t stroke, brain injury
neuropathy –> PLS
common fibular N neuropathy
drop foot or DF weakness d/t peripheral neuropathy
what does the PLS have positive effect on
static and dynamic balance
posterior leaf spring w/ modified calf shell design
‘L’ shaped w/ wider calf shell behind malleoli
larger foot plate
what does the wider calf shell do
control in the sagittal and frontal planes
why is a posterior leaf spring w/ modified calf shell given to a pt
for weak DF
but gives more control and some M/L control
carbon fiber PLSO/’drop foot’ has
various designs
DF and PF control
flat foot plate
controls primarily in –> carbon fiber PLSO/’drop foot’
sagittal plane
does not control in frontal plane
some have a –> carbon fiber PLSO/’drop foot’
posterior strut
others have pretibial shell
solid ankle design
trim lines of calf shell advanced anterior to the malleoli
3/4 or full foot plate
3 point pressure system
what does the solid ankle control
valgus and varus
DF and PF
the solid ankle has
max control
no movement
what should the solid ankle provide
resilient heel for heel strike or rocker bar to assist push off
when is solid ankle indicated
w/ spasticity or severe PF spasticity
MS, CP or progressive neurologic dzs
solid ankle shows –> balance
some improvement in static balance
negative effect on dynamic balance
what might we need to add for ambulation –> solid ankle
AD
what shows a significant improvement w/ gait –> solid ankle
adding a rocker bar (rigid AFO)
increases step length and velocity
improve toe off
solid ankle w/ flange
flange or extension added to calf shell
what does the flange do
to increase force arm or place of applying force
what does the solid ankle w/ flange increase
movement control
increased force arm
increased force arm –> solid ankle w/ flange
3 point pressure
middle force/central force in system
close to joint you want to control
foot plate –> solid ankle w/ flange
full
3/4 plate
anterior floor reaction design
solid ankle/sometimes in PF
posterior velco closure
high pre-tibial shell
high pre-tibial shell –> AFR
just below patella
higher than posterior
prevent knee from buckling
how does the AFR work
posterior directed force at tibia
extension moment at the knee
posterior directed force @ tibia –> AFR
prevent knee from buckling
what is the AFR good for
quad weakness
controls ankle movement
indication for AFR
quad weakness/excessive knee flexion - WBing
control ankle motion - WBing
spastic diplegic CP
spastic diplegic CP –> AFR
esp w/ moderate to severe knee flexion
what does the AFR show w/ research
improved gait kinematics
decreased DF and knee flexion
when is AFR most effective
w/ knee flexion contracture < or equal to 10 degrees
PLSO –> custom/stock
either
PLSO –> plane of control
sagittal
PLSO –> muscle weakness
anterior tib
PLSO –> gait cycle
HS/swing
mod PLSO –> custom/stock
either
mod PLSO –> plane of control
sagittal
frontal
mod PLSO –> muscle weakness
anterior tib
M/L muscles
mod PLSO –> gait cycle
HS
MS
swing
carbon PLSO –> custom/stock
stock
carbon PLSO –> plane of control
varies
carbon PLSO –> muscle weakness
depends on design
carbon PLSO –> gait cycle
HS/swing
solid ankle/ w/ flange –> custom/stock
custom
solid ankle/ w/ flange –> plane of control
all 3 planes
solid ankle/ w/ flange –> muscle weakness
all muscles (spasticity)
solid ankle/ w/ flange –> gait cycle
stance/swing
AFR –> custom/stock
custom
AFR –> plane of control
sagittal
(foot all 3)
AFR –> muscle weakness
all ankle muscles
quads
AFR –> gait cycle
stance/swing
recent addition
fxnal neuromuscular electrical stimulation
fxnal neuromuscular electrical stimulation has
cuff holding stimulator just below the knee
electrodes or foot switches to stimulate DF
what do you need w/ fxnal neuromuscular electrical stimulation
intact peroneal N
what doesnt the fxnal neuromuscular electrical stimulation work well w/
recurvatum
contraindications –> fxnal neuromuscular electrical stimulation
pacemaker
defib
metal implants
hx of phlebitis
