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735: Orthotics and Prosthetics > Introduction to Orthotics > Flashcards

Introduction to Orthotics Flashcards

1
Q

What is an orthotist?

A

A person who specializes in the design, fabrication, fitting, and alignment adjustment of orthoses

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2
Q

What is an orthosis?

A

any device added to the body to stabilize or immobilize a body part, prevent deformity, protect against injury, or assist with function

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3
Q

What are the 4 basic goals of orthoses?

A
  • Maintain or correct body segment alignment
  • Assist or resist joint motion
  • Provide axial loading via the orthosis, therefore providing relief of distal weight bearing forces
  • Protect against physical insult
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4
Q

In regards to function what are the ideal characteristics of an ideal orthosis?

A
  • Meets the individuals mobility needs and goals
  • Maximizes stance phase stability
  • Minimizes abnormal alignment
  • Minimally compromises swing clearance
  • Effectively pre-positions the limb for initial contact
  • Is energy efficient with the individual’s preferred assistive device
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5
Q

In regards to comfort what are the ideal characteristics of an ideal orthosis?

A
  • Can be worn for long periods without damaging skin or causing pain
  • Can be easily donned and doffed
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6
Q

In regards to cosmesis what is the ideal characteristic of an ideal orthosis?

A

Meets the individual’s need to fit in with peers

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7
Q

What are the 6 types of LE orthoses?

A
  • foot orthosis (FO)
  • ankle foot orthosis (AFO)
  • knee orthosis (KO)
  • knee ankle foot orthosis (KAFO)
  • hip knee ankle foot orthosis (HKAFO)
  • hip orthosis (HO)
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8
Q

What are 2 categories of FOs?

A
  • accommodative

- corrective

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9
Q

When and how is an accommodative foot orthosis used?

A

When the foot cannot attain neutral a FO may shim the gap to fix the positioning

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10
Q

How does a corrective foot orthosis work?

A

It helps the foot attain a neutral position by either unloading compromised tissue or providing total contact

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11
Q

What are 5 types of foot orthoses?

A
  • heel wedges/posting
  • SACH heel with rocker sole
  • metatarsal bars
  • University of California Biomechanics Laboratory (UCBL)
  • Supra Maleolar Orthosis (SMO)/Dynamic Ankle Foot Orthosis (DAFO)
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12
Q

What are the most common prescribed external shoe modification?

A

The rocker sole and solid-ankle cushion-heel (SACH) heels

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13
Q

How do rocker soles assist with gait?

A
  • mimic action of the forefoot joint
  • aid in roll off
  • simulate forefoot dorsiflexion
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14
Q

When can a SACH heel with a rocker sole be used?

A

whenever there is minimal or no motion at the forefoot joint or hindfoot joint, due to fusion, fracture, cast immobilization, orthosis design, pain, or arthritis

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15
Q

What is the purpose of the metatarsal bars?

A

The flat surface placed behind the metatarsal heads can help relieve pressure on the heads themselves

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16
Q

When should met bars be sued?

A

In patients with metatarsalgia who would benefit from a rapid transfer of weight from the shafts of the metatarsal heads to the distal end of the toes, with limited extension of the digits

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17
Q

Met bars are typically __ inch in vertical height

A

1/4

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18
Q

What is the major difference between metatarsal bars and rocker soles?

A

Met bars have a much flatter plantar surface, providing a broader area of contact with the ground

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19
Q

What does UCBL stand for?

A

University of California Biomechanics Laboratory orthosis

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20
Q

The UCBL is an orthotic intervention for what joint instability?

A

subtalar

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21
Q

The UCBL controls what 2 types of deformities?

A
  • flexible calcaneal deformities (rearfoot valgus or varus)

- deformities of the midtarsal joints (forefoot abduction or adduction)

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22
Q

How does the UCBL control calcaneal and midtarsal deformities?

A

By grabbing the calcaneus and supporting the midfoot with high medial and lateral trim lines, which improves the angle of pull of the Achilles tendon, providing a more stable foundation for the articular surfaces of the talus, navicular, and cuboid bones.

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23
Q

The UCBL is also used to improve the functional alignment of children and adolescents with what deformity?

A

flexible pes planus (a longitudinal arch deformity)

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24
Q

Supra Maleolar Orthosis (SMO) are also known as what?

A

DAFO=Dynamic ankle foot orthosis

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25
Q

SMOs/DAFOs possess a low profile design that crosses the ankle, however they have ___ invasive trim lines than a standard AFO

A

less

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26
Q

What are the 2 functions of the DAFO?

A
  • provides sagittal plane control of the ankle and foot during stance
  • facilitates foot clearance during swing
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27
Q

Where do the DAFOs proximal trim lines fall? Distal?

A

just superior to the ankle joint

they encase more of the forefoot

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28
Q

The DAFO is extremely helpful in what patient population? Explain why and how…

A

In children with mild to moderate diplegic cerebral palsy, because it is designed to redistribute plantar pressures by reducing overall stimulation of reflexes that otherwise reinforce extensor hypertonicity

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29
Q

By providing a stable base during stance phase what 4 gait parameters does the DAFO improve in children with spastic diplegia?

A
  • swing limb clearance
  • stride length
  • cadence
  • self-selected walking speed
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30
Q

What is the biggest complain of DAFO use?

A

Sweaty feet due to the confinement of the foot within the plastic DAFO shell and shoe

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31
Q

What are the 5 categories of ankle foot orthoses?

A
  • Metal bars
  • Total Contact
  • Floor reaction
  • Unweighting
  • Immobilizing
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32
Q

What is the SAFO aka?

A

Rigid AFO

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33
Q

What is the solid AFO typically made of and why?

A

A relatively thick thermoplastic to hold the ankle in foot in a biomechanical neutral position

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34
Q

The proximal border of the solid AFO is typically trimmed to fall 1.5 inches below what bony landmark?

A

head of the fibula

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35
Q

The footplate can be lengthened beyond the metatarsal heads distally into a toe plate if what is a concern?

A

hypertonicity

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36
Q

What is a disadvantage of having a longer footplate on the solid AFO?

A

it is more difficult to don shoes

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37
Q

How many control systems are incorporated into the SAFO design?

A

4

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38
Q

Describe the first control system in the SAFO for the control of plantarflexion during swing phase

A

There is a fulcrum force applied at the anterior ankle (Velcro, strapping, shoe laces) that is opposed by a distal counterforce upward under the metatarsal heads and a proximal counterforce at the posterior proximal surface of the AFO

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39
Q

Describe the second control system in the SAFO for the control of dorsiflexion during stance phase

A

There is an upward and inward compressive force at the posterior heel, opposed by a distal downward counterforce delivered by the shoe, and a proximal force applied by the anterior closure straps just below the knee

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40
Q

Because the ankle is locked in a SAFO there is a(n) ______ moment at the knee during stance

A

extensor

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41
Q

Because of its ability to create an extensor moment during stance a SAFO is useful in what types of patients?

A

Those with stroke, cerebral palsy, or other neuromotor dysfunction

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42
Q

Describe the third control system in the SAFO for the control of varus and inversion of the foot

A

A medially directed force is applied just above and below the lateral malleolus with laterally directed counterforces at the proximal medial tibia and the medial foot

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43
Q

Describe the fourth control system in the SAFO for the control of valgus and eversion of the foot

A

A laterally directed force is applied just above and below the medial malleolus with medially directed counterforces at the proximal medial tibia and the medial foot

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44
Q

When are bilateral metal uprights/bars used?

A

Only in specific situations such as a polio patient has been using them their entire life

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45
Q

Solid AFOs can take on different styles, what are a few of them?

A
  • carbon fiber
  • spiral
  • posterior leaf spring (provides flexibility at the ankle)
  • dynamic
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46
Q

What are a few advantages to using a total contact AFO?

A
  • They provide a sleek, intimate fit with total contact to provide better control
  • They are lightweight and easy to conceal
47
Q

How should a total contact AFO be adjusted if there is midtarsal joint deformity with forefoot abduction or adduction?

A

trim lines are adjusted to capture the shafts of the first and fifth metatarsals

48
Q

How should a total contact AFO be adjusted if there is too much subtalar valgus?

A

the height of the medial wall is increased, and a flange might be placed proximal to the medial malleolus

49
Q

The overall goal of total contact AFOs is to limit what?

A

knee hyperextension

50
Q

Floor reaction AFOs (FRO) use floor reaction forces through the tow aspect of the foot plat to prevent what?

A

forward tibial progression and subsequent knee collapse

51
Q

In what type of patients is a floor reaction AFO typical used in?

A

Those with quadriceps weakness and decreased motor control of the knee, such as CP children with crouched gait and those post polio

52
Q

Floor reaction forces do help to limit forward tibial progression and knee collapse it can be assumed these patients will still require the use of what type of AD?

A

Lofstrand crutches or roller walker

53
Q

What type of patients are FROs not appropriate for?

A
  • genu recurvatum

- ACL deficient knees

54
Q

What transtibial socket type does the unweighting AFO utilize?

A

patellar tendon bearing

55
Q

When are immobilizing AFOs commonly used?

A

Following a LE injury when ankle immobilization is desired such as distal tib-fib fracture, foot bone fractures, tendocalcaneous rupture, and possible in a diabetic foot that has developed Charcot’s foot

56
Q

What are 2 specific immobilizing AFOs?

A
  • Crow AFO

- CAM Walker

57
Q

In what patient type is a Crow AFO used in?

A

Charcot ankle and foot and patients with chronic plantar ulcerations

58
Q

True or False

AFOs can be articulated or nonarticulated

A

True

59
Q

If motion assistance is the desired effect how can the double action ankle joint accomplish this?

A

a coil spring is placed in the channel and a screw is used to adjust compression until the desired level of assistance is achieved

60
Q

If motion resistance is the desired effect how can the double action ankle joint accomplish this?

A

A solid steel pin is inserted instead of the spring to stop motion beyond a particular point in the ROM

61
Q

How does functional neuromuscular electrical stimulation work?

A

A cuff containing small electrodes positioned laterally over the peroneal nerve allow for dorsiflexion activity

62
Q

What are a couple of examples of wearable FES units?

A
  • The Hanger WalkAide System

- Odstock Dropped Foot Stimulator

63
Q

What are 3 reasons a knee orthosis may be used?

A
  • genu varum
  • genu valgum
  • genu recurvatum
64
Q

What are 3 types of KOs?

A
  • Athletic KO
  • Non-articulated KO
  • Custom or off the shelf KO
65
Q

Athletic knee orthoses are typically _____ and a major sensation that plays a role is proprioception

A

preventative

66
Q

Why are athletic KOs sometimes considered controversial?

A

The short lever arms may not be sufficient to diminish realistic damaging forces

67
Q

Describe a non-articulated KO

A

They are used for short term use and often make transfers and gait difficult

68
Q

What is a name brand of a non-articulated KO that is used in patients with genu recurvatum?

A

Swedish knee cage

69
Q

Off the shelf KOs provide _____ control of the knee and restrict what?

A

limited

gross motion

70
Q

When are knee-ankle-foot orthoses considered?

A

Only when stability during stance cannot be effectively provided by one of the AFO options

71
Q

KAFOs are prescribed when there is impairment of ankle control as well as what 2 other things?

A
  • hyperextension or recurvatum that jeopardizes structural integrity of the knee joint
  • abnormal or excessive varus or valgus angulation that occurs during weight bearing in stance phase
72
Q

What are the 3 KAFO subtypes?

A
  • Single/Double bar (upright) KAFO
  • Total contact KAFO
  • Ischial Weight Bearing (unweighting) KAFO
73
Q

What are 5 advantages to using a single/double bar KAFOs?

A
  • accommodates volume fluctuations
  • cooler than total contact
  • highest material strength
  • has locking abilities
  • can utilize various knee joints
74
Q

What are 2 advantages of total contact KAFOs?

A
  • more customizable

- distribute the load better

75
Q

What is the brand name of the type of orthosis that is a lightweight variation of a traditional KAFO designed for persons with paraplegia after SCI?

A

Craig Scott Orthosis

76
Q

How does the Craig Scott Orthosis in combination with posture provide stability?

A

Patients tend to stand with hip hyperextension, exaggerated lumbar lordosis, and a backward leaning trunk which when combined with the orthosis’ dorsiflexion-assist ankle joints and offset locking knee joints requires little or no muscular activity to provide enough stability for a two-point swing-through gait pattern when used with Lofstrand crutches

77
Q

In what type of patients are ischial weight bearing or unweighting KAFOs used in?

A

paralytic limbs

78
Q

What are the disadvantages of using hip-knee-ankle-foot orthoses?

A

They are very restrictive and laborious to swing-to or through in gait

79
Q

What types of patients utilize hip-knee-ankle-foot orthoses?

A
  • children with myelomenigocele

- SCI patients

80
Q

What are 4 types of HKAFOs?

A
  • Reciprocating Gait Orthoses (RGO/ARGO)
  • postural
  • total contact
  • leather and metal upright
81
Q

How does a reciprocating gait orthoses (RGO) work?

A

It uses the flexion power of one hip to extend the opposite hip

82
Q

What types of special postural equipment is considered a HKAFO

A
  • standing frames
  • parapodiums
  • swivel walkers
83
Q

What is a disadvantage of RGOs?

A

Require high energy consumption so they never really have been functional for most SCI patients

84
Q

In what types of patients are hip orthoses (HOs) used?

A

In children with Leg calve Perthes disease (AVN) or congenital hip dislocations

85
Q

What does SWASH orthosis stand for?

A

Standing Walking And Sitting Hip Orthosis

86
Q

What is the purpose of a SWASH orthosis?

A

Maintains femoral abduction in standing, walking and sitting

87
Q

When is a hip abduction orthosis used?

A

In patients post-operatively to position the femoral head optimally within the acetabulum

88
Q

Describe the components of bilateral metal upright AFOs

A

calf band and stirrups

89
Q

What is the advantage of a carbon fiber AFO?

A

they are energy returning

90
Q

Describe the cons of a spiral AFO

A

There is limited control in all planes (master or none)

91
Q

What is the most commonly used AFO?

A

posterior leaf spring AFO

92
Q

Describe the shape of the posterior leaf spring AFOs and the outcomes of the design

A

It has a skinny AP trim line which does not allow for good ML support

93
Q

What is the advantage of a dynamic AFO?

A

contains an aggressive spring assist due to the fact that it tilts forward

94
Q

Add to DOUBLE ACTION ANKLE

What does BiCAAL stand for?

A

Bichannel adjustable ankle lock

95
Q

What is the most commonly used AFO? What is it used for?

A

posterior leaf spring (PLS) AFO

prevention of foot drop

96
Q

Add to DOUBLE ACTION ANKLE

What does BiCAAL stand for?

A

Bichannel adjustable ankle lock

97
Q

Describe the BiCAAL

A

An AFO that contains an ankle joint with the anterior and posterior channels that can be fit with pins to reduce motion or springs to assist motion

98
Q

What is the Klenzak housing AFO?

A

A spring assist AFO that has double metal uprights with a single anterior channel for a spring assist to aid dorsiflexion

99
Q

What determines the limits of ankle dorsiflexion in an AFO?

A

the anterior (DF) stop

100
Q

What is the anterior stop typically set at in AFOs?

A

5 degrees

101
Q

What does the 5 degrees of ankle dorsiflexion allow for?

A

knee flexion

102
Q

What is the result if the anterior stop is set greater than 5 degrees?

A

The knee could buckle

103
Q

What determines the limits of ankle plantarflexion in an AFO?

A

posterior (PF) stop

104
Q

What is the posterior stop typically set at in AFOs?

A

5 degrees

105
Q

What does the 5 degrees of ankle plantarflexion allow for? What are the benefits of this?

A

knee extension

It can be used to control an unstable knee that has a tendency to buckle

106
Q

What is the result if the posterior stop is set greater than 5 degrees?

A

genu recurvatum or knee hyperextension

107
Q

What do T straps do?

A

control varus and valgus at the ankle

108
Q

A medial T strap buckles around the lateral upright and correct for _____

A

valgus

109
Q

A lateral T strap buckles around the medial upright and correct for _____

A

varus

110
Q

What are 2 types of KAFOs that can be used in SCI patients to walk with the knee locked?

A
  • drop ring locks

- Pawl lock with bail release

111
Q

Describe how the Pawl lock with bail release KAFO works

A

It hooks on to the back of a chair to push it up and unlock the knee

112
Q

Add after HIP ORTHOSIS

What is a patellar bottom attachment used for?

A

To keep the foot off the floor in NWB patients

113
Q

What is required when using a patellar bottom attachment?

A

a lift on the opposite LE

114
Q

In what patient population is a patellar bottom attachment used in?

A

Legg-Calve Perthes disease

735: Orthotics and Prosthetics (14 decks)

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