L2 Orthotic Exam Flashcards
Pre-Orthotic Exam
Interview
Chart Review
Outcome Measures
Assessment of function/task analysis
impairment test
What subjective might lead you to consider the need for an orthotic device?
instability at ankle or knee
history of falls
injury
reports of decreased gait endurance or gait speed
Orthotics Prosthetics Users Survey
self reported questionnaire
5 modules
maintain awareness of improvement in activity
evaluate changes in functional status and QOL
Task analysis
when functional activity is limited, this can be used to ascertain the impairments that might restrict the individual’s ability to perform the functional task
Outcome measures that can be used
10 meter walk test
6 minute walk test
functional gait assessment
TUG
box and blocks test
action research arm test
Assessment of function with trial device
use of trial orthotic device to immediately compare function with and without orthotic device
Immediate effect
testing without an orthosis followed by retesting immediately after donning an orthosis
Training Effect
testing with the orthosis, followed by a period of use with the orthosis, then re-testing with the orthosis
Therapeutic Effect
testing without the orthosis, followed by a period of use with the orthosis, the retesting without the orhtosis
Combined effect
cumulative effects of both the immediate and training effects. initial test without the device followed by a period of training and then retesting with the device
Evaluation of Impairments
confirm whether or not the client has the impairments suspected based upon the functional analysis
gather info related to the specific region of the body that may require an orthosis
exam to include relevant aspects of the body
Fixed or structural deformities
should be accommodated or supported by an orthosis
Flexible or non-fixed deformity
an orthosis should be designed to apply corrective forces
Impaired proprioception
pts with impaired proprioception may require bracing even in motor function is adequate
Increased muscle tone
may require a more rigid or restrictive orthosis
Cardio/Pulmonary Implications for orthotics
- fluctuating edema = challenging fit
- PVD affects the quality of skin, more skin breakdown. slower healing time
- energy expenditure
What goal categories should you use for an orthotic?
functional goals
specific goals for orthosis
Patient or Function Based Goals
improving independence with functional mobility
independence with donning/doffing device
independence with wear schedule
independence with skin inspection
Orthotic Goals
- to assist joint movement when it is insufficient
- to stabilize a joint by stopping or limiting motion when it is excessive, abnormal, or unwanted
- to protect a joint from excessive, unwanted or deleterious loading or forces that may cause pain or injury
- to assist in the management of joint or skeletal deformities
Key components of orthotic prescription
medical and treatment diagnosis
impairments that affect function
functional goal for orthosis
specific orthotic goals
location of orthosis
any specific device recommendations
precautions
justification of need
Orthotic Justification
- Describe need
- Include an explanation of how orthosis will enhance or maitain functional mobility
- Length of need of orthosis
- Patient’s condition (must have neuro, circulatory, or ortho diagnosis)
AFO Specific Justification
Must include statements of the following:
1. Patient is ambulatory
2. Pt has weakness or deformity of ankle/foot
3. Patient requires stabilization for medical reasons
4. Patient has ability to benefit functionally from orthotic device
KAFO Specific Justification
must include following statements
1. patient is ambulatory
2. patient has weakness or deformity of ankle or foot AND requires knee stability
3. Requires stabilization of foot, ankle, knee for medical reasons
Orthotic Checkout Exam
done after the patient receives orthosis and returns to therapy
exam of orthotic device
re-exam of client’s physical status
exam of orthosis on client, static
exam of orthosis on client, dynamic
exam of the skin after 30 min
Initial Wear Schedule
Day 1 = wear time 1 hour, split between AM/PM
Continues as so up through day 4 (increase the hour to match the numerical day)
Day 5 = can increase wear time at your discretion
Patient Ed on skin checks
after every wear, patient should remove shoes, device, and socks, then check skin
any redness should go away with 15-20 min
if redness continues, stop wearing the orthosis and contact orthotist
Observation of client’s physical status
observe changes in body weight, girth, ROM, functional status
Exam of orthosis on client, static
joints are aligned properly, no areas of excessive pressure, static balance is fine
Exam of orthosis, dynamic
orthosis is stable, functions as prescribed, no excess skin pressure or irritation, does the pt need extra training, is the patient satisfied