L23 Orthotic Devices

Question 1

Orthosis

Answer 1

• Greek orthos, meaning to “straighten”
• Provides functional stability to a joint or prevents, corrects, or compensates for a deformity or weakness
• Lend stability to weak joint
• Correct or maintain alignment
• Correct skeletal deformities
• Shoe insert  reciprocating gait orthosis

Question 2

Goals of Orthoses

Answer 2

• Maintain or maximize function
• Prevent deformity or contracture
• Improve positioning or range of motion
• Allow protection and position for proper healing and recovery
• Improve mobility and quality of life

Question 3

Orthotic Considerations

Answer 3

• Cost
• Energy efficiency
• Cosmesis
• Temporary vs. Permanent
• Therapeutic vs. Assistive
• Dynamic vs. Static
• Powered or non powered
• Encourage normal movement
• Facilitate movement
• Don/Doff

Question 4

Static

Answer 4

• prevent or limit motion
• No moveable parts
• Reduce stress and maintain joint alignment
• Prevent deformities and soft tissue contracture
• Scar reduction; reduce
  inflammation and pain
• Position for proper healing
• Protection against further injury

Question 5

Dynamic

Answer 5

*Facilitate movement
*Moveable parts
*Increase range of motion (ROM); stretch soft tissue contractures
*Assist muscle weakness or spasticity
*Allow for exercise -> improve ROM and strength

Question 6

Three-point pressure system

Answer 6

Principal force acting at or near joint opposed by two forces: one proximal and one distal to joint

Question 7

Leverage

Answer 7

mechanical advantage of a force applied at a distance from a fulcrum; increase lever arm length - decrease force necessary to stabilize joint - increase comfort

Question 8

Ground Reaction Force

Answer 8

Can be used to stabilize a joint more
proximal to orthosis

Question 9

Axial Forces

Answer 9

Directed along the long axis of the bone; reduce axials force by transferring weight through an orthosis

Question 10

Pressure

Answer 10

force over area; generally beneficial to distribute forces that orthosis applies to body over a large area

Question 11

Shear stress

Answer 11

Caused by tangential forces applied to loading bearing surface of the body; minimize shear stress at the interface between body and orthosis

Question 12

Creep

Answer 12

Time-dependent strain or change in shape of material due to stresses and loading; depends on stiffness and viscoelastic properties of material; creep occurs in muscles and soft tissues

Question 13

Cervical Orthoses

Answer 13

hard and soft

Question 14

Cervical thoracic (CTO)

Answer 14

provides motion control in all three planes

Question 15

Cervicothoracolumbosacral (CTLSO)

Answer 15

Treatment of scoliosis; end point
control, transverse support and correction of the curve

Question 16

Spinal Orthoses

Answer 16

• Cervical (CO)
• Cervical thoracic (CTO)
• Thoracolumbosacral (TLSO)
• Lumbosacral (LSO)
• Cervicothoracolumbosacral (CTLSO)

Question 17

Lower Limb Orthoses

Answer 17

• Foot Orthoses (FO)
• Ankle-Foot Orthoses (AFO)
• Knee Orthoses (KO)
• Knee-Ankle-Foot Orthoses (KAFO)

Question 18

Foot Orthoses (FO)

Answer 18

Aemi rigid or rigid inset that corrects foot alignment, improves function, relieves pain

Question 19

Ankle-Foot Orthoses (AFO)

Answer 19

Controls amount of dorsiflexion and plantarflexion of ankle; CP, foot drop, weak muscles

• Semi-rigid L-shaped braces stabilize both the foot and ankle to bring muscles and joints into alignment.
• braces extend up the calf,
• made of metal or hard plastic
• straps that can hold the device in place
• bring stability to foot, ankle and lower leg
• used to correct foot drop.
• AFOs account for 26 % all orthotics in US

Question 20

Knee Orthoses (KO)

Answer 20

Provide support, correct deformity, prevent injury, knee OA

Question 21

Knee-Ankle-Foot Orthoses (KAFO)

Answer 21

Severe knee extensor and hamstring weakness, knee instability, spasticity of hamstrings; persons with SCI

Question 22

Process for Making AFOs

Answer 22

1- Taking measurement of the body segment
2- Taking a negative impression
3- Creating a positive model
4- Modifying the positive model
5- Shaping the orthosis or prothetic socket
6- Fitting to the patient

Question 23

3D Printed AFOs

Answer 23

• CYBER team (University of Michigan, Altair Engineering and Stratasys) to transform the design, comfort, utility and customization of Ankle Foot Orthotics (AFO)
• create the digital workflow for additive manufacturing design
• fused deposition modeling (FDM®) fabrication methods and Altair® OptiStruct® analysis software for the production of customized ankle-foot orthoses (AFO)

Question 24

3D Printed Foot Orthoses

Answer 24

• Clemson University
• foot problems from diabetes need foot
  orthotics that can take weeks to make and
  are not always the right softness
• 6 or 7 foam-like materials

Researchers at Clemson:
* Laser scan patient’s foot and use pressure sensing
to identify high pressure areas
* Create an orthotic with 3D printing
* Vary the hardness of the material in a
thousand different blends
* Alter the internal geometries to make them harder or softer in different areas

Question 25

Hocoma Lokomat

Answer 25

* Driven gait orthosis * Used to treat individuals with neurological diseases or injuries such as stroke, SCI, brain injury, MS and cerebral palsy

Question 26

Upper Limb Orthoses

Answer 26

* Finger Orthoses: immobilization of specific joints * Hand Orthoses: arthritis; immobilization after surgery * Wrist-Hand Orthoses (WHO): rheumatoid arthritis, stroked, radial nerve palsy * Elbow Orthoses (EO): posterior or anterior immobilization * Shoulder Orthoses: after humerus fracture or shoulder surgery * Shoulder-Elbow-Wrist-Hand Orthoses (SEWHO): brachial plexus injury, after burns for prevention of contractures

Question 27

Static Orthosis

Answer 27

* A rigid device with no moving parts * Fabricated from plaster or low emperature thermoplastic materials Indications for Static Orthotic Intervention * To support body part during the acute phase of injury * To support unstable joints or inflamed tissues * To protect repaired structures * To substitute for decrease muscle function * To prevent or minimize undesired motion * To maintain ROM increases

Question 28

Serial Static Orthosis

Answer 28

A rigid device fabricated low temperature thermoplastics or plaster that provides progressive mobilization as ROM is gained

Question 29

Static Progressive Orthosis

Answer 29

* Similar to serial static * Component pieces are included with the thermoplastic orthosis –to progress ROM * MERiT (maximize end range time) –or TERT (Total End Range Time)

Question 30

Indications for Serial Static or Static Progressive Orthosis

Answer 30

* To resolve joint stiffness, soft tissue or tendon tightness to increase PROM * Recommended for long-standing scar or adhesion difficulty * The scare is encouraged to grow

Question 31

Dynamic Orthosis

Answer 31

A rigid device with moving parts that provides mobilization to joints and soft tissues through adjustments of the components Indications for Dynamic Orthoses * To resolve joint stiffness or tendon tightness * To provide muscle substitution * To correct or minimize joint deformities * To allow controlled mobilizing forces