L4 UE Orthotics Flashcards
Orthosis refers to
permanent device to replace or substitute for loss of function
Splint refers to
temporary device that is part of a treatment program
Medicare now requires…
any device applied by an orthotist or therapist to be called an orthosis
Therapist fabricated
typically work with low temp thermoplastics that can be directly applied to skin
faster to make, patients leave with device on same day, not as durable, easy to adjust
Orthotist Fabricated
work with high temp thermoplastics
requires casting, takes days to fabricate, durable, better for long term, less easy to adjust
Biomechanical Reference
using principles of kinetics and forces acting on the body, a unique combination of physics and physiology
Make sure to
minimize pressure!
avoid shear force and ischemia
Continuous force applied to extremity should not exceed
50 gm/cm2
Managing Pressure
-pressure is more critical in areas w/less tissue
-assess tissue tolerance to pressure or shear force
-provide max contour
-don’t add padding, create area of relief then pad
Forearm based orthosis should cover
2/3 of the forearm in length
width should be 1/2 the circumference
edge should be rounded/flared
Stabilizing force
prevents migration or rotation of the orthosis on the arm can be used to protect unstable system like a fx or serve as a base for mob as in static progressive orthosis
Manipulatory forces
static forces that direct or control internal and external forces to produce desired outcome
Actuating forces
require a system to generate a dynamic force
Sensorimotor approach
used for individuals having damaged central nervous systems to inhibit or facilitate normal motor responses
Rehabilitative approach
focusing on ability to facilitate return to max function
Finger based
dorsal or volar mallet and which joint
Hand based
thumb spica vs flexion block or extension block
Forearm based
wrist cock up, ulnar or radial gutter, thumb spica
What pathology can benefit from an orthosis?
fractures
inflammatory processess
limiting motion while structures are healing
weakness/paralysis
promoting mobility active and passive
Immobilization/static orthosis
immobilize for fracture healing
position to prevent deformity (like burned hand)
rest tissue to decrease inflammation
Purposes of serial static or static progressive
sub for loss of motor function
correct an existing deformity
provide controlled motion
aid in fx alignmnet and wound healing
restriction orthoses
allow controlled motion to facilitate safe mobility to keep tendons gliding and limit soft tissue contracture while protect healing structures
Thermoplastic high temp
tolerates high force like weight bearing without failure
Thermoplastic low temperature
heated in water between 135 to 180, can be draped directly on the skin
Properties of thermoplastic materials
memory
drapability
elasticity
bonding/ self adherence
self-finishing edges
Memory
ability to return to original shape
Drapability
ease with which the material conforms to the underlying shape
Elasticity
the material’s resistance to stretch and tendency to return to previous shape after stretch
material can be worked more aggressively
useful for less cooperative patient
Creases of hand
mark where edege of the orthosis needs to end to allow motion distally
Longitudinal arch
formed by phalanges and mcp flexion and extension
Distal transverse arch
formed by carpal bones
proximal transverse arch
formed by MCP joint
Prehension Patterns
tip
lateral
tripod
spherical
power
extension
Dorsal wrist cock up
used if palm needs to be free
can be the base for dynamic orthosis
less supportive due to weight of hand on small bar, but potential for pressure
must relieve ulnar styloid dorsally
Volar Wrist Cockup
most commonly used
two types; radial bar and thumb hole
Radial bar volar wrist cock up
easier to adjust bar, but frequently velcro comes off bar as it is such a small piece of velcro
Thumb hole volar wrist cock up
no hook velcro needed to attach distal loop velcro
needs to clear thenars and CMC jt with hole for thumb
Why use a custom wrist orthosis?
radial nerve palsy
zone 5 extensor tendon laceration
tenosynovitis
ganglion
TFCC
Be cautious…
know your limitations
refer out when possible
consider off shelf when appropriate
