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Prosthetics&Orthotics > L8: Orthotics for Managing NMSK and MSK Impairment > Flashcards

L8: Orthotics for Managing NMSK and MSK Impairment Flashcards

1
Q

Orthotics and NMSK Impairment

HypOtonicity

A

LMNL→ spina bifida, PN injuries, some CVAs, polio, SCIs

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2
Q

Orthotics and NMSK Impairment

Athetosis

A

Fluctuating muscular tone

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3
Q

Orthotics and NMSK Impairment

HypERtonicity

A
  • CVA, CP, SCIs
  • Vs. Spasticity→ spasticity is velocity-dependent*
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4
Q

Orthotics and NMSK Impairments

A

“Functional” vs. “Abnormal Tone”

Functional→ the USE tone for functional tasks, may not benefit them to “fix” it

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5
Q

Orthotics and NMSK Impairments

Cases you may come across

A

HypOtonicity, Athetosis, HypERtonicity, “Functional” vs. “Abnormal” tone

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6
Q

Brunnstrom Stages of Recovery (for abnormal tone)

Stages I→VI

A
  • Stage I: Flaccidity (immediately after onset)
  • Stage II: Spasticity Appears
  • Stage III: INC in Spasticity
  • Stage IV: DEC in Spasticity
  • Stage V: Further DEC in Spasticity
  • Stage VI: Disappearance of Spasticity
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7
Q

Brunnstrom Stages of Recovery + Orthotic Options

Stage I: Flaccidity (immediately after onset)

A

Flaccidity (immed. after onset)

  • NO “voluntary” mvmts of affected side
  • Orthotic options: Goal==> stability
    • Ankle→ MAFOs, non-articulated AFO, DF assist
    • Knee→ single-axis (locked), offset KAFOs
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8
Q

Brunnstrom Stages of Recovery + Orthotic Options

Stage II: Spasticity Appears

A

Spasticity Appears

  • Basic synergy patterns→ no longer isolated mvmts
  • MIN voluntary/isolated mvmts
  • Pt gains control over voluntary synergies
  • Orthotic options:
    • Ankle→ MAFOs, hinge ankle, DF assist
    • Knee→ single-axis (lock/unlock), offset KAFO
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9
Q

Brunnstrom Stages of Recovery + Orthotic Options

Stage III: INC in Spasticity

A

INC in Spasticity

  • Synergy patterns still predominate→ some mvmt patterns out of synergy mastered
  • Orthotic Options: as previous, AND:
    • If edema mod-severe→ Metal upright AFO to accomodate
  • ADD: length+firmness to footplate, tone inhibiting bumps, INC ht in trimlines, add thickness of varying deg to plastic
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10
Q

Brunnstrom Stages of Recovery + Orthotic Options

Stage IV: DEC in Spasticity

A

DEC in spasticity

  • W/ progress→ more complex mvmt combos learned as basic synergies lose dominance
  • Orthotic options: As previous, whatever is approp.
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11
Q

Brunnstrom Stages of Recovery + Orthotic Options

Stage V: Further DEC in Spasticity

A

Further Dec in Spasticity

  • Re-Eval foot/ankle, gait, posture and functional defs
  • Functional prognosis more clear→ gait defs/compensations more defined
  • Orthotic options: depends on motor control
    • PLS, spiral/hemispirals, DF assist/PF stop, stance/swing phase KAFOs
  • As they progress thru stages→ MORE DOFs!! vs max stability needed EARLIER***
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12
Q

Brunnstrom Stages of Recovery + Orthotic Options

Stage VI: Disappearance of Spasticity

A

Disappearance of Spasticity

  • Indiv jt movements/Coord. approaches normal
  • Orthotic options: as above but re-eval in order to optimize function*
  • Ideally MINIMAL orthotic→ Maintain stability and Promote mobility w/ progress. gait
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13
Q

Orthotics and NMSK Impairment

Orthotic use typ adjunct to OTHER interventions to MIN. spasticity

A
  • Oral meds, injections (botox), Sx’s,
  • Selection of approp. AFO may change w/ ea. procedure/prognosis:
    • Goal==> Optimize function/safety!
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14
Q

Orthotics and NMSK Impairment

ID exactly where in Gait Cycle abnormal tone or mm function is impaired

All phases:

*long but just keep reading it!!!

A
  • IC→
    • Full knee ext? What part of foot making contact first? (forefoot w/ spastic PFs)
  • LR→
    • Limb loaded effectively? If not, what is compromising loading (tone, contractures, strenght/power)?
  • MSt→
    • Tone inhibits tibia progressing over foot? Adeq hip/pelvic control?
  • MSt-TSt→
    • Transition from mobile adaptor to rigid lever for heel rise? Contd forward progress of trunk and pelvis w/ hip ext?
  • PSw→
    • Toe rocker? Can knee pre-flex before Sw to clear foot?
  • Swing→
    • Adeq clearance of limb? Adeq DF, knee flex and hip flex?
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15
Q

Orthotics an MSK Impairment

Orthopedic use of orthotics Correction and Management of:

A
  • Congenital/Develop. disorders, Overuse injuries, Systemic dis’s, Neoplasms
  • Ex. Overuse→ T/S compress. Fx w/ OP
    • limit motion, bracing→
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16
Q

Orthotics an MSK Impairment

Indications for Hip Orthotics:

A
  • Inadeq/ineff. dev. of acetabulum and head of femur→ infancy
  • AVN of femoral head
  • Loss cartilage and abnorm bone deposition assoc. w/ OA
  • Loss bone strength/density→ OP
17
Q

Orthotics an MSK Impairment

Orthotic mgmt of hip dysf:

Specific Ex’s

A
  • Legg-Calve Perthes (dev. dysplasia hip)
  • Post-op in adults
  • Soft tissue contractures/post-sx lengthening (ADDs)
  • Trauma
18
Q

Orthotics an MSK Impairment

Hip Orthoses do what to joint?

A

Protect or position joint w/in desirable range of flex/ext and Add/Abd

*will NOT control IR/ER alone

19
Q

Orthotics and MSK Impairment→ Developmental Dysplasia of Hip (DDH)

What is it?

A
  • Dysplasia, sublux, disloc.
    • breech births, hypERmobility, malpos. in utero
      • Extreme flex or adduction or extreme IR
  • Result→ femoral head not sitting properly in acetabulum→ won’t form in first year
20
Q

DDH and infants dx’d from birth→ GOLD STANDARD brace???

A

Pavlik Brace

21
Q

Pavlik Brace GOLD STANDARD for:

22
Q

Orthotics and MSK Impairs: DDH

Bracing (infants)

A
  • GOLD STANDARD→ Pavlik Brace
    • Pos’s femoral head in Flex (100-120degs) and Abd (30-40degs)→ Norm dev. of hips
    • LIMITS→ EXT/ADD
  • should be able to kick actively (proprio)
  • Progress wearing 24h/day to night or naptime
23
Q

Orthotics and MSK Impairs- DDH (Toddlers-School Age)

Older infants dx after 6mos…

A

ABD brace OR Hip Spica

*Scottish-Rite brace

24
Q

Orthotics and MSK Impairs- DDH (Toddlers-School Age)

Hip ABD brace→ how’s it set?

A

Set in 90degs Flex and 30-45degs ABD→ uses “bar” connecting LEs

*easier to hold/bathe

25
Q

Orthotics and MSK Impairs

Legg Calve-Perthes (LCP)

A
  • Healthy school-aged children
  • Flattening of femoral head and AVN (now unstable)
  • Goal of Orthotic→ Contain femoral head w/in acetabulum during active stages of dis. to ensure optimal remodel
26
Q

Orthotics and MSK Impairs:

LCP→ Bracing

A
  • Atlanta/Scottish-Rite brace
    • holds hips in 30-45* of ABD
27
Q

Orthotics and MSK Impairs

DDH

28
Q

Orthotics and MSK Impairment:

Fx (post-Sx) Orthoses

*we want pressure off and promote healing

Designed to?

A
  • Maint. body part in optimal alignment, limit jt motion, unload WB forces
  • Total contact thermoplastic circumferential control of fx site while allowing mobility
    • will not unload jt completely
29
Q

Orthotics and MSK Impairs:

Fx (post-sx) Orthoses

Fx stability enhanced how?

A
  • Hydrostatic pressure forces created as rigid wall of orthosis compress soft tissue and mm.
  • Lever arm created by extension of orthosis above/below Fx***
30
Q

Orthotics and MSK Impairments:

Fx (post-sx) Orthoses

Orthotic options:

A
  • Short leg walkers (walking boot) w/ rocker bottom→ severe sprains, Achilles injury)
  • Ankle-foot fx orthosis
  • KAFO
  • PTB Fx orthosis

Prosthetics&Orthotics (19 decks)

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