L8 UE Orthoses Flashcards
Orthosis Definition
externally applied device used to modify the structural and functional characteristics of the neuro muscular and skeletal systems by applying forces to the body
Types of orthoses
static
serial static
static progressive
dynamic
functional
All orthoses should come with…
education
differentiates PTs from orthotic fitters/techs
Orthoses can be either
fabricated or off the shelf
Functions of orthotics
immobilization
positioning
mobilization
What are the benefits of immobilization with orthotics?
provide symptom relef
protect healing structure
provide joint alignment
Positioning/Mobilizing Orthosis
designed to change or mobilize tissues
blocks one motion and transfer muscle force to another joint
helps assist weak or absent joint motion
Example of use for positioning orthosis
radial nerve palsy
lack of wrist and digit extension
Restriction Orthosis
limits mobility within a prescribed safe range
Static Orthosis
immobilization/protection in an acute phase
positioning for capsular length safe position
removable for hygiene
removable for early motion when permitted
Serial Static Orthosis
contracture correction or mobilizing
provides low load in long duration stretch
can be worn full time or nocturnally
casting falls into this category
can be removed as tissue change happens
Serial Casting
use of plaster to hold tissue in elongated state. the cast is changed and reapplied 2-3 times per week w/mobs. Done until contracture is resolved
Goal is 5° of change in the contracture with each change of the cast
Overall purpose is provide prolong stretch to soft tissues
Static Progressive Orthosis
Provides static pull, low load long duration stretching using non-dynamic components like velcro or turnbuckles
Purpose is to correct contracture, and the pt has control of the stress load/tension
used for claw hand contracture
Claw Hand Contracture orthosis
placed into MCP flexion and IP extension
serial static hood adjusts as MCP gains flexion
Primary tissue involved in joint stiffness
periarticular connective tissue like ligament and joint capsule
Increase in PROM is directly proportional to the
time the joint is held at end range
Low load prolonged stretch was more effective than
high load brief stretch in treatment of stiff joints
To increase PROM 5°
static progressive splint or serial casting
To increase PROM 15°
static splint
An increase needed for 20°or more of PROM
don’t use a splint
Dynamic Orthoses
use of elastic or spring tension to position
motion can occur against resistance and dynamic component returns segment to original positing protecting anatomic musculotendinous unit that is intended to do that particular motion
Functional Orthosis Uses
ulnar nerve palsy, unable to flex MCP to allow for grasp
would use a anti claw orthosis allowing grasp
Mobilization Orthosis
lack of joint mobility
requires 90° line of pull and frequent adjustments
Low Temp Thermoplastics
material is activated at 140-170°
material can be applied directly to patients skin
Characteristics of low temp thermoplastics
rigidity
memory
coating
conformability
resistance to stretch
thickness
perforation
Types of orthotic based on fabrication
- Off the shelf/prefabricated
- Pre-fabricated with custom components
- Custom Orthotics (static, static progressive, dynamic)
Prefabricated Orthoses
Wrist cock up
exos
push metagrip
oval 8
silver ring splints
healy weber cubital tunnel
Orthotic Fabrication
Need to:
1. ask if your patient has any sensory deficits
2. Protect bony prominences
3. Protect superficial nerves
4. Educate your patient about the purpose
5. Educate your patient on the wear and care of the orthosis
DO NOT
immobilize what does not need to be immobilized
- clear the flexion crease of any joint that you want flexion at
- Clear the full thenar eminence if you want motion of the thumb
- Check the patient’s motion
- Check their ability to hold an item for function if that is permitted
How to protect bony prominences
prepad so once padding is removed there is an area of relief
cut material away from area
adding padding to a sensitive area ADDS PRESSURE
Trigger Finger Orthosis
Custom: volar paddle, PIP ful cylinder, PIP 3/4 cylinder
Off the shelf: Oval 8, trigger finger solutions
Hand Based Thumb Spica Orthosis
Many types, based on personal preference
Purpose is to limit CMC motion, limit MCP motion, allow function
Diagnoses used for CMC OA, MCP sprain
