L9 Orthotics Flashcards
four considerations when prescribing orthotics
advantages: how orthotic will improve mobility and gait/protect/influence tone
disadvantages: complications in ADLs, mobility, energy cost, expense
indications of usefulness to individual patient
contraindications due to pt circumstances
ideal orthotic should function to:
maximize stance stability
minimize abnormal alignment
minimally compromise swing clearance
reduce joint contractures
preposition limb for initial contact
energy efficiency
AFO for joint integrity assists with:
ligament support to prevent unwanted motion and prevent joint damage
AFO for limb length assists with:
unequal leg length by adding a heel lift
AFO for motor control assists with:
preventing unwanted motion
AFO for muscle performance assists with:
endurance and weakness from weak muscle
AFO for muscle spasticity/posture assists with:
reduces equinus gait and PF
AFO for sensory loss assists with:
returning stability lost due to a lack of sensation/proprioception
Assessment areas for orthotics
ROM
synergistic movement
sensation
skin protection with an orthotic
socks: should cover entire area of orthotic, keep skin dry, and have no wrinkles
on first wear: check brace 20 min into wearing at edges and bony prominences, assess for redness
how long should it take for an orthotic to affect gait?
IMMEDIATE
drop foot: orthotic
AFO: leaf spring or DF assist
ankel instability orthotic
solid AFO, hinged AFO
ankle PF weakness orthotic
solid AFO w support strap
hinged
knee hyperextension orthotic
sets ankle at neutral w minor DF
orthotic with integumentary protection
provide joint protection from instability along with padding and cut outs to relieve pressure on wound
common reasons for orthotic prescription
weakness
stroke
CP
TBI
peripheral neuropathy
alignment
SCI
progressive disease
3 points of force at AFO
under met heads, anterior ankle, posterior calf
3 points of force in KAFO
posterior ankle, distal knee, mid thigh
carbon fiber orthotic advantage
lightweight and durable
which patients are commonly described KAFOs
SCI
muscular dystrophy
spina bifida
polio
used for muscle weakness
priority in AFO targeting gait
adequate fit and improvement in mechanics on variable surfaces
priority in AFO targeting STS
increase GRF through limb while managing decreased DF by modifying chair height
priority in AFO targeting floor to stand
manage decreased DF and difficulty manuevering, providing tall object to assist
priority in AFO targeting balance
reduce joint mobility and make sure orthotic doesn’t increase falls
priority in AFO targeting stairs
prioritize safety
essential features of orthotic
address impairment
protects skin
must be worn 6-8 hours a day without pain
easy to put on/take off
cosmetic appearance
job and recreation considerations
gait phases most important in orthotics
mid stance: hyperextension
mid swing
terminal swing
solid AFO
large trim lines
more support
anterior strap covering foot and keeping in brace
dynamic AFO/flexible
used in children to allow tibial advancement in stance
hinged AFO
requires ROM
peds or adults who need stability specifically in STS
allows tibial advancement
ground force AFO
people with crouched gait, flexed at hip and knee
stability and prevents forward collapse at knee with anterior support below knee
leaf spring AFO
flexible
best used if pt only has foot drop
when should a patient get a custom molded orthosis
for patients with impaired sensation
significant hypertonicity
risk of progressive deformity associated with this condition
orthotic material types
thermoplastic: off the shelf, rigid but not durable
carbon fiber: light weight, durable, factory made, no med/lat support
leaf spring AFO for drop foot
mass produced with dynamic thermoplastic
support weight of foot in swing phase to enhance limb clearance
controlled lowering of the foot in the loading response
DF assist orthotic
preposition foot for heel stroke at IC
limited med/lat stabiltiy in stance
contributes to push off for limb clearance
not good for neuro/spasticity
solid AFO
resist PF in swing for limb clearance by applying fulcrum of force at the anterior ankle w straping
larger trim lines for tibial control
calcaneal support
interferes with all three ankle rockers or tibial advancement
hinged AFO
thermoplastic
allow sagittal plane motion
allows more mobility w m/l stability
less negative impact on functional mobility and dynamic postural control
allows tibial advancement
elastic vs pin HAFO
pin PF stop to stop PF
elastic DF check strap to limit DF
anterior floor reaction orthosis
anterior support for impaired motor control of knee and quad weakness
restricts tibial advancement and prevents knee flexion in stance phase
assessment for an orthotic should look at what parts of the LE?
alignment not standing in shoes, rear and sagittal
calcaneal flexibilty/rigidity
prone flexibility: gastro/soleus length, midfoot range, first ray range
subtalar joint neutral
