Lab 4: Hip and Special Orthoses Flashcards
What orthosis is shown in the image?
Post-operative hip orthosis
Describe the optimal fit for a post-op hip orthosis
Pelvic band is laterally between the greater trochanter and iliac crests, over the sacrum. Inferior band extends into the gluteal region without interfering with sitting. Thigh cuff just proximal to knee
What motions are controlled with a post-op hip orthosis?
Flexion and adduction
Describe the force system to control hip flexion with a post-op hip orthosis
Primary: originates posterior at the inferior border of the pelvic girdle on the operative side and is directed anterior
Secondary: originates anterior at the superior portion of the pelvic girdle and is directed posterior
Secondary: originates anterior at the distal thigh cuff and is directed posterior
Describe the force system to control LEFT hip adduction with a post-op hip orthosis
Primary: originates on the left area of the pelvic girdle and is directed right
Secondary: originates lateral and superior in the area of the pelvic girdle on the right and is directed left
Secondary: originates on the medial portion thigh cuff on the left and is directed left
What is the purpose of a post-op hip orthosis?
Reduce chance of dislocation
What are cons of the post-op hip orthosis?
Difficult to don, unacceptable with respect to cosmesis
What orthosis is shown in the image?
Pavlik Harness
What is the purpose of a Pavlik harness?
Treatment of congenital hip dislocation or development of dysplasia of the hip in young infants
What is the wear schedule for a Pavlik harness?
As often as possible for several months until hip stabilizes
What ages is the Pavlik harness appropriate for?
Birth - 6 months
What developmental milestone is considered the indication to progress from the Pavlik harness to a different orthosis?
Weight bearing in quadruped and supported standing
What orthosis is shown in the image?
Ilfeld Splint
When is an Ilfeld splint indicated?
Treatment of congenital hip dislocation and developmental dysplasia, but it is more appropriate for a child just prior to and during the early stages of walking
What is the general positioning of the hip and knee with the Pavlik harness and Ilfeld splint?
Knee flexion, hip flexion, abduction, and ER
What orthosis is shown in the image?
Hip adduction control orthosis
What is the definition of a SWASH orthosis?
Standing walking and sitting hip orthosis
Describe the optimal fit for the SWASH orthosis
Pelvic band between greater trochanter and iliac crest. Abdominal strap below umbilicus, thigh cuffs 3-4” from groin.
What motions does a SWASH orthosis control?
Adduction
Describe the force system that controls adduction of the LEFT hip with a SWASH orthosis
Primary: combination of forces originating from the superior and inferior lateral portions of the left thigh band and is directed right
Secondary: originates from the right lateral portion of the pelvic band and is directed left
Secondary: originates from the distal medial portion of the left thigh band and is directed left
What is the purpose of a SWASH orthosis?
Restrict hip adduction, minimize imbalance at the hip joint, increase BOS
What pt would a SWASH orthosis be indicated for?
CP, spina bifida, head injury
What is a con of the SWASH orthosis?
Does not include distal components that may be necessary to improve function with optimal alignment
What orthosis is shown in the image?
Twister
When is a twister indicated?
Spastic CP to control excessive adduction and IR
Describe how a twister functions
Cabling system biases the child towards ER and abduction during ambulation. Steel cables are anchored to the pelvic band and AFO
What is a negative biomechanical consequence of wearing a twister?
Increased stress on the knee through the tibia
What orthosis is shown in the picture?
Scottish Rite Orthosis
When is a Scottish Rite Orthosis indicated?
Legg-Calve-Perthes
What motions are controlled and allowed with a Scottish Rite Orthosis?
Hip held at 45 degrees of abduction, allows for full mobility of knee and ankle
What orthosis is shown in the image?
Denis Browne Splint
When would a Denis Browne Splint be prescribed?
Children with a flexible foot deformity such as clubfoot, valgus, varus, abnormal tibia torsion
What is a negative biomechanical consequence of the Denis Browne Splint?
Increased stress on the knee and questionable management of the foot and ankle
What device is shown in the image?
Parapodium
Where should the foam knee block sit on a parapodium?
Just inferior to the knee joint
What is the purpose of a parapodium, and what patients is it indicated for?
Spina bifida. Allows them to being weight bearing through LE with good alignment
What orthosis is shown in image?
Metal HKAFO
When would a HKAFO be indicated?
Poor hip, knee, and ankle control when standing is required
What conditions would an HKAFO be prescribed for?
Spina bifida, CP, SCI
What are the disadvantages to an HKAFO?
Heavy, restrictive, ambulation requires excessive amounts of energy so it limits function
What orthosis is shown in the image?
Reciprocating gait orthosis
What is the purpose of a reciprocating gait orthosis?
Provides opportunity for a reciprocal gait pattern in individuals with little to no active hip flexion
Describe how a pt uses a reciprocating gait orthosis
Lateral weight shift through use of UE and upper trunk
What patients would be appropriate for a reciprocating gait orthosis?
Older children with spina bifida who have mastered standing and ambulating with a parapodium. SCI
What is the purpose of cranial shaping orthoses?
Gently correct the shape of a babies skull over time
When is a cranial shaping orthosis indicated?
Moderate to severe cranial asymmetry due to intrauterine constraint or extrauterine compression due to sleeping positions, time in swings, car seats, torticollis
What time frame is appropriate to use a cranial shaping orthosis?
Prior to hardening of fontanels, which fuse by 12 months. Research supports the orthosis being introduced before 6 months
What deformity is present in the image?
Plagiocephaly
What deformity is present in the image?
Brachycephaly
What deformity is present in the image?
Brachycephaly with Plagiocephaly
How do cranial helmets work?
Gentle, persistent pressure applied to inhibit growth in prominent areas and allowing growth in flattened regions
What is the wear schedule for cranial shaping orthoses?
23 hours per day for several months or until optimal symmetry is achieved. Research indicated that it will take significantly less time if initiated prior to 6 months
