lab 9: orthotics Flashcards
▪A 10 year old male with spastic diplegic CP functioning at a GMFCS level II, MACS level I and FMS of 5/4/3 comes to his yearly CP clinic follow-up appointment.
▪He has out-grown his current pair of bilateral solid ankle AFOs and needs new pair
▪He displays:
-decreased DF at initial contact
-pronation throughout stance
-mild knee flexion during mid-stance of about 10 degrees
▪He presents with bilateral DF ankle range w/ Knee Ext:
▪ R1 = -10
▪ R2 = +5
What ORTHOTIC REC? He plays competitive soccer
GFR AFO?
What does PTG stand for?
Patient first (age, Dx, functional level)
Task (ambulation? stretch?)
Goal (goals of the device)
“Prioritize The Goals”
Case 4: midfoot break
What forced movement is often associated with midfoot break?
ankle DF
The angle between AFO shaft and foot complex
AA (ankle anlgle)
The angle between shaft of orthotic and vertical
shaft to vertical angle (SVA)
Is MAS or Tardieu scale reliable?
No
*spasticity is not reliable between PTs or even when tested due to:
-time of day
-how many times spasticity was tested
-temperature
When you evaluate the patient, what does this include taking into acount
What is a common mistake with AFO ankle angle set at neutral?
sometimes patients do not have the range
*is the only solution for this issue to set the AFO in PF? no…
If a patient is an 8 year old boy with spastic, diplegic CP, GMFCS level 3
-more trouble walking in class, needs increased assistance to walk
-wears bilateral solid AFOs with no problems –> now remove AFOs and find bright red spot over right heel and left navicular
what happened?
-8 years old: growth spurt, probably outgrew them
-check ankle angle ROM (probably tightened)
-recommend not wear AFOs until he gets new ones bc of skin integrity
Task examples for ambulatory AFOs
- Stability in Stance/Balance
- Foot Clearance in Swing
- Pre-positioning of the foot for initial contact
- Adequate Step length
- Energy Conservation
5 prerequs of gait
Non-ambulatory AFO task examples
- Contracture Management
- Wound healing, protection, or prevention
- Positioning
Orthoses can do 4 things:
- motion
- motion
- force
- a body part
resist motion, assist motion, transfer force, protect a body part
Orthoses that maintain/improve alignment
pavlick harness (DHD)
hip orthosis for Legg-calves perthes disease
cranial shaping orthosis (plagio)
wrist-hand orthosis to minimize ulnar dev (RA)
women with metatarsalgia will be more
comfortable with a FO that includes a pad underneath
the metatarsal shafts.
What does this orthosis do?
transfer force
*pad transfers force from met heads to other
What are ways to improve comfort of the AFOs?
-minimize pressure by maxing area (higher trimlines?
-provide sufficient leverage
▪The common basic pressure system for most
orthoses is the____ force system
principal force acting in one
direction and two counterforces acting in the
opposite direction located proximal and distal to the
principal force.
3 point
A parapodium (THKAFO)
exerts a ___ pressure system
4 point
What are other examples of orthoses that apply circumferential or total contact pressure?
- elastic sleeve
- sure step SMO
- Sensory dynamic pressure garmet
- theratogs
Winters Gait Classification Group 1-4
Group 1 – characterized by: foot drop during swing; flat foot or forefoot
contact during initial contact; excessive hip and knee flexion
during swing; adequate DF during stance
Group 2 – more constant PF throughout gait
Group 3 – progressing to knee hyperextension & increased lumbar
lordosis
Group 4 – most severe pattern, characterized by limited hip movement
and significantly increased lumbar lordosis
discussion about adding group 0 for higher functioning
Midfoot breakdown:
hinged AFO vs solid AFO
maybe need inner boot SMO
What is surestep SMO and what are they designed for?
For coronal plane issues
Shorter trim lines and toe plate
For Down syndrome
Down Syndrome is characterized by:
▪ Hypotonia
▪ Ligament Laxity (AA instability in 15%) –> take x-rays between age 3-5 yrs
▪ Flatfeet
▪ Cognitive limitations
▪ Delayed Milestones
-cardiac
-thyroid
-hip (DHD, acetabular dysplasia)
▪Designed for those clients that have sagittal plane TC joint issues in addition to coronal SUBTALAR joint issues
*mild knee flexion, not for crouch gait
SMO with PLS extension
▪ITW
▪Spastic Hemiplegic CP functioning at a GMFCS level II
SMO with PLS extension is good for what kinds of clients?
-spastic hemiplegic CP at GMFCS level 2
-ITW
-mild mild knee flexion
types of trimlines for solid AFOs
- solid
- semi-solid
- PLS
- lateral medial flange for hindfoot varus/valgus control –> sabolich tab
generally clumsy, may walk up on their toes,
and show gross motor regression
-NEW onset of issues of toe walking, tripping, falling
-pseudohypertrophy of calf
-GOWERS SIGN
patient is young and prob has…
DUCHENNE MUSCULAR DYSTROPHY
Gait characteristics of DMD
wide BOS
lumbar lordosis
knee hyperextension
toe walking
ambulation often lost with DMD by age
12 years
*prolonged walking and standing delays the development of scoliosis (which affects 75-90% of non-amb children with DMD)
What is the predictable pattern of involvement for DMD?
-proximal to distal
(early neck flexors, abs –> pelvic muscles and quads –> distal UE/LE muscles)
How to tell difference between DMD and ITW
-patient history!
new onset of toe walking/clumsiness or not?
-check Gower’s sign
pronation is a natural thing that happens in stance when a patient has tight ___
GASTROCS
end at spinal mm atrophy slide 75 (need to finish)
