LE and spinal orthoses Flashcards
Why is an orthotic used?
-to address pathological symptoms
-control motion, pain, or deformity
MOTION
-by stopping, limiting, or assisting at a specific joint or position
PAIN
-by limiting or stopping motion, or by reducing stress to a joint through support or through shock-reducing cushion
DEFORMITY
-by supporting an existing deformity and preventing it from progressing
-by altering the position of the deformity to what is considered natural
Goals of an orthotic
meets the individual mobility needs and goals
maximizes stance phase stability
minimizes abnormal alignment
minimally compromises the swing phase
pre-positions the limb for initial contact
ensuring the device will work with patient’s preferred assistive device
-can be worn for long periods without damaging the skin or causing pain
-can be easily donned and doffed
Basic principles of orthoses
-balanced parallel force system used to control joint motion
-one corrective force and two stabilizing forces (three points of force application)
-the larger the corrective force, the larger SA required for force application
Classification of orthoses:
They are named for the joints that they cross
FO
AFO
KAFO
HKAFO
KO
HO
Foot orthoses facts
-rigid, semi-rigid, or flexible
-custom fabrication and off-the-shelf
-subtalar joint support (frontal plane)
-fits into shoes/low profile
INDICATIONS
-pes planus (pronation)
-pes cavus (supination)
-plantar fasciitis
-heel spurs
-metatarsalgia
-mild-moderate calcaneal varus/valgus
-mild-moderate midfoot deformity
-laxity
-diabetic neuropathy
OPTIONS
-full length/partial length (consider discrepancy in leg length)
-material: soft vs firm
-reinforcement
-off-loading
What is a UCBL orthotic?
TYPE: FO
-thermoplastic
-custom
-controls calcaneus and midfoot
–transverse plane
–frontal plane
**MOST CORRECTIVE FO
INDICATIONS:
-flexible moderate pronation/calcaneal deformity
-moderate deformity
-plastic materials (range of rigid support)
-require larger/wider shoe size
SMO facts
Type: FO
-plastic
-custom
-controls calcaneus, midfoot
–transverse plane
–frontal plane
-ankle support
–frontal plane
-allows free DF and PF
-rigid outer surface and a more flexible material inside
INDICATIONS:
-ankle instability (frontal plane)
-flexible calcaneal and midfoot deformity (frontal, transverse)
-moderate-severe deformity
-visible above shoe line
Types of AFOs
solid AFO
semi rigid
articulated (joint)
GRAFO - ground reaction
PLS AFO - posterior leaf spring AFO
Arizona
CROW
Richie Brace
Universal AFO fitting goals
-increase ankle stability
-improve cadence
-increase balance/step length
-limit foot drop
-increase knee stability
-limit genu recurvatum (hyperextension)
-create heel to toe gat pattern
-guided control in 3 planes
-increase PT confidence and increase endurance and decrease fatigue
Metal AFO facts and indications
-aluminum sidebars attached to a standard shoe
-leather or metal calf band
-custom
-articulation at ankle (hinge)
–> free motion
–> limited motion
–> assisted DF and PF
controls ankle motion in sagittal plane
INDICATIONS
-ankle motion management (sagittal plane)
-edema (if there is constant fluctuating volume) –> need to avoid thermoplastic device
CONS
-increased weight
-more time for fabrication
-increased maintenance
PLS-AFO facts and indications
posterior leaf spring orthosis
-thermoplastic material
-custom and off the shelf
-posterior plastic strut has material flexibility
–> sagittal plane
-footplate suport
–> transverse plane: midfoot
–> promotes weight acceptance at initial heel contact
–> keeps angle of ankle at 90 degrees
INDICATIONS
-**drop foot
-tib ant. weakness
-DF paralysis
-lightweight
-low profile
-off the shelf options
-minimal foot deformity
Dynamic carbon fiber AFO facts and indications
-carbon fiber material
-off the shelf, some custom
-energy storing in sagittal plane
POSTERIOR PANEL VS ANTERIOR PANEL
-anterior for PF weakness
-posterior panel for DF weakness
INDICATIONS
-thin, lightweight
-low profile
-can be used for dropfoot
-DF or PF weakness
–CVA
–MS
–neuropathy
SA- AFO facts and indications
“solid ankle foot orthosis”
-thermoplastic or carbon materials
-custom
-trimelines are anterior to malleoli
-fixed ankle for all phases of gait
3 planes of control
-sagittal –> stability
-frontal –> support
-transverse –> support
INDICATIONS
-low tone
-potential or complete paralysis of gastroc or soleus
-mild instability of knee
-deformities of the ankle (varus, valgus)
-contracture/spasticity management
-traumatic LL injury with pain
Ground reaction AFO facts and indications
-thermoplastic materials
-custom
-padded anterior tib section
-knee extension moment in stance (pushes tibia back)
–sagittal plane
-ankle support
–frontal plane
–transverse plane
INDICATIONS
-crouch gait
-quad weakness 3-/5
-knee instability
-weak PFs
CONTRAINIDCATIONS
-genu recurvatum
>20 degrees knee flexion contracture
Articulated AFO facts and indications
-thermoplastic or carbon
-custom fabrication
-ankle articulation
OPTIONS
-dorsiflexion assist
-PF/DF stop
Three planes of control
-sagittal plane controlled motion
-frontal plane support
-transverse plane support
INDICATED
-drop foot
-need for natural ankle motion
-medial/lateral ankle instability
-varus/valgus deformity
-plantarflexion contracture
CONS:
-allowing motion reduces control;
-ankle joints add bulk and weight
-poor cosmesis
AFOs with inner booties facts and indications
- 2 different thermoplastic materials
-custom fabrication
-inner molded soft bootie
-rigid AFO outer plastic
INDICATIONS
-severe ankle deformity
-bony prominences
-sensitive skin, sensory issues
-need for rearfoot or frontal plane control
-pressure distribution of dorsal strap
Arizona AFO: leather ankle Gauntlet facts and indications
-leather gauntlet reinforced with plastic, lace up
-custom molded
**designed to immobilize
-frontal plane support
-adjustability for edema management
-low profile increased comfort solid ankle and articulating styles
INDICATIONS
-posterior tibia tendon dysfunction
-tendonitis
-ankle arthritis
-DJD
-chronic sports injuries
CROW - charcot restrain orthotic walker
Type: AFO
-thermoplastic with custom soft foam liner and insert
-rocker bottom
-requires shoe lift for CL side
PLANES OF SUPPORT
-sagittal
-frontal
-transverse
** common for diabetic patients
INDICATIONS
-charcot joint - is a syndrome in patients who have peripheral neuropathy, or loss of sensation, in the foot and ankle–> leads to greater risk of fracture
-chronic diabetic ulcers
-ischemic necrosis
-fracture management
Richie brace facts and indications
TYPE: AFO
INDICATIONS:
-PTTD (mild to moderate)
-lateral ankle instability
-peroneal tendinopathy
-cavo-varus deformity
FEATURES:
-semi-rigid support
-control of 1st ray, midtarsal, and subtalar joint
-control of ankle inversion/eversion
-unrestricted sagittal ankle motion
PRAFO: pressure relief ankle foot orthosis facts and indications
-soft padded fabric/lambswool, plastic reinforcement PLS
-off-the-shelf
SUPPORT:
-sagittal plane support of ankle position
-transverse plane support of the hip position
-no posterior heel contact
-adjustable
INDICATIONS
-supine bedrest
-prevent PF contractures
-maintain neutral hip rotation while supine–>plastic stoppers that prevent internal rotation
**not intended for ambulation
KO - knee orthosis, ACL, or unloader facts and indications
MATERIAL: composite, metal, carbon graphite, titanium knee hinges
-can be custom or off-the-shelf
SUPPORT:
-sagittal (flexion/extension stops)
-frontal
-transverse (limited)
-lightweight
INDICATIONS:
-ACL, PCL, MCL, LCL instabilities
-high-intensity athletic activities
-OA, offloading support
Post-op knee braces
-fabric reinforced with metal uprights in specific ROM position
-off-the-shelf
SUPPORT –> Limited ROM allowed
-sagittal
-frontal
-immobilizer
-Short-term use
KAFO facts and indications
MATERIAL
-thermoplastic with metal, carbon fiber, metal, and leather
SUPPORT:
-sagittal
-frontal
-transverse
Variety of joint types and function
-torsion/contracture management
-stance control
-C-brace (microprocessor)
INDICATIONS
-when stability during stance cannot be provided by AFO
-when hyperextension of the knee impacts joint integrity
-varus/valgum is present
-genu recurvatum
-hamstring/quad weakness or paralysis
-spastic/flaccid paralysis of the lower limb
–> ex: post-polio syndrome
PART TIME USE
-stance/ambulation therapy
-contracture management
CONS
-increased weight and bulk
Hip orthoses facts and indications
MATERIAL
-thermoplastic pelvis and thigh cuff with metal hip joints, fabric/foam lined
-custom or off-the-shelf
-unilateral or bilateral
SUPPORT PLANES
-frontal plane (abduction/adduction control)
-sagittal plane (hip stops)
INDICATIONS
-Legg-Calve Perthes, developmental dysplasia of the hip, post-surgical, hip dislocation
SWASH facts and indications
“sitting, walking, and standing hip orthosis”
TYPE: HO
Material: Thermoplastic hip and thigh cuffs, metal uprights that allow motion through a specific range
-off-the-shelf
-pediatric
SUPPORT:
-maintains hip abduction (frontal plane)
-limits adduction while sitting, standing, walking
-free flexion-extension ROM of the hip (sagittal plane)
INDICATIONS
-spastic hemi/di/quadriplegia
-hip adduction tone
-post botox
-risk of hip displacement
-gait scissoring
-allows motion and ambulation
HKAFO/RGO:
RGO: reciprocating gait orthosis
MATERIAL
-thermoplastic with metal joints nd metal uprights
-custom
PLANES OF CONTROL (hip knee ankle)
-sagittal
-frontal
-transverse
RGO:
-reciprocating pelvic attachment allows reciprocal gait pattern
–> Need trunk rotation/strength
INDICATIONS
-part-time use for stance and ambulation (therapy)
-myelomeningocele
-spina bifida
-paraplegia
-spinal cord injury (C8-T12)
CONS
-increased bulk and weight
-expensive
Cranial remolding orthoses facts and indications
MATERIAL: thermoplastic with foam liner
-custom
-cranial growth-dependent remodeling
INDICATIONS
-plagiocephaly
- brachycephaly
-scaphocephaly
-cranial deformation secondary to torticollis
-post op craniosynostosis
-ages 4-12 months
** good outcomes but poor insurance coverage
Fitting goals for spinal orthoses
-substitute/assist axial muscle actions
-function as a kinesthetic reminder
-protect anatomical structures
-prevent/reduce pain
-prevent progression of condition
-reduce severity of deformity
Soft cervical collar facts and indications
-soft foam
-off shelf
SUPPORT:
-sagittal
-frontal
-easy don/doff, velcro
-inexpensive
INDICATIONS
Soft tissue injuries
Hyperextension/flexion injuries
Post-surgical Fusion
Mild cervical arthritis/nerve pain
Philadelphia cervical collar facts and indications
-lightweight foam
-off-the-shelf
SUPPORT:
-moderate C2-C5
-thoracic extension: C6-T2
–> sagittal plane
–> frontal plane
–> transverse plane
*tracheotomy access
INDICATIONS
-post-surgical application
-trauma, fractures
-immobilization for cervical metastasis
-cervical arthritis
-degenerative diseases
Miami J cervical collar facts and indications
MATERIAL: plastic, fabric-padded removable liners, two pieces, velcro closure
-off shelf
SUPPORT:
-moderate C2-C5
-thoracic ADDITION: C6-T2 (upper thoracic)
–> sagittal plane
–> frontal plane
–> transverse plane
MRI compatible
INDICATIONS
Post surgical application
Stable cervical spine injuries
Degenerative diseases
Cervical arthritis
CTO/Minerva
CTO- cervical thoracic orthoses
“Minerva”
MATERIAL: Thermoplastic, fabric pad lining, metal uprights
-off shelf
-can be applied while the patient is in supine in the hospital
RIGID IMMOBILIZAITON C3-T2
-sagittal (flexion and extension)
-frontal
INDICATIONS
Stable cervical fractures
Post-surgical application
Immobilization for cervical metastasis
SOMI: sternal occipital mandibular immobiler
MATERIAL: Metal uprights with foam lining, straps
-off shelf
Rigid immobilization C2-C7
-sagittal (mostly flexion)
-frontal plane (mild)
-transverse plane
INDICATIONS
-stable displaced fractures
-cervical disc immobilization
-post-surgical immobilization
HALO
MATERIAL: Thermoplastic vest with fabric liner, metal uprights, titanium skull pins
MAX immobilization of C1-C3
-sagittal
-frontal
-transverse
-pinless option available (less infection)
INDICATIONS
**UNSTABLE C spine fractures
-dens type I, II, III of C2
-C1 with rupture of transverse lig
-SCI
-post-surgical management
CONS
-risk of infection at pin sites, scarring
LSO
MATERIAL: Thermoplastic shell, soft foam liner
Custom fabrication or off-the-shelf
THREE PLANES OF CONTROL:
-L1-L5
-sagittal, frontal, transverse
-bivalve (two pieces, front and back)
Trimlines:
* sub scapula
* xyphoid process
* Sacrum
* Contain ASIS for pelvic control
INDICATIONS:
Post-surgical immobilization
Low back pain management
Compression fractures
Non-surgical disc treatment
Obese patients
Laborious work
-IMMOBILIZATION OF:
-flexion/extension
-some rotation and side bending
BOB- Boston overlap brace anterior overlap LSO
MATERIAL: Thermoplastic, variable flexibility/rigidity, lined or unlined
custom fabrication
SUPPORT:
-sagittal
-frontal
-transverse
-overlap closure anteriorly
IMMOBILIZATION: L3-L5 (lower lumbar) through abdominal compression (hydrostatic loading) (hydrostatic load on soft tissue/organs helps to reduce load through axial skeleton
Trimlines:
* Posterior sub scapula
* Xyphoid process
* Distal sacrum
* Contain ASIS for pelvic stabilization
INDICATIONS:
Post surgical immobilization
Low back pain management
Compression fractures L3-L5
Non-surgical disc treatment
Disc disease
Spondylosis, Spondylolysis, Spondylolisthesis
Anti-lordotic posturing
CASH- cruciform anterior spinal hyperextension
MATERIAL :
-aluminum uprights with foam pads, straps
-off shelf
-lightweight, anterior design
SUPPORT
-flexion limited T6-L1 (maintain extension)
–> sagittal plane
INDICATIONS
-anterior compression fractures (anterior column burst fracture)
-mild kyphosis
-frail patients in need of minimal support
-reduction of kyphosis in OA
Jewett Hyperextension Brace
MATERIAL
-Aluminum uprights with foam pads, straps
-off-the-shelf
-Lightweight, anterior design, easy donning
SUPPORT
-flexion limited T6-L1
INDICATIONS
Anterior compression fractures T6-L1 Burst fractures
Post Surgical Immobilization
Mild kyphosis
Frail patients in need of minimal support
Reduction of kyphosis in osteoporosis
Soft TLSO hyperextension corset
-Fabric/elastic with rigid thermoform reinforcement, more comfortable
-off the shelf
POSTURAL REMINDER- limits thoracic flexion in the sagittal plane
-good cosmesis, lightweight
INDICATIONS:
-Geriatric kyphosis
-Stable anterior thoracic compression fractures
-Accommodates frail individuals
-More comfortable for the elderly
Lumbar-sacral corset
-Elastic or neoprene, plastic or metal reinforcement, moldable stays, off-the-shelf
-mild-mod support:
– > sagittal (flexion and extension)
–> abdominal compression (hydrostatic loading)
INDICATIONS:
-LBP
SI belt
-1.5-2” wide elastic webbing and posterior pad
-off the shelf
-low profile
-pressure on SI joint
INDICATIONS
-SIJ pain
-SIJ subluxations
-pregnancy SI support
TLSO
MATERIAL: Thermoplastic, many design variations
-bivalved (straps on both sides)
-lateral opening
-anterior/posterior opening
-lined/unlined
-may have struts
-flexible/rigid plastic
-intimate, total contact
-can have openings for feeding tubes, etc
-custom
SUPPORT:
-sagittal plane
-frontal plane
-transverse
Trimlines:
-sternal notch, the spine of the scapula
INDICATIONS
Post-surgical immobilization Unstable/Stable fracture management T3- L3
Pain management
**Can include hip joint & thigh cuff for lower lumbar stabilization
** can also include cervical attachment (CTLSO)
Neurologic injuries
Custom for atypical shapes
*TYPICALLY NEED ASSISTANCE FOR DONNING
TLSO for scoliosise
-Thermoplastic with padding, additional padding for corrective forces
-custom
-design depends on the curve
SUPPORT
-sagittal
-frontal
-transverse
DOSE: hours per day
INDICATIONS:
-curves with apex T8 and below
-curves > 25 degrees
—> consider age of patient and growth
–> consider skeletal immaturity
- non-surgical intervention
GOALS:
-50% correction
-prevent progression of curve
CTLSO: Milwaukee scoliosis brace
-thermoplastic pelvic section
-Anterior & posterior uprights (aluminum) -Neck ring
-padding at apex/strapping
-custom, time-consuming to produce
PLANES:
-sagittal, frontal, transverse
INDICATIONS:
-treatment of curves with apex above T8
CONS:
-outdated
-low compliance
Night-time bending brace for scoliosis
-Thermoplastic, foam lining
-Anterior opening
-Custom fabrication
SUPPORT:
-sagittal (curve)
-frontal plane (lordosis, kyphosis, rotation)
-transverse plane
-only worn at night
TYPES: Charleston Bending brace, providence brace
INDICATIONS
-Idiopathic Scoliosis, Single Curves,
-Curvature of 25-40 degrees
CONS
-low compliance
