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Orthotics Final > LE Orthotics LECTURE > Flashcards

LE Orthotics LECTURE Flashcards

1
Q

Who initiates the need for LE orthotics?

A

The PT!
Have to consider the patient’s structural and functional needs, and patient goals/willingness to utilize the orthotics.
- may need to educate patient on need and impact of orthotic, do a trial ambulation or transfer with and without the orthotic and educate on safety risks without using the orthotic (fall risk)

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2
Q

What are some factors to consider when evaluating for LE orthotics?

A

Patient’s height — will impact the height of orthotic
Patient’s weight — will impact choice of materials
Patient’s DX — static/progressive
Current level of activity
Anticipated level of activity
Degree of deformity — is it fixed or flexible
ROM at ankle, knee, etc
Strength — of entire LE (MMT)
Sensation
Swelling
Ambulation with and without device

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3
Q

What does the recommendation for the device look like?

A
  • Justification for device
  • Rationale for choice — especially important if primary PT isn’t going to meet with orthotist team
  • Team may ambulate very short distances while completing evaluation, but not likely at distance of therapists during treatment
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4
Q

What are possible orthotic materials

A

Plastic
Metal
Hybrid
Carbon Fiber
FES

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5
Q

What determines the choice of orthotic materials

A

Consideration of patient presentation/needs will determine choice of materials

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6
Q

What is generally more preferred by patients?

A

Plastic AFOs or carbon fiber due to the ability to adjust foot wear, and cover it with clothings
— But plastic AFOs have direct contact with the skin throughout the LEs which may be a caution due to sensation or swelling

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7
Q

Indications for a metal system orthotic?

A

Interim management — allows therapist to make changes to the system.
Swelling
Poor sensation — really depends on patient’s ability to perform good skin checks
Poor skin quality — like history of ulcers or easily tears
Severe spasticity?

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8
Q

Advantages of metal system orthotics

A

Easy alignment
Good consistent foot wear
Ability of therapist to adjust
Minimal direct skin contact

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9
Q

Disadvantages of metal system orthotics

A

Weight
Appearance (Cosmesis)
Shoes
Limited control of foot

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10
Q

Where should the calf band be on the shank?

A

1.5 inches distal to the neck of the fibula!!!

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11
Q

Where does the anatomical axis of the ankle pass through? What about medial upright?

A

Anatomical axis — through malleoli
Medial upright — may curve anteriorly to align orthotic ankle axis to anatomical axis

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12
Q

What directions of the stirrup moving for the metal ankle joint correspond with osteo kinematics? What about upright moving?

A

Stirrup moves forward = Dorsiflexion
Stirrup moves backward = plantarflexion
Upright moves forward = tibial progression/knee flexion
Upright moves backward = knee hyperextension

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13
Q

What is a T strap

A

Something you can add to the orthotic to limit hind foot movement in the frontal plane —> control varus/valgus control
- patient could be constantly landing on the outer border off their foot then they aren’t landing flat so have to add the strap to pull the foot in order to get flat foot contact.

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14
Q

Where do you place the T strap to control inversion/eversion?

A

Control inversion — stitched to lateral side of shoe and buckled around medical upright
Control eversion — stitched to medial side of the shoe and buckled around lateral slide

these are not really commonly utilized - general for excessive inversion/eversion when we are worried about ligaments

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15
Q

Advantage of plastic AFOs

A

Light weight
Improved control - especially through the foot
Cosmesis
Patient willingness to wear

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16
Q

Disadvantages of plastic AFOs

A

Intimate fit - directly on skin
Cannot adjust for large volume changes
Therapist cannot make adjustments to the system

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17
Q

What is the foot plate length in a plastic system

A

To sulcus — most common
To end of toes — in cases of spasticity or toe clawing (common with brain injury and peds)

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18
Q

What are the options for the ankle joint in a plastic system

A

Can be articulated or non articulated
choose articulated if the plan is to eventually use the articulated joint because it has to be built into the joint from the beginning

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19
Q

The amount of control and type of a non articulated plastic orthotic depends on…

A

Type of plastic — polypropylene most common
Trimlines of the brace

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20
Q

What is a flexible/posterior leaf spring?

A

Smallest amount of support. The trim lines are very posterior to malleoli, basically covering the Achilles
- Indicated for foot drop only u
- Maintains neutral foot during swing
no control at the knee.

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21
Q

What is a semi rigid AFO

A

More full brace then flexible at shank and foot
Trimlines behind malleoli - cut back behind them
Indicated for foot drop, slightly more control at foot may assist with inversion/eversion

22
Q

What is a rigid AFO

A

Trimlines bisect the malleoli
Provides PF stop, resists DF
Used to control foot drop and knee hyperextension
since it resists DF its going to prevent tibial progression.

23
Q

What is a solid AFO

A

Provides DF stop AND PF stop
Trimlines are anterior to malleoli
Used to control knee buckling in stance and drop foot in swing.
highest level of control

24
Q

What is a ground reaction force AFO

A

A non articulated AFO/solid AFO wiht increased control for the knee.
— Either a single unit where instead of a calf band has a plastic segment up to the patellar tendon. Puts pressure on the patellar tendon so when you land and move into stance the GRF will come all the way up and put even more resistance to tibial progression
OR CAN BE A SOLID AFO WITH A FRONT SHELL — on the tibia up to patellar tendon that will provide increased knee control as well.

25
Q

What are the considerations for training with AFOs

A
  • Fixed ankle AFOs limit PF and DF on purpose
  • Has impact on functional abilities of patient
  • HAVE TO TRAIN: sit to stand, up/down stairs, ramps/inclines, grass/uneven floors
26
Q

What does an articulated AFO provide

A

Will have some more motion control
These are used to control foot drop and dependent on PF resistance/stop may impact knee hyperextension too.

27
Q

What possible settings can you have with an articulated AFO

A

Free DF
PF resistance/stop
DF assist possible
Can adjust angle or amount of limited motion

28
Q

What are the types of ankle joint systems

A

All generally allow orthotist to make recommendations on joint system.
(Overlap, gillette, gaffney, Oklahoma, insert stirrup, PF stop)

29
Q

What do carbon fiber AFOs allow

A

DF assist. Properties of carbon fiber during rocker of stance phase, impression provides a bounce back to provide DF assist during swing.

30
Q

What if yo put a spring use in posterior channel?

A

Can set up channels to have a spring instead of a pin and compression of the spring in stance phase provides DF assist once lifted in swing.

31
Q

When are KAFOs commonly used?

A

With patients with SCI. May also be utilized with patients with peripheral nerve injury to the femoral nerve
significant high demand on UE strength, ability to control hips by trunk position.

32
Q

Benefits of KAFOs

A

Decreased contracture
Maintain UE strength
Decrease instances of osteoporosis
Patient mental health
*effort is significantly high, use low — most programs have specific requirements of UE strength and control to even initiate paragait training

33
Q

What is the three point control system for KAFOs?

A

Sagittal plane — controls knee flexion/extension
Frontal plane — restrains tibia abduction/adduction to prevent unwanted varus/valgus at the knee

34
Q

Advantages of locked knee KAFO

A

Stability at the knee

35
Q

Disadvantages of locked knee KAFO

A

High energy expenditure = decreased activity levels
Creates gait deviation
Uneven stride length or swing to gait required
Functionally longer limb
Secondary medical considerations long term due to compensatory patterns required at other joint — impacts contra limb/hip and trunk

36
Q

What is a drop lock

A

Most common lock
Released by manually lifting metal ring up
Locked by manually sliding ring down over joint
- lift up = unlocks = can get flexion
- push down = locks = in extension

37
Q

What is a bail lock?

A

Like a bucket handle thing
Bail lock is released when bail is lifted to allow knee flexion
Helpful because patients could back up into a chair and use chair to lift bail release.
not used much anymore due to unintentional releases and big fall risk

38
Q

What is a posterior offset knee joint?

A

Provides knee extension assistance during stance phase
GRF vector remains anterior to the mechanical axis and produces an extension moment at the knee.

39
Q

What is a Scott Craig KAFO

A

Provides stance phase hip extension moment by manipulating GRF vector posterior to the hip joint.
PF stop forces the legs to rotate as a whole forward during loading response.
Hip is stabilized in slight extension by GRF and stabilized by anterior iliofemoral ligament in midstance.
KAFO must be set in 7-10 degrees of DF to place legs anterior to hip in stance. Ankles locked and knees locked

40
Q

What is a spreader bar?

A

Attached between legs to keep them parallel and in line with one another
— Allows for swing throug gait with legs operating as a unit. Need the right angle at the ankles, knees locked and symmetrical to have a nice stance.

41
Q

What kind of footwear can be used with plastic orthoses?

A
  • Generally shoes need to be 1/2 size larger on the side requiring AFO
  • Laced and Velcro closures work best — want a firm control at foot
  • Heel height is critical - all shoes must have similar heel heights and must be minimal heel height.
42
Q

What about socks?

A
  • Generally provide cushion, absorb perspiration, reduce shear forces.
  • Over the calf tube socks, specialty socks, stockinette, compression garments
  • Make sure limb is covered for length of AFOs
  • Don socks without wrinkles
43
Q

What are areas of concern for skin inspections?

A

areas that are most likely to rub, have shearing or whatever with the brace they put on
- Malleoli
- Navicular bone
- Calcaneus
- Base of 5th metatarsal
- Head of 1st and 5th metatarsal
- Calf band
- Check locations of all Trimlines

44
Q

What is the wear time for patients?

A

Depends on patient presentation, corrections needed, sensation, skin quality
- Need to be part of the training to patient and caregiver
- Start with1-2 hours of wear time. Gradually increase every couple of days
- Skin checks after each initial use

45
Q

What is a sign of an ill fitting orthotic and needs immediate attention from the orthotist/team?

A

Redness lasting over 15 minutes and over areas of concern

46
Q

What is included in patient education?

A

When they need to wear it
Donning/doffing
Wear schedule
Skin inspection
Maintence — likely areas to break down first
Changes that must be made by orthotist
Training to not place any additional foam inside brace for comfort.

47
Q

What is a big concern for patient/family education?

A

Big concern is use of bathroom at night - can patient safety get to bathroom at night without putting the orthotic on?

48
Q

What needs to happen for the check out process?

A

Examination of orthotic off the client
Re-exam of client
Static assessment of orthotic on client
Exam of orthotic on client during gait/transfers
Exam of donning/doffing ability
After wear and use for 30-60 minutes plus skin check

49
Q

What is an FES system?

A

Electrodes in calf band to stimulate anterior tib
Triggered by sensor set up to stimulate at specific angle on tibial inclination
Indicated for FOOT DROP ONLY — no control at the knee and no control for frontal plane motion

50
Q

What must happen with an FES system?

A
  1. Need to evaluate patient sensation/response to stimulation
  2. Need to have significant set up specific to patient and patient gait cycle
51
Q

What makes getting an FES system difficult?

A

Not always covered by insurance
Most hospitals and clinics do not have a trial option for patients to use
May be contraindicated for patients with pacemakers, metal implants, and history of phlebitis. (NO FES IF KNEE REPLACEMENT)

Orthotics Final (4 decks)

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