LE, UE, Spinal Orthotics Flashcards
What is a PRAFO stand for?
Pressure Relieving Ankle Foot Orthosis
What is a PRAFO indicated for?
Contracture prevention and pressure prevention caused by:
Neuro involvement (CVA, SCI, TBI)
Orthopedic (hip fracture, amputation)
Long term immobility (ICU)
What is the main orthotic principle?
3 point pressure system
What are design considerations for orthotics?
diagnosis, prognosis, comorbidities, height, weight, cost, cosmesis, degree of deformity, degree of correction, musculoskeletal factors, mobility requirements, stability requirements, anticipated functional level
What are the 5 trim lines?
Proximal (focuses on knee) Anterior (determines motion at ankle) Ankle Foot (medial and lateral stability) Metatarsal (effects push off, if behind MT heads you'll have more rocker but less push off, if past toes it extends push off)
What do you evaluate as a PT for orthotics?
Functional ROM: midtarsal, subtalar, talocrural, knee, and hip joints
Functional Muscle Strength: focus on general LE muscle groups
What do you look at for foot alignment?
Supination, pronation, skeletal deviations
What do you look at for ankle alignment?
foot drop, medial/lateral instability, plantarflexion contracture
What do you look at for knee alignment?
Flexion, genu recurvatum, genu varum, genu valgum
What is the foundation of any orthotic?
SHOES
What are characteristics of prefabricated AFOs?
"off the shelf" limited fit and function mild involvement temporary use diagnostic procedures
What are custom fit orthotics?
prefabricated device modified to fit a specific patient
What support does custom fit orthotics provide?
Provide limited fit and function
mild to moderate involvement
temporary use
diagnostic procedures
What is the process for getting a custom fabricated orthotic?
casting, measurement, negative mold, positive mold, fabrication, modification
What is the most common orthotic in kids?
Supramalleolar (SMO/DAFO)
What support does a DAFO provide?
allows DF and PF
provides forefoot, midfoot, and subtalar stability
tone management
has no force or stability around ankle
What does ground reaction orthotic facilitate?
pre-tibial cuff facilitates knee extension
rigid foot plate facilitates push-off
capable of tri-planar motion control
What is purpose of patellar tendon bearing orthotic?
reduces force on mid-foot and heel
What does a solid ankle orthotic do?
trim lines encompass malleoli to immobilize ankle and provide medial and lateral stability.
Maximum motion control in all planes
Disrupts normal gait because it doesn’t allow PF or rocker.
What is purpose of semi solid orthotics?
Trim lines bisect malleoli which takes away some restriction of solid AFO.
Allows some DF in late stance.
Provides some M-L stabilization
What is posterior leaf spring?
Stores energy during loading.
Releases energy to facilitate swing.
Provides little M-L stability
What does a articulated AFO do?
various materials can be used
can address multiple biomechanical functions (DF stop, PF stop, DF assist)
varying levels of adjustability
Size/weight and cosmesis may be problematic
What are types of articulated AFOs?
Oklahoma ankle joint with PF stop
Gillete ankle with DF assist
Chamber axis hinge
What is metal upright orthosis?
Easily adjustable
maximal stabilization
may be indicated for patients with high risk feet or fluctuating edema.
weight and cosmesis are major concerns
How are dorsiflexors affected in pathologic gait?
DF peak during swing and heel strike in normal gait, prevents foot slap.
Compensatory gait patterns: steppage gait, hip hike, circumduct
orthotic considerations: DF assist
How are plantarflexors affected in pathlogic gait?
Peak activity during push off in normal gait
Compensatory patterns: lurching gait because they can’t propel forward
Orthotic considerations: move MT trim lines to make foot plate rigid, DF stop will create rigid lever for push off
What do quadriceps do in pathologic gait?
Peak activity during heel strike of gait.
Compensatory gait patterns: hyperextension of knee, may flex trunk so their knee can be locked out, may have hand in pocket to push knee back and lock it
Orthotic considerations: posteriorly offset knee joint so it’s easier to lock it out.
What does a KAFO do?
provides maximal stability
creates functional leg length discrepancy
increases energy expenditure
What do stance control KAFOs do?
stability during stance
knee flexion during swing
larger and more expensive
locking mechanisms vary
What are requirements for KAFOs
adequate cognitive function
hip flexion and extension strength >3/5
What are contraindications for KAFOs?
knee flexion contracture >10 spasticity uncorrectable valgus/varus >15 poor balance or ataxia hip flexion strength
What are neuromuscular electrical stimulation devices?
electrically stimulates tibialis anterior
some units can stimulate quads and hamstrings
What is an IDEO?
Intrepid Dynamic Exoskeletal Orthosis
rigid foot plate and ankle enlage limit ankle motion and facilitate push off
3-4 inch cushion blunts heel strike and allows transition from heel to forefoot
PF position facilitates deflection of strut and energy storage through terminal stance
What are purposes of orthotics?
support and align immobilize, restrict, or mobilize prevent or correct deformity substitute or enhance motion reduce pain and discomfort
What are indications for spinal orthotics?
Correct of prevent deformity Relieve pain Support fracture healing Post-op protection Prevent further injury Support and align
What are the 3 spinal orthotics principles?
3 point pressure system
Increase hydrostatic pressure, provide kinesthetic reminder, modify support systems
What are parts of the extrinsic stability of the spine?
Flexors: psoas, abdominals
Extensors: erector spinae, paraspinals
What intrinsic components of the spine?
Ligaments: linkage, transfer loads, smooth motion
Discs: shock absorption
What are design considerations of spinal orthotics?
Necessity, cosmesis, weight, available ROM, cost, adjustability, effectiveness, functionality
What is purpose of soft collars?
Facilitate spinal alignment, limit some ROM, provide kinesthetic reminder
What are the types of collars?
Soft collar
Semi-rigid collars- Miami J, aspen, philidelphia
What is a SOMI or Lerman-Minerva?
cervical orthoses with thoracic extension
often indicated with bed ridden patients
What is a halo?
Tri-planar motion control of cervical spine
Maximum immobilization
Restricts 90-95% of normal motion
poor patient acceptance with high complication ratew
What is an over the counter LSO?
Flexible LSO (lumbosacral corset)
What does a chairback LSO do?
restricts sagittal plane motion
tightening of abdominal support reduces lumbar lordosis
What does a Knight LSO do?
Restricts sagittal and coronal plane motion
tightening abdominal support reduces lumbar lordosis
What do TLSOs do?
restricts sagittal and coronal plane motion
tightening abdominal support reduces lumbar lordosis
Tightening axillary straps facilitates thoracic extension
What is a Jewett hyperextension TLSO indicated for?
Compression fracture
kyphosis
arthritis
What TLSO is more common in geriatric patients?
CASH hyper extension TLSO
restricts flexion
What is a turtle shell brace?
rigid TLSO (body jacket) restricts sagittal, coronal, and transverse plane movement
What is a CTLSO?
TLSO with cervical extension
What are orthotic indications for scoliosis?
skeletal immaturity (premenarche) curves between 20 and 40 degrees documented progression single or double curves
What is a accommodative TLSO?
addressed fixed deformity
aligns head and trunk over pelvis: reduces shear forces, facilitates UE use, enhances mobility base, facilitates respiratory function
What is a corrective TLSO?
progressive correction of idiopathic spinal curvature
stabilization of congenital spinal curvatures
prevent and or correct deformity
What are the types of corrective TLSOs?
Boston brace: gold standard, worn full time 18-23 hours/day
Milwaukee brace: upper thoracic and cervical curves, worn full time
Charleston bending brace: for smaller, flexible lumbar curvature, worn only at night
What is physical therapy for corrective TLSO?
skin care trunk mobility and strengthening aerobic training postural feedback and training functional training with brace
What are indications for UE orthotics?
Trauma: vocational, burns, MVAs
Congenital deformity
Disease: RA, SLE, neurological impairments, especially those associated with abnormal tone
What is purpose of UE orthotics?
symptom relief, immobilization, protection, scar management, provide resistance, compensate, prevent deformity, stabilization, correct deformity, aid function, influence spastic muscle
What are designs of UE orthotics?
Static
Serial static: modify brace weekly
Static progressive: use static components to apply force
Dynamic: uses elastic components to apply force
What is the anatomy of the extensor mechanism?
Mechanism relies on excursion of extensor tendons
extensor excursion is less than that of flexors
So extensor mechanism is more likely to shorten and it is more difficult to compensate for loss of extensor excursion
What is functional anatomy of MCP and PIP?
Ligament length dependent on joint position
What is prone to shortening in MCP and PIP?
MCP extension: collateral ligaments are slack and prone to shortening
PIP flexion: volar plate is slack and prone to shortening
What is the anti-deformity position of the hand?
MCP flexion with PIP and DIP extension (intrinsic plus)
What is intrinsic plus position?
MCP flexion with PIP/DIP extension
Positioning MCP in flexion protects IP extension
Commonly used after trauma, burn, or tendon repair
What is intrinsic minus position?
MCP extension wit PIP/DIP flexion
Often results from intrinsic denervation of ulnar nerve
Unopposed extension cause MCP hyper extension and IP flexion
What happens to pressure to an area?
It is never eliminated it is only distributed
must accommodate for bony prominences
What are common prominences under pressure?
olecranon humeral epicondyles styloid processes base of 1st MC joint dorsal thumb, MP, and IP joints pisiform
What are common nerves under pressure?
Radial groove of humerus (radial) Cubital tunnel (ulnar) Distal forearm (ulnar) Carpal tunnel (median) Volar digital nerves
What is position of hand in a functional hand splint?
Wrist in 20-30 of extension
thumb in palmar abduction
MCPs in 15-20 of flexion
IPs in slight flexion
What is intrinsic plus wrist and MCP position in splints of palmar burns?
30-40 degrees extension of wrist
70-90 flexion of MCP
What is intrinsic plus position of wrist in dorsal burns?
neutral to slight extension
What is intrinsic plus position of wrist and MCPs in crush injuries?
0-30 degrees wrist extension
60-80 degrees of MCP flexion
What is IP and thumb position in intrinsic plus splint?
extension of IP joint
palmar abduction of thumb
What is position of wrist splint for carpal tunnel syndrome?
0 degrees
In radial nerve palsy what is position of wrist splint?
30 degrees
What is position of wrist splint in wrist extensor tendonitis?
20-30 degrees
With a colles’ fracture how is wrist positioned?
up to 30 degrees
What is position of wrist in RA?
comfort level up to 30 degrees
With RSD/CRPS what is splint position?
as tolerated
Splint position with wrist joint synovitis?
0-15 degrees
What are syndromes that may cause the thumb to be immobilized?
DeQuervain’s: inflammation of APL and EPB synovial sheaths
RA
Gamekeepers thumb: ulnar collateral ligament injury
What is position of thumb if it needs to be splinted?
25-30 degrees of abduction with MP joint in neutral
