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Prosthetics & Orthotics > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

Definition of Orthosis

A

A static or dynamic EXTERNALLY APPLIED DEVICE

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2
Q

What are orthosis used for?

A

(IMPROVE FUNCTION!!)

  • prevent deformity
  • Correct deformity
  • support segment for WB = Unload
  • Assist movement, facilitate movement, limit movement
  • Decrease pain or discomfort
  • Improve posture/ alignment
  • Immobilize
  • Provide feedback
  • Improve cosmesis
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3
Q

Indications for orthoses

A
  • Impaired (posture, muscle performance, joint mobility, motor function, sensory integrity, peripheral nerve integrity, integumentary integrity)
  • Acute conditions. (Trauma, post-surgery)
  • Chronic conditions (Musculoskeletal, neuromuscular)
  • Prophylactic
  • No age or practice limitation
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4
Q

What does brace orthosis

A

Resists or directs force

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5
Q

Two types of orthosis

A

Brace or splint

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6
Q

What does a splint do?

A

Maintained or attains a position

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7
Q

How are orthoses named?

A

By body part/ joint encompassing

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8
Q

What are prefabricated also called and what are they used for?

A

Custom- fitted

  • mid-mod joint involvement
  • temp use
  • diagnostic procedure
  • do NOT fit or function as well as custom made
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9
Q

Custom made orthosis

A
  • mod-severe joint involvement
  • extended or permanent use
  • Give individual fit & max function
  • MORE pricey
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10
Q

Material used for orthoses

A

-Thermoplastic, metals , carbon fiber

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11
Q

Thermoplastic

A

-Light weight, easy to clean, total contact (distributes pressure over larger area), can wear different shoes w/ plastic

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12
Q

What does total contact provide in orthoses

A

Distributes pressure over large area

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13
Q

Metals for orthoses

A
  • Steel, aluminum, titanium
  • stronger
  • SOme heavier; bulkier
  • more maintenance; oil joint
  • limited shoe wear
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14
Q

Carbon fiber orthoses

A

Greater elasticity

Lighter

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15
Q

Principles of design (6)

A
  • distribute pressure (p= f/a)
  • Length of force arm (think resistance)
  • Control ground reaction force (GRF)
  • Control degrees of freedom
  • 3 point pressure
  • 4 point pressure
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16
Q

when the control ground force is in front of the knee….

A

knee ext

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17
Q

when the control ground force is behind the knee….

A

knee flex

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18
Q

why would you want to control degree of freedom ?

A

its allows the brain to focus on a smaller amount of motion . (brace controls virus/valgus in knee; brain worries about flex/ext)

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19
Q

why is it common for functional knee braces to be 4 point pressure

A

so that there is no pressure on the patella

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20
Q

orthotic solution for gene recurvatum

A
  • 3 point system/ manipulate GRF
  • usually done with AFO to prevent PF
  • Swedish knee cage also used to prevent knee ext
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21
Q

3 point pressure systems using concave/ convex?

A

2 points on concave

1 point on convex

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22
Q

How would you set up a WC with a 3 point pressure system to reverse decorticate posturing ?

A

Tilt in space WC

-butt, back, gravity

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23
Q

foot lifts

A

correct limb length discrepancies

  • SI disfunction
  • Opposite limb of KAFO to help make clearing orthoses easier
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24
Q

Heel lifts

A

reduce achilles tendon stress (achilles tendinitis)

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25
Q

Heel cups

A

Redistribute fat pad to improve shock absorption

-Heel spurs & plantar fasciitis

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26
Q

foot orthoses arch supports

A

rigid pes planus

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27
Q

rigid and semirigid corrective foot orthotics normalize?

A

abnormal subtalar and tarsal-metatarsal joint mechanics

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28
Q

example of AO

A

aircast

  • controls talocrural joint
  • accommodates swelling
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29
Q

examples of AFO

A

swedeO (fabric)
sure step
langer total control

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30
Q

CAM walker

A
  • immobilizes ankle joint
  • no unloading of distal structures
  • rocker bottom
  • Removable and adjusts to volume changes
  • accommodates swelling
31
Q

articulated AFO can allow for

A

energy conservation

-springs allow for a more continuous gait

32
Q

what are parts for articulated AFO?

A

DF/PF stops, dual channel (springs and stoppers)

33
Q

AFO with plastic in back helps with

A

controls PF. (knee hyper ext)

34
Q

AFO with plastic in front help with

A

controlling DF (knee flex )

35
Q

AFO with plastic in front controls?

A

tribal advancement and helps maintain knee ext during mid stance

36
Q

what is important to note about knee immobilizers?

A
  • the deg. on the flex/ext stop is rarely accurate.

- important to educate pt. on proper donning (axis on joint line)

37
Q

4 point pressure KO systems are ?

A

single axis or polycentric joints

38
Q

4 point pressure KO systems are suppose to limit

A
  • genu recurvatum
  • anterior tibial translation
  • varus/ valgus forces
  • rotation ?
  • Enhance proprioception (mostly)
39
Q

Unloading knee brace use what to do what?

A

3 point pressure systems to redistribute WB

40
Q

examples of when to use an unloading knee brace?

A

Genu valgum
genu varum
knee OA

41
Q

what are neoprene sleve with buttress and T-strap orthosis used for?

A

altering patellar tracking

42
Q

what are infra patellar straps used for?

A

decrease strain on patellar tendon by decreasing patella-patellar tendon angle

43
Q

what are the different types of KAFO knee locks?

A

bail lock
drop lock
ratcheting locks

44
Q

with a KAFO where is the weight bearing ?

A

through the ischium comparable to a quadrilateral TF prosthesis socket
-It unloads proximal tibia and femoral condyle

45
Q

Extension assist KAFO, what does it do?

A

elastic webbing controls heel rise in MidSt and increases knee extension in TSw

46
Q

with a stance control KAFO PF produces what force at the knee?

A

extension force

47
Q

with a stance control KAFO DF does what at the knee?

A

releases the extension force

48
Q

a stance control KAFO are helpful for?

A

fatiguing diseases like MS and CMT

49
Q

why can stance control KAFO be problematic

A

hard/ heavy to swing leg to advance

-when DF all weight is on the heel

50
Q

Name a sequelae of stroke that would contraindicate a stance control AFO

A

Stroke or TBI where there is PF tone and cannot DF to unlock the knee

51
Q

what type of pt would a HKAFO be good for?

A

CP or SCI but have to be very strong to be able to be able to hold self up and swing both leg forward

52
Q

HpO are usually seen on

A

kids to maintain hip ABD

53
Q

post op hip abduction orthosis are used for?

A

pt with dementia who will not follow precautions or challenging hip surgeries

54
Q

LSHO limit?

A

hip adduction, flexion, and IR

55
Q

hip spica (spika) LSHO are?

A

to immobilize the hip completely,

not east to don/ doff

56
Q

which LSHO orthoses controls forces at the hip most effectively ?

A

Hip Spica (spika)

57
Q

which LSHO exert larger pressure at its edges?

A

post op hip ABD orthosis

58
Q

what are RGO?

A

reciprocal gait orthoses (HKAFO)

-ext, unload, spring forward

59
Q

What are the pavlik harness used for?

A
  • to treat reducible developmental hip dysplasia in children less than 6 months old
  • draws femurs into flexion and abduction
60
Q

what are the pavlik harness not appropriate for?

A

for fixed tetatologic islocations of the hip

61
Q

what is the scottish rite brace used for

A
  • weight bearing and hip abd.

- W/B in abd improves development of femoral head

62
Q

what disease uses the scottish rite? and what is the disease?

A

legg calve perthes disease

-it is a degenerative disease of the hip causes osteopenia and necrosis of femoral head

63
Q

what do splinting/casting for contractures prevention do?

A

long duration , low load passive stretch

64
Q

what is an active splint for contracture prevention ?

A

dyna splint

-good for synergies, hypertone, and spasticity

65
Q

What is a passive adjustable splint for contracture prevention

A

RCAI

-set an angle and it stays

66
Q

what is a passive splint for contracture prevention ?

A

mult-podus boot

  • Used alot for patient with low arousal.
  • neutral alignment with DF and IR/ER.
  • off loads the calcaneus
67
Q

can cast be used for splinting to prevent contracture ?

A

yes. not commonly used. more often seen in inpatient

68
Q

examples of post op shoes ?

A
  • cast shoes (can be dangerous when ambulating)

- wedge shoes (eliminates forefoot WB (forefoot offloading shoes)) good for diabetic patients with ulcer

69
Q

how should you evaluate a patient for LE orthosis

A
  • Evaluate in standing, w/o external support as appropriate
  • Evaluate walking, w/o support if appropriate
  • want to be able to see/visulizing AT LEAST feet, knees and ankles
  • Viewing iliac crest and lumbar spine can also be helpful
  • ANT, POST, LAT VIEWS!
70
Q

what test should be performed when evaluating a pt for LE orthosis?

A
  • MMT (k ext, PF/DF)
  • ROM (K ext (0 deg)/flex, DF(0-5 deg))
  • Sensation (protective, proprioception, kinesthesia, somatosensory) for balance
71
Q

How to test proprioception for balance?

A

have patient close their eyes.

  • If patient has good balance and then poor balance when eyes are closed they rely on eye sight for balance.
  • for these patients an orthoses should not effect balance.
72
Q

before providing a patient with an orthosis what should you do?

A

trial walking with a temporary interventions.

-heel lifts, toe lifts straps, DF wraps or straps (use an ace bandage), off the shelf orthoses

73
Q

What are some considerations for LE orthosis (6)

A
  • check for slipping, alignment
  • Evaluate donning/ doffing (independence/ caregiver)
  • Pressure areas, skin care (skin may get red in beginning)
  • Care giver education
  • Monitor for wt loss or gain ( 10lb change orthosis/ 5 lb prosthesis)
  • ROM

Prosthetics & Orthotics (3 decks)

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