Lecture 1 Flashcards
Definition of Orthosis
A static or dynamic EXTERNALLY APPLIED DEVICE
What are orthosis used for?
(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
Indications for orthoses
- 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
What does brace orthosis
Resists or directs force
Two types of orthosis
Brace or splint
What does a splint do?
Maintained or attains a position
How are orthoses named?
By body part/ joint encompassing
What are prefabricated also called and what are they used for?
Custom- fitted
- mid-mod joint involvement
- temp use
- diagnostic procedure
- do NOT fit or function as well as custom made
Custom made orthosis
- mod-severe joint involvement
- extended or permanent use
- Give individual fit & max function
- MORE pricey
Material used for orthoses
-Thermoplastic, metals , carbon fiber
Thermoplastic
-Light weight, easy to clean, total contact (distributes pressure over larger area), can wear different shoes w/ plastic
What does total contact provide in orthoses
Distributes pressure over large area
Metals for orthoses
- Steel, aluminum, titanium
- stronger
- SOme heavier; bulkier
- more maintenance; oil joint
- limited shoe wear
Carbon fiber orthoses
Greater elasticity
Lighter
Principles of design (6)
- 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
when the control ground force is in front of the knee….
knee ext
when the control ground force is behind the knee….
knee flex
why would you want to control degree of freedom ?
its allows the brain to focus on a smaller amount of motion . (brace controls virus/valgus in knee; brain worries about flex/ext)
why is it common for functional knee braces to be 4 point pressure
so that there is no pressure on the patella
orthotic solution for gene recurvatum
- 3 point system/ manipulate GRF
- usually done with AFO to prevent PF
- Swedish knee cage also used to prevent knee ext
3 point pressure systems using concave/ convex?
2 points on concave
1 point on convex
How would you set up a WC with a 3 point pressure system to reverse decorticate posturing ?
Tilt in space WC
-butt, back, gravity
foot lifts
correct limb length discrepancies
- SI disfunction
- Opposite limb of KAFO to help make clearing orthoses easier
Heel lifts
reduce achilles tendon stress (achilles tendinitis)
Heel cups
Redistribute fat pad to improve shock absorption
-Heel spurs & plantar fasciitis
foot orthoses arch supports
rigid pes planus
rigid and semirigid corrective foot orthotics normalize?
abnormal subtalar and tarsal-metatarsal joint mechanics
example of AO
aircast
- controls talocrural joint
- accommodates swelling
examples of AFO
swedeO (fabric)
sure step
langer total control
CAM walker
- immobilizes ankle joint
- no unloading of distal structures
- rocker bottom
- Removable and adjusts to volume changes
- accommodates swelling
articulated AFO can allow for
energy conservation
-springs allow for a more continuous gait
what are parts for articulated AFO?
DF/PF stops, dual channel (springs and stoppers)
AFO with plastic in back helps with
controls PF. (knee hyper ext)
AFO with plastic in front help with
controlling DF (knee flex )
AFO with plastic in front controls?
tribal advancement and helps maintain knee ext during mid stance
what is important to note about knee immobilizers?
- the deg. on the flex/ext stop is rarely accurate.
- important to educate pt. on proper donning (axis on joint line)
4 point pressure KO systems are ?
single axis or polycentric joints
4 point pressure KO systems are suppose to limit
- genu recurvatum
- anterior tibial translation
- varus/ valgus forces
- rotation ?
- Enhance proprioception (mostly)
Unloading knee brace use what to do what?
3 point pressure systems to redistribute WB
examples of when to use an unloading knee brace?
Genu valgum
genu varum
knee OA
what are neoprene sleve with buttress and T-strap orthosis used for?
altering patellar tracking
what are infra patellar straps used for?
decrease strain on patellar tendon by decreasing patella-patellar tendon angle
what are the different types of KAFO knee locks?
bail lock
drop lock
ratcheting locks
with a KAFO where is the weight bearing ?
through the ischium comparable to a quadrilateral TF prosthesis socket
-It unloads proximal tibia and femoral condyle
Extension assist KAFO, what does it do?
elastic webbing controls heel rise in MidSt and increases knee extension in TSw
with a stance control KAFO PF produces what force at the knee?
extension force
with a stance control KAFO DF does what at the knee?
releases the extension force
a stance control KAFO are helpful for?
fatiguing diseases like MS and CMT
why can stance control KAFO be problematic
hard/ heavy to swing leg to advance
-when DF all weight is on the heel
Name a sequelae of stroke that would contraindicate a stance control AFO
Stroke or TBI where there is PF tone and cannot DF to unlock the knee
what type of pt would a HKAFO be good for?
CP or SCI but have to be very strong to be able to be able to hold self up and swing both leg forward
HpO are usually seen on
kids to maintain hip ABD
post op hip abduction orthosis are used for?
pt with dementia who will not follow precautions or challenging hip surgeries
LSHO limit?
hip adduction, flexion, and IR
hip spica (spika) LSHO are?
to immobilize the hip completely,
not east to don/ doff
which LSHO orthoses controls forces at the hip most effectively ?
Hip Spica (spika)
which LSHO exert larger pressure at its edges?
post op hip ABD orthosis
what are RGO?
reciprocal gait orthoses (HKAFO)
-ext, unload, spring forward
What are the pavlik harness used for?
- to treat reducible developmental hip dysplasia in children less than 6 months old
- draws femurs into flexion and abduction
what are the pavlik harness not appropriate for?
for fixed tetatologic islocations of the hip
what is the scottish rite brace used for
- weight bearing and hip abd.
- W/B in abd improves development of femoral head
what disease uses the scottish rite? and what is the disease?
legg calve perthes disease
-it is a degenerative disease of the hip causes osteopenia and necrosis of femoral head
what do splinting/casting for contractures prevention do?
long duration , low load passive stretch
what is an active splint for contracture prevention ?
dyna splint
-good for synergies, hypertone, and spasticity
What is a passive adjustable splint for contracture prevention
RCAI
-set an angle and it stays
what is a passive splint for contracture prevention ?
mult-podus boot
- Used alot for patient with low arousal.
- neutral alignment with DF and IR/ER.
- off loads the calcaneus
can cast be used for splinting to prevent contracture ?
yes. not commonly used. more often seen in inpatient
examples of post op shoes ?
- cast shoes (can be dangerous when ambulating)
- wedge shoes (eliminates forefoot WB (forefoot offloading shoes)) good for diabetic patients with ulcer
how should you evaluate a patient for LE orthosis
- 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!
what test should be performed when evaluating a pt for LE orthosis?
- MMT (k ext, PF/DF)
- ROM (K ext (0 deg)/flex, DF(0-5 deg))
- Sensation (protective, proprioception, kinesthesia, somatosensory) for balance
How to test proprioception for balance?
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.
before providing a patient with an orthosis what should you do?
trial walking with a temporary interventions.
-heel lifts, toe lifts straps, DF wraps or straps (use an ace bandage), off the shelf orthoses
What are some considerations for LE orthosis (6)
- 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
