Lecture 18: Orthotics Physical Rehabilitation Flashcards
device worn to restrict or assist motion or to transfer stress from one area of the body to another
orthosis/brace
Temporary orthosis
Splint
Health care professional who designs, fabricates, and fits orthoses for the limbs and trunk
Orthotist
Health care professional who designs, fabricates, and fits shoes and foot orthoses
Pedorthotist
Splint = temp
Orthotic = longer term
What is a university of california berkley (UCB)
Foot level on orthosis
Foot control only
Insurance typically doesnt pay for it
Shoes are foundations for most orthotics - need to wear shoes w/ orthosis
Medical versus over the counter - some states medicate will pay for the medical ones
* ugly
AFO
* composed of a foundationm an ankle control, foot control, and a superstructure
* can contorl the knee as well as ankle
* Foundation
* control of the foot
* Insert foundation require shoe
* can control the knee
* limiting or assisting PF and/or DF
* Big thing for these is to help toes clear on swing phase
Stirrup
* U shaped steel fixture
* Center portion riveted to bottom of shoe
* Heavy and bulky
* long term users (typically dont see short term users for these)
Posterior leaf spring AFO
* Plastic insert
* Prefavricated or custom made
* Streamlined and light weight
* Ear;y stance-posterior upright acts as a leaf spring bending backward slightly
* Swing phase-upright recoils “springing” forward to lift the foot
* Adjustment limited
* Can remove material to weaken spring but cannot add to increase rigidity
posterior = skinny on back which gives it a little bit of spring
* good for low tone
Articulated spring assist AFO - can adjust how much spring were giving them (little screw on there)
* Adjustable motion assistance
* Steel DF spring assist
* Incorporated into each stirrup near ankle
* Spring compresses in stance and rebounds during swing
* Tightness of spring adjusted by turning screw on top of spring
* Bulkier than posterior leaf spring
* Yield slightly into PF at heel contact
* Slight protection against inadvertent knee flexion
avoid too much DF if they’re going to buckle at the knee
Ankle DF = knee
flexion
Ankle PF = knee
ext
Limit knee flexion by limiting DF or increasing PF
Limit knee hyperextension by limiting PF or increasing DF
AFO w/ posterior stop
* Prevent toe drag
* PF resistance with metal ankle with posterior stop
* Imposes flexion force at knee during early stance
* Prevent knee hyperextension
Anterior stop
* Hinge limits DF
* achiebe propulsion during late stance
* Prevent knee collapse (mild)
Solid AFO
* limits active muscle activation
* very stable
* Pain or severe instability
doesnt work well w/ swelling
Floor (ground) reaction orthosis
* Proximal portion of the plastic AFO
* * Anterior shell imposes posterioly directed force near the knee (extension movement)
* Resists knee flexion
* Attempts to stop knee buckling
* Used w/ a solid ankle or limited motion ankle
* Force transmited proximally
gives them a little anterior shove
Adults w/ Hemiplegia:
* Prevent or reduce plantar flexor and inventor contractures
* Improve balance
* Enhance gait by restoring heel contact
* Absorb shock on the paretic limb
* Increase midstance stability
* Improve forward progression in late stance
* Enable paretic limb to clear floor during swing phase
* Posterior ankle stop reduces genu recurvatum
* Anterior ankle stop or anterior upright facilitate weight shift to paretic limb
* Increase velocity
* Reduce energy cost of walking
* Comfort and fucntion more important than appearance to most - if they’re long term users
want to limit PF so they don’t have toe drag but they still need some for propulsion - its a balance
If they just have loss of DF what do they use
PLS - cheaper / easier and provides clearance
Motor loss confined to poor DF =
Posterior leaf spring ago
If they have pain/instability thst afo will be solid
Severe spasticity-spring assist for joint motion is contraindiacted because the spring action may serve to increase spasticity
* you don’t want to increase tone
orthotic management for these kids
typically dont do functional estem at the same time as AFO
Knee locks
* provides secruity regardless of terrain
* Drop ring lock-Lock will not drop into place while the pt rises from a chair
* Both medial and lateral joints locked
* Thigh level release
keep afos away from heat becuase thats how they’re made to adapt on you
so putting it on flex the knee to increase ankle DF
