LECTURE 4: ORTHOTICS Flashcards
-A good Orthotic Evaluation should include assessment of:
- Diagnosis
- Motor Control
- Range of Motion Coordination
- Posture
Sensation - Skeletal Alignment
- Balance
- Strength
- Observational Gait
Analysis
Orthosis Design must do what?
- Control the boney segments of the lower extremity
- Meet musculotendinous objectives: assess ligamentous laxity, mm strength
- Meet motor control objectives
- Meet functional objectives
if you get a patient’s COM over BOS in stance, you will get much better WHAT
PUSH OFF
A device that is attached or applied to the external surface of the body to improve function, restrict or enforce motion, or support a body segment.
ORTHOSES
what is passive force in normal gait?
gravity…GROUND REACTION FORCE!
critical to conservation of energy!
what are the 4 basic functions needed for normal gait?
- WB stability
- stance limb progression
- shock absorption
- energy conservation
*in order of importance!!!
- Weight Bearing Stability
The pattern of muscle control is dictated by
the changing alignment of the body weight
line (vector) to the individual joint. As the
vector moves away from the joint center, a
rotational force or moment develops that
must be controlled by opposing muscles to
preserve postural stability
What is happening with countering muscle force of our patients needing orthoses?
Muscle force needs to counter GRF
- absent
- spastic
- out of phase (not contracting at right time)
in Stance, foot is not moving. Why does GRF move?
COM center of mass
moves over foot
◦ Co-contraction of antagonists
is rare. T/F
true. usually
IC: what if tib ant is not working?
want orthosis to do what tib ant is not doing
(there is a plantar flexor moment, need eccentric control)
LR: what mm are firing?
glutes
quads: stabilize knee
tib ant
GRF: hip flexion, post knee, post ankle
midstance: MM and GRF
torso is rotating in midstance, GRF: moving forward!
-quads UNTIL it zeros out
-plantar flexors
*plantar flexor-knee extensor couple –> UNIQUE POINT IN STANCE!
what is the MOST IMPORTANT THING in midstance?
controlled tibial advancement with ECCENTRIC PF control!
** mm are quiet
in midstance to terminal stance: zero concentric contractions happening! no energy to do this. How?
COM keeps moving! and torque from plantar flexors
*ballistic moment of plantar flexors
*without calf, knee will buckle and they will fall. So short step
when does gastroc come to help soleus?
terminal stance! knee extender
*1.4-2.4x BW is on the forefoot, so NEED STABILITY AT FOOT
In swing phase, what is important for the orthoses?
enough DF in foot
pick up weight in foot
fixing swing phase is easy. What is hardest?
re-establishing 3rd rocker (forefoot rocker, push off)
What are the buckets of pathological patterns?
- structural impairments
- motor unit insufficiency
- peripheral sensory and motor impairment
- central control dysfunction
structural impairments include:
- Contributing
pathologies are:
o Contractures
o Skeletal Deformity
o Musculoskeletal Pain
motor unit insufficiency pathologies include:
Muscle weakness:
* Lower Motor Neuron
Disorders
– Poliomyelitis
– Guillain-Barre’
* Muscular Pathology
– Muscular Dystrophy
*knowing where limb is in space is an advantage
peripheral sensory and motor impairment pathologies
Peripheral Sensory
and Motor
Impairment:
* Cauda Equina Spinal
Cord Injury
* Spina Bifida
* Acute Trauma
central control dysfunction
o Upper motor neuron
lesions
o Brain lesions
- stroke,
- acute head injury
- cerebral palsy
- Cervical and high
thoracic level
lesions
*challenge is spasticity
Patients with motor unit insufficency can…
substitute for local weakness since
sensation and control have been maintained
