Lecture 5: UE orthotics Flashcards
name an orthotic that goes from shoulder to the fingers
SEWHFO
(shoulder elbow wrist hand finger orthotic –> crosses all these joints)
additional: hinged or dynamic
What are 2 goals for orthotic intervention?
- prevent movement
- pace structure at most comfy/resting position
goal of immobilization device
- pain relief
- protect swollen structures
- maximize function
- maintain tissue length
- reduce fx, protect healing structures
- prevent contractures
- influence spasticity
goal of mobilization orthosis
- move/stretch certain soft tissue to create change
- very beneficial! *helps facilitate CELL GROWTH
How does a mobilization orthosis work?
older collagen cells are absorbed, replaced with new collagen cells
Restriction orthosis is what?
restricts or blocks aspect of joint motion
-applied to limit motion, can restrict some portion of movement while allowing motion in opposite direction
what are 2 types of static orthoses?
- static: immobilized
- serial static: made with low temp plastics, can be remolded
(applied with units they cross in a lengthened position)
types of dynamic orthoses?
- dynamic
- static progressive
What is a dynamic orthosis?
-elastic force to mobilize tissues for ROM increases!
-OUTRIGGERS
What are static progressive orthoses?
apply low load to tissue’s end range in one direction (low load, long duration)
force is static/non-elastic
-INELASTIC TAPE, STRAPPING MATERIALS, LINE, TURNBUCKLES, HINGES
*like braces, adjustments
in order to disperse pressure, you should ____ the area of force
INCREASE
*against all contours, make sure there are enough conformities
What is position of function for the hand?
Wrist:
MP:
PIP:
DIP:
Thumb:
Wrist: 20-30 extension
MP: 35-45 flexion
PIP: 45 flexion
DIP: relaxed flexion
Thumb: palmar abduction
What is position of rest for the hand?
Wrist:
MP:
PIP:
DIP:
Thumb:
Wrist: 30-40 extension
MP: 60 to 90 flexion
PIP and DIP: extension
Thumb: palmar abduction
*for volar plate and ligaments
what are straps for orthotic components?
not just for putting them on! also positioned for certain purposes
THICKNESS: ___ is better for fingers, ____ is better for proximal!
thinner: fingers
thicker: proximal
*or weight considerations
straps: what material can be used?
velcro usually
*can be canvas, leather, bandages
*wide enough to distribute pressure, avoid bony prominences
What is a stockinet?
To help absorb and disperse perspiration
Improves comfort
Easier to change than replacing bonded liner
What is open cell and close cell foam?
open cell: collapses w/ sufficient pressure
close cell: air cannot escape, always some cushion
What are outriggers?
used as pulley or to attach dynamic components
low profile: acts as pulley
high profile: for direct attachment of elastic components
dynamic component of orthotic design: pull should be ___ to bone
perpendicular to long axis of bone
(otherwise can cause pressure, shear, wounds)
what is better about high profile vs low profile outrigger?
high: less adjustment to maintain 90 degree pull
but less attractive, inconvenient, more cumbersome, not able to get clothes over orthotic
vascular/nerve injury precautions for orthotics
be careful over bony parts,
sensation impairments,
especially with circumferential orthotics!
be careful of areas with venous/lymphatic return
Orthotic Checkout:
- achieve purpose?
- maintain proper joint position?
- does it fit contours?
- does it restrict or immobilize not necessarily?
- Is it long enough?
- Is it stable?
- Are edges smooth?
- Are all possible pressure points relieved?
- Does orthotic allow optimal functional use of hand?
When evaluating, patient should try wearing orthosis for ____ minutes
15-20 minutes
What should you look for after trial 15-20 minutes wear time?
remove, check for redness, blanching, PRESSURE AREAS
What is this and what is it used for
wrist cock-up WHO
What is important to include in eval besides wear check?
Can the patient /caregiver don and doff the
orthotic, independently (if required) & correctly?
Does the patient understand wear and care
instructions?
Is the orthosis cosmetically acceptable to the
patient?
Does the orthosis do what it is supposed to do?
What is this and what is it used for
HFO: thumb spica, hand based
What is this and what is it used for
WHFO: thumb spica, forearm based
What is this and what is it used for
Dorsal Hood, WHFO
What is this and what is it used for
WHO: clamshell
What is this and what is it used for
dynamic WHFO: dynamic MCP extension w/ radial stabilization
*following MCP joint arthroplasty, allow extensor tendons to heal
What is this and what is it used for
WHFO, dynamic, MCP extension, high profile
What is this and what is it used for
EO w/ dynamic: for elbow extension (red tube is elastic)
What is this and what is it used for
WHFO w/ dynamic: tenodesis assisted finger flexion w/ extension block
*for if they had finger tendon
What is this and what is it used for
WHO w/ dynamic
wrist dynamic flexion and extension high profile
What is this and what is it used for
EWHO w/ dynamic
Dynamic
supination/pronation orthotic. Dynamic tension applied by twisting rubber torsion tube opposite direction of desired
force (2-3 turns
usually enough
dynamic elbow flexion orthosis
