MSK Orthotics (1) Flashcards
purpose of a brace/orthosis
assist motion
restrict motion
correct motion
provide feedback
assist motion –> purpose
w/ use of elastic straps or spring
restrict motion –> purpose
with use of stops or hinges
correct motion –> purpose
with long duration stretch
provide feedback –> purpose
afferent input from cutaneous receptors may lead to improved position sense
3 categories of knee bracing
prophylactic
rehabilitative
fxnal
prophylactic –> categories
designed to prevent or reduce the severity of a knee injury
rehabilitative –> categories
designed to allow protected motion of the injured knee treated surgically or non-surgically
fxnal –> categories
designed to provide stability to the unstable knee
hinge design for knee braces/orthoses
single
polycentric
multi-axis cam action
polycentric hinge
“fource point” hinge
fource point hinge
knee extension constraint hinge brace
potential training tool to assist athletes in increasing knee flexion angle during landing tasks
hinge technology of fource point hinge
patented
leaf spring mechanism provides 5 levels of resistance during extension
patented –> fource point hinge
designed to keep the knee out of “at risk” position
what does the fource point hinge apply
resistance during knee extension
resistance engages in last 25 degrees of extension
athletes <25 years who return to sport
have a secondary ACL injury rate of 23%
30-40x greater risk
decrease in anterior shear force on the tibia
should reduce the load on the ACL
risk factors for ACL injury may be minimized by
training through increased flexion angle during jump landing
wearing a FP consistently
increased the knee flexion angle
how much did the knee flexion angle increase while wearing a Donjoy FP hinged brace
8-10 degrees
brace prescription is based on
7 factors
7 factors of base prescription
goal of brace
activities for brace usage
pt’s build and varus and valgus alignment
pt’s ability to don and doff the brace
cosmesis of brace
materials used and weight of brace
cost
goals of brace
prophylactic
rehabilitation
fxnal
goal of prophylactic knee braces
eliminated or decreases the severity and incidence of injuries to the knee
resulting from both contact and non-contact stresses
characteristics of an ideal prophylactic brace
supplement the resistance of the knee to injury
doesnt interfere w/ knee fxn
doesnt increase overall risk in other joints
adaptable to various anatomical configurations
not hazardous to others
durable and cost effective
efficient in preventing injuries
goal of rehabilitative braces
provides controlled motion to allow tissue healing
characteristics of ideal rehabilitative brace
provide adequate control of motion
avoid excessive loads on healing tissue
allow locking hinge if needed
adjustable to variable leg sizes and shapes, adapt for edema and atrophy
easily donned and doffed
durable and economical
comfortable
uses of rehabilitative braces
function
function of rehabilitative braces
to provide protection against accidental loading
ligament injury/reconstruction
quad rupture/patellar tendon rupture
patalla femoral realignment
goal of fxnal knee braces
assists or provides fxnal stability of the knee
characteristics of an ideal fxnal knee brace
support the joint w/o restricting fxn
be adjustable for changes in thigh girth
be able to withstand demand of activity
types of fxnal knee braces
hinge, post, strap or hinge, post, shell
stock or custom
stock or custom are dependent on–> types of fxnal
size and shape of leg
demand of activity
cost
examples of fxnal knee braces (least to most restrictive)
sleeve
medial and lateral hinge
hinge, post, strap or hinge, post, shell
fxn of a sleeve
compression
retention of body heat
protect and provide proprioception
uses of a sleeve
arthritic knee
tendinitis
materal
typically either elastic or neoprene
medial and lateral hinge fxn
controls valgus/varus and extension (hyper)
uses of medial and lateral hinge
medial or lateral instability
hinge, post, strap or hinge, post, shell fxn
attempts to control medial/lateral, ant/post and IR/ER
hinge, post, strap or hinge, post, shell has…
6 degrees of freedom
6 degrees of freedom –> hinge, post, strap or hinge, post, shell
sagittal plane
frontal plane
transverse plane
sagittal plane –> hinge, post, strap or hinge, post, shell
anterior translation of tibia and hyperextension
frontal plane –> hinge, post, strap or hinge, post, shell
medial and lateral
transverse plane –> hinge, post, strap or hinge, post, shell
controls ER of tibia with extension of knee
uses of hinge, post, strap or hinge, post, shell
ACL or PCL with rotary instability
hinge, post, strap or hinge, post, shell term
“de rotation”
breakdown/transition braces are
designed to be used during both stages of rehabilitation and fxnal
breakdown/transition braces examples
patella braces
“unloading” OA braces
patella braces goals
to improve tracking or prevent subluxation/dislocation of patella
types of patella braces
donut
horseshoe
dynamic buttress
extension stop w/ buttress
strap “counterforce”
McConnel strapping
goal of unloading OA braces
to decrease knee compartment forces caused by OA
indications of unloading OA braces
isolated unicompartmental OA (M/L)
