Orthoses

Question 1

Orthosis defined

Answer 1

An external appliance worn to restrict or assist motion or to transfer load from one area to another

Question 2

Purposes of Orthoses

Answer 2

Stabilize joint, Assist with movement at a joint, Protect joint, prevent deformity or injury

Question 3

Stabilize joint uses

Answer 3

Joint with weak musculature or compromised structure
Severe fracture

Question 4

Assist with movement uses

Answer 4

Compensate for diminished muscular function at a joint

Question 5

Protect joint uses

Answer 5

Prophylaxis to a joint or soft tissue structure that is possibly at risk for pathology
- post injury - history of injury - predicted deterioration

Question 6

Prevent deformity uses

Answer 6

Reduce, halt or reverse the process of joint deformity

Question 7

Pathologies related to Orthoses (3)

Answer 7

Soft tissue (ligamentous, muscular/tendon)
Joint pathology (degenerative joint disease, meniscal)
Neurological (UMN lesions, CVA, TBI, LMN lesions, Peripheral nerve injury, ALS)

Question 8

3 steps of determining orthosis needs

Answer 8

1. PT examination (clinical judgements)
2. Prognosis and developing a plan of care
3. Implementing plan of care (intervention)

Question 9

PT Exam components

Answer 9

Patient history
Functional assessment
Gait, balance and motor coordination
Muscle performance
AROM, PROM
Tone
Sensory integrity
Integumentary integrity

Question 10

Prognosis and plan of care components

Answer 10

Based upon exam findings and purposes, and orthosis may achieve a better functional outcome
Goal of orthosis

Question 11

Implementing plan of care

Answer 11

Prescription recommendation to physician and orthotist
Application of orthosis
Education of patient and family

Question 12

Types of lower extremities (3)

Answer 12

!. Categories (joints included)
2. Classification (brace material)
3. Subclassifications (Solid or articulating)

Question 13

Components of Orthoses (3)

Answer 13

1. Interface (portion that is in contact with the limb - distributes forces)
2. Joints (allows or limits motion, must be aligned with anatomical joint)
3. Structural components (Supports or link interface, attaches one component to another)

Question 14

Influence motion at the knee

Answer 14

Allowing Plantar flexion provides an extension moment at the knee, and limiting plantar flexion reduces recurvatum at the knee

Limiting dorsiflexion stabilizes the knee into extension.

Question 15

Plantar flexion assistance

Answer 15

Helps will push off

Question 16

Dorsiflexion assistance

Answer 16

Swing clearance

Question 17

Metal AFO (A/D)

Answer 17

Advantages (Heavy duty, edema fluctuations, better control of spasticity)
Disadvantages (Cosmesis, heavier, shoe dependent)

Question 18

Valgus/Varus T-straps

Answer 18

Medial T strap - corrects pronation or calcanea valgus
Lateral T strap - corrects supination or calcanea varus

Question 19

Plastic AFOs / MAFO (A/D)

Answer 19

Advantages (Cosmesis, lighter weight, more flexible design, more joint choices, better M-L control)
Disadvantages (Poor skin integrity, decreased sensation, less durable, High tone difficult to control)

Question 20

Solid AFO

Answer 20

Motion is controlled by -
rigidity of the plastic
trim lines (more anterior more rigid)
reinforcement (flange)

Question 21

Posterior Leaf Spring

Answer 21

Minimal rigidity
Controls for DF
No knee control
Indication: Foot drop without increased tone and good knee control

Question 22

MAFO with flange

Answer 22

Controls eversion/pronation or inversion/supination

Question 23

Patellar Tendon Bearing

Answer 23

Limit the amount of weight transmitted though the foot
Plastic brim with a slight indentation over the patellar tendon

Question 24

Carbon Fiber (A/D)

Answer 24

Advantages (Lightweight, Energy return at toe-off, normal shoe, can use orthotics, good for isolated foot drop)
Disadvantages (not good for extreme spasticity, deformity, large calves, tall people, significant PF contracture, poor sensation, and decreased skin integrity)

Question 25

Articulating MAFO (A/D)

Answer 25

Advantages (use available ROM and strength, improves functional mobility, more assisting muscle groups)
Disadvantages (heavier, increased maintenance, decreased M-L control, bad for flaccid limb or clonus, increased cost, may not control knee/ankle)

Question 26

Types od joints

Answer 26

Klenzak (single channel, DF assist)
Dual Channel (stops or springs on either side)
Gillette/Tamarack (plastic rubber band, DF assist)

Question 27

Antieror Stop

Answer 27

DF stop
Limits DF
Controls knee buckling

Question 28

Posterior stop

Answer 28

PF stop
Limits PF
Controls toe clearance and knee recurvatum

Question 29

Adjuncts

Answer 29

Shoe lifts and toe glides (toe clearance)

Question 30

What does the research say!?

Answer 30

AFO over no AFO
Favors MAFO over Carbon
More participation = greater gains
More research is needed

Question 31

Upper extremity supports purpose

Answer 31

Supports weka/flaccid arm

Question 32

Types UE supports

Answer 32

Flexed arm slings
Extended elbow slings
Lap trays (full and half)
Arm trough
Foam wedge
Compression gloves

Question 33

Indications for sling

Answer 33

Protect hemiparetic arm during functional mobility
Minimize risk for traction injury
Support the weight of arm
May facilitate functional mobility of patient

Question 34

Sling guidelines

Answer 34

Minimize sling use!
Only use for safety and transfers
Each patient has different needs!