Orthoses Flashcards
Orthosis defined
An external appliance worn to restrict or assist motion or to transfer load from one area to another
Purposes of Orthoses
Stabilize joint, Assist with movement at a joint, Protect joint, prevent deformity or injury
Stabilize joint uses
Joint with weak musculature or compromised structure
Severe fracture
Assist with movement uses
Compensate for diminished muscular function at a joint
Protect joint uses
Prophylaxis to a joint or soft tissue structure that is possibly at risk for pathology
- post injury - history of injury - predicted deterioration
Prevent deformity uses
Reduce, halt or reverse the process of joint deformity
Pathologies related to Orthoses (3)
Soft tissue (ligamentous, muscular/tendon)
Joint pathology (degenerative joint disease, meniscal)
Neurological (UMN lesions, CVA, TBI, LMN lesions, Peripheral nerve injury, ALS)
3 steps of determining orthosis needs
- PT examination (clinical judgements)
- Prognosis and developing a plan of care
- Implementing plan of care (intervention)
PT Exam components
Patient history
Functional assessment
Gait, balance and motor coordination
Muscle performance
AROM, PROM
Tone
Sensory integrity
Integumentary integrity
Prognosis and plan of care components
Based upon exam findings and purposes, and orthosis may achieve a better functional outcome
Goal of orthosis
Implementing plan of care
Prescription recommendation to physician and orthotist
Application of orthosis
Education of patient and family
Types of lower extremities (3)
!. Categories (joints included)
2. Classification (brace material)
3. Subclassifications (Solid or articulating)
Components of Orthoses (3)
- Interface (portion that is in contact with the limb - distributes forces)
- Joints (allows or limits motion, must be aligned with anatomical joint)
- Structural components (Supports or link interface, attaches one component to another)
Influence motion at the knee
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.
Plantar flexion assistance
Helps will push off
Dorsiflexion assistance
Swing clearance
Metal AFO (A/D)
Advantages (Heavy duty, edema fluctuations, better control of spasticity)
Disadvantages (Cosmesis, heavier, shoe dependent)
Valgus/Varus T-straps
Medial T strap - corrects pronation or calcanea valgus
Lateral T strap - corrects supination or calcanea varus
Plastic AFOs / MAFO (A/D)
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)
Solid AFO
Motion is controlled by -
rigidity of the plastic
trim lines (more anterior more rigid)
reinforcement (flange)
Posterior Leaf Spring
Minimal rigidity
Controls for DF
No knee control
Indication: Foot drop without increased tone and good knee control
MAFO with flange
Controls eversion/pronation or inversion/supination
Patellar Tendon Bearing
Limit the amount of weight transmitted though the foot
Plastic brim with a slight indentation over the patellar tendon
Carbon Fiber (A/D)
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)
Articulating MAFO (A/D)
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)
Types od joints
Klenzak (single channel, DF assist)
Dual Channel (stops or springs on either side)
Gillette/Tamarack (plastic rubber band, DF assist)
Antieror Stop
DF stop
Limits DF
Controls knee buckling
Posterior stop
PF stop
Limits PF
Controls toe clearance and knee recurvatum
Adjuncts
Shoe lifts and toe glides (toe clearance)
What does the research say!?
AFO over no AFO
Favors MAFO over Carbon
More participation = greater gains
More research is needed
Upper extremity supports purpose
Supports weka/flaccid arm
Types UE supports
Flexed arm slings
Extended elbow slings
Lap trays (full and half)
Arm trough
Foam wedge
Compression gloves
Indications for sling
Protect hemiparetic arm during functional mobility
Minimize risk for traction injury
Support the weight of arm
May facilitate functional mobility of patient
Sling guidelines
Minimize sling use!
Only use for safety and transfers
Each patient has different needs!
