Orthosis & Prescriptive W/C

Question 1

FO - Heel-spur Insert Orthosis

Function

Answer 1

Heel gel cushions used for Plantar Fasciitis

Slant forward = takes pressure off the heel & shifts load forward (anterior) onto the forefoot
- Load will be taken more by the forefoot

Question 2

FO - Longitudinal Arch Support / Scaphoid Pad

Function

Answer 2

Medial side of shoe

Helps w/ pes planus or another sort of arch flattening condition = holds arch

Scaphoid pad is not as supportive

Question 3

FO - Metarsal Pad

Function

Answer 3

Convex pad that is placed right behind the MTP joints - on the MT shafts

Offloads the metatarsal heads & puts the load back onto the shafts
OR
Helps create a Transverse arch to reduce irritation of MT heads/nerves (Morton’s neuroma)

Question 4

FO - Heel Wedge

Answer 4

Helps lift up one side of the heel to alter alignment in the REAR foot

Pes valgus (everted = turned outwards) - heel lift will tilt it laterally for more normal alignment

RIGID Pes varus (inverted - outside of foot is making contact) - MEDIAL heel lift so load is distrubed evenly across foot
- accomodate the rigid deficit

Question 5

FO - Metatarsal Bar / Rocker Bar

Function

Answer 5

Similar to a metatarsal pad -> helps disperse load of MTP joints & more onto the MT shafts

Rocker bar = same function except it has a more transverse & angled to rock past late stance phase

Question 6

AKO - Posterior Leaf Spring

Type & Function

Answer 6

Motion Assisted
Most common for drop foot - LMN disorders

The primary function of the posterior leaf spring orthosis (PLS) is to prevent excessive equinus or drop foot in swing. The name of the orthosis, posterior leaf “spring,” suggests that it also mechanically augments push-off in stance.

Flexible Plastic Hinge

Question 7

What is the most commonly used AFO for drop foot?

Answer 7

Posterior Leaf Spring

Question 8

AFO - Steel DF Spring Assist

Type & Function & Population

Answer 8

Motion Assisted

Same function except now uses springs instead of flexible plastic

PF = spring gets compressed & when pt lifts foot up the springs uncoil & pull the foot up into DF

More bulky

LMN disorders - drop foot

Question 9

What populations are CONTRAINDICATED for motion-assistance AFOs?

Answer 9

Pt w/ SPASTICITY

Spring RAPIDLY brings foot in DF which could provoke clonus > impact on balance & may lead to a fall

Question 10

Plastic Hinge

Type & Function

Answer 10

Motion Resistance

Allows DF but not PF

Question 11

AFO - Posterior Stop

Type & Function

Answer 11

Motion Resistance

Allows DF but prevents PF
- Stops plantar surface from moving back

Question 12

AFO - Anterior Stop

Type & Function

Answer 12

Motion Resistance

Allows PF but not DF

• Want this type of AFO for people w/ paralysis &/or weakness in gastroc/soleus
• Deep DF = lack strength to push themselves up & into push off in PF & by limiting PF it allows the pt to maintain a mechanically advantageous position for push-off

Question 13

AFO - Solid AFO

Type & Function

Answer 13

Motion Resistance

Blocks all ankle movements at the talocrural (PF & DF) & subtalar (eversion/inversion)

Prescribed for pt with complete instability at the ankle

Question 14

AFO - Hinged AFO

Type & Function

Answer 14

Motion Resistance

Limits subtalar mvmt & PF BUT allows for a controlled amount of DF
- Good for someone w/ subtalar OA & need to restrict this motion while still allowing for DF for tem to walk appropriately

Question 15

KAFO

Function

Answer 15

Has knee hinges on either side to provide stability & strength in the Medial-Lateral direction & prevents hyperextension

Used for pt with more extensive paralsis OR deformity

Question 16

HKAFO

Function

Answer 16

Essentially a KAFP w/ the addition of a pelvic band around waist/trunk
- used to help restrict hip motion - ONLY allows hip flexion and extension

Question 17

THKAFO

Function

Answer 17

Covers a part of the thorax - KAFO w/ lumbar-sacral attachment
- More of a training device - not normally used after discharge
- Requires lots of energy!!

Question 18

How is an orthosis prescribed?

Answer 18

An orthosis is chosen based on patient’s impairments & activity limitations (diagnosis less important)

• Need to consider which orthosis would MOST benefit them in order to help with their function

Question 19

Role of a FO

Answer 19

Helps to enhance function by relieving pain
- this is accomplished by transfering the WBing stress off an intolerant area & onto a pressure tolerant area - SHIFT LOAD

Corrects alignment w/ a FLEXIBLE segment & accomodates for FIXED deformities

Question 20

Key points for educating a patient about AFOs

(5)

Answer 20

1. Wear time will vary depending on age, condition, activity level, and goals
2. Always wear socks with AFO
   Wrinkle free
   Smooth textures
   Long enough to roll over top edge of AFO
3. Always wear shoes with AFOs
   Prevent slipping and falling * ALL orthosis
   Fit AFO all the way in the shoe
4. Build up time wearing AFO (unless instructed otherwise)
   Applies to first time AFO wearers only - b/c skin is not used to it
5. Inspect the skin frequently
   Pay close attention to bony areas
   Inspect skin each time AFO is taken off

Question 21

Poor positioning puts the pt at increase risk for…

3 issues

Answer 21

1. Sacral sitting (posterior pelvic tilt) = makes it more difficult to complete bladder empting - this could lead to a urinary tract infection
2. Kyphotic or scoliotic spine posture in sitting = affects breathing & ability to clear secretions effectively - this could increase the risk of respiratory infections
3. Poor alignment of the head/neck/trunk while eating = increase the risk of aspiration

Question 22

Back support height…

Answer 22

Back support height is determined based on the user’s trunk control, functional abilities & comfort

• A shorter back is more approp for users with good trunk control, ability to maintain good alignment & who will be propelling the W/C (more room for arm movement)
• A taller back support is needed for users who require tilit-in-space feature - has to hold the wt of the body