Orthosis & Prescriptive W/C Flashcards
FO - Heel-spur Insert Orthosis
Function
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
FO - Longitudinal Arch Support / Scaphoid Pad
Function
Medial side of shoe
Helps w/ pes planus or another sort of arch flattening condition = holds arch
Scaphoid pad is not as supportive
FO - Metarsal Pad
Function
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)
FO - Heel Wedge
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
FO - Metatarsal Bar / Rocker Bar
Function
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
AKO - Posterior Leaf Spring
Type & Function
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
What is the most commonly used AFO for drop foot?
Posterior Leaf Spring
AFO - Steel DF Spring Assist
Type & Function & Population
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
What populations are CONTRAINDICATED for motion-assistance AFOs?
Pt w/ SPASTICITY
Spring RAPIDLY brings foot in DF which could provoke clonus > impact on balance & may lead to a fall
Plastic Hinge
Type & Function
Motion Resistance
Allows DF but not PF
AFO - Posterior Stop
Type & Function
Motion Resistance
Allows DF but prevents PF
- Stops plantar surface from moving back
AFO - Anterior Stop
Type & Function
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
AFO - Solid AFO
Type & Function
Motion Resistance
Blocks all ankle movements at the talocrural (PF & DF) & subtalar (eversion/inversion)
Prescribed for pt with complete instability at the ankle
AFO - Hinged AFO
Type & Function
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
KAFO
Function
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
HKAFO
Function
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
THKAFO
Function
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!!
How is an orthosis prescribed?
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
Role of a FO
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
Key points for educating a patient about AFOs
(5)
- Wear time will vary depending on age, condition, activity level, and goals
- Always wear socks with AFO
Wrinkle free
Smooth textures
Long enough to roll over top edge of AFO - Always wear shoes with AFOs
Prevent slipping and falling * ALL orthosis
Fit AFO all the way in the shoe - Build up time wearing AFO (unless instructed otherwise)
Applies to first time AFO wearers only - b/c skin is not used to it - Inspect the skin frequently
Pay close attention to bony areas
Inspect skin each time AFO is taken off
Poor positioning puts the pt at increase risk for…
3 issues
- Sacral sitting (posterior pelvic tilt) = makes it more difficult to complete bladder empting - this could lead to a urinary tract infection
- Kyphotic or scoliotic spine posture in sitting = affects breathing & ability to clear secretions effectively - this could increase the risk of respiratory infections
- Poor alignment of the head/neck/trunk while eating = increase the risk of aspiration
Back support height…
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
