Orthotic Fitting And Devices Flashcards
Custom fit versus custom fabricated
Custom fit orthoses are off-the-shelf, custom fabricated orthoses are created from a custom mold of the patient.
Five things to know before walking into a patient room
- Patient name
- Referring physician
- prescription
- diagnosis
- Insurance information
Arches of the hand
- Proximal transverse arch (heel of palm, CMC joint)
- Distal transverse arch (MCP joint of palm, mobile)
- Longitudinal arch (dorsal arch of curved/cupped hand)
Mallet finger deformity
Flexion of DIP joint
Boutonnière deformity
Flexion of PIP joint
Swan – neck deformity
Extension of PIP joint, flexion of DIP
Cock-up orthosis
WHO for wrist fracture, carpal tunnel, and post-op
Stabilizes hand and wrist, with thumb loop
Resting hand splint
WHO for contracture management
Brace on palmar surface of hand and wrist, padding straps over dorsal surface. Support for longitudinal arch of hand.
Static Progressive WHO
For patients with severe flexion deformity of hand and wrist
“Handlebar” aspect and pump up to extend over time
Volar opening WHO
Dorsal hand brace so as not to impede on burns, incisions, or sensitivity on the underside (volar) surface of hand and wrist
Wrist-driven WHO
Adjustable to help patient pick up items, must have wrist extensor power
ROM elbow orthosis
Adjustable support for fractures, ROM flexible
Elbow de-contracture orthosis
3-point pressure over the elbow to pull into extension. Padded, with adjusted ROM. Can be static or dynamic.
Cubital tunnel orthosis
To relieve entrapment of the ulnar nerve. Usually worn while sleeping and used as a kinesthetic reminder. Posterior rigid support of elbow with three anterior straps
Humeral fracture orthosis
- short version
Rigid “pauldron” orthosis with chest strap to support a fracture in upper 2/3 of humerus.
- long version
Rigid 2-part brace for upper and lower arms, joined by adjustable bar. Supported by sling. For fracture of the lower humerus
Clavicle fracture orthosis
“Wing sling” to hold shoulders back to reduce pressure/pull force on clavicle. Arm sling may also be used.
Shoulder subluxation orthosis
“Hemi sling”
Used to decrease vertical (g) force on the shoulder girdle in patients with weak or injured arms
Shoulder abduction orthosis
Holds shoulder in slight abduction, decreases contracture and g force on shoulder
Side pillow and neck/waist strap, ball for hand
Airplane orthosis
Soft chest piece and pauldron that holds shoulder at large (almost horizontal) angle of abduction. Provides immobilization and/or controlled ROM
Shoulder abduction rotation orthosis
“Waving” position
Rigid side and arm piece that immobilizes arm for palsy or contracture prevention.
The hyoid bone is at what vertebral level?
C3
The sternal notch is at what vertebral level?
T1
The xiphoid process is at what vertebral level?
T10
The spine of the scapula is at what vertebral level?
T3
The inferior angle of the scapula is at what vertebral level?
T7
The belly button is at what vertebral level?
L2
The iliac crest is at what vertebral level?
L4
The ASIS is at what vertebral level?
S1/S2
Movement of the lumbar vertebrae
Flexion/extension
Lateral bending
Almost no rotation
True or false
The thoracic portion of the vertebrae is the most mobile.
False
The thoracic portion is the LEAST mobile because the ribs restrict movement
Movement of cervical vertebrae
- Most mobile portion of spine
- movement in all three planes
- carries vertical force of skull
Guilford cervical orthosis
Rigid low-profile collar and “suspenders.” Metal bar in front and back for support. Difficult to don and doff.
NOT for patient who is intubated!
Provides increased immobilization compared to other CO’s
Sternooccipitomandibular Immobilizer (SOMI)
Interchangeable headband and chin piece.
Controls cervical flexion but not extension
HALO
Can only be used with no existing skull fractures
Used for spinal realignment and to maintain stability
Adult - 4 pin sites @ 8lbs pressure
Children - usually 6 pin sites @ 4lbs pressure
Jefferson cervical fracture
Fractures of the anterior and/or posterior arches of the atlas (C1)
Odontoid fractures
3 types
- Tip only (stable, semi-rigid CO)
- Base (most severe/unstable, needs HALO or surgical fusion
- Body of the dens (may need HALO or SOMI)
Cervical SpondyLOSIS
Abnormal wear on vertebrae. Space between the vertebrae narrows and begins to press on nerves emerging from spinal cord.
SpondyLOLYSIS
Usually effects L4/L5
Stress fracture of the “spinous process”
Common in active teens and young adults
SpondyLOLISTHESIS
Vertebral slippage as a Progression of spondylolysis
Grade 1: 0-25% Grade 2: 26-50% Grade 3: 51-75% Grade 4: 76-99% Grade 5: 100%
Boston overlap brace
Custom fab, lightweight brace for back injuries and pain. Anterior overlap opening with straps.
Ankylosing spondylitis
Ossification of vertebral joints (bamboo back)
Gradually increasing pain, stiffness, and flexion
Jewett orthosis
3-point pressure system to hold back in extension, to relieve compression fractures.
Kinesthetic reminder
CASH orthosis
Cruciform Anterior Spinal Hyperextension Orthosis (cross chest)
For anterior spinal compression fractures of T10-L3
ATE
Anterior thoracic extension for an LSO to make it a TLSO
