ORTHOTICS Flashcards
1
Q
Stress Equation
A
Physical Stress = force/area
2
Q
Factors that Affect the level of physical stress on tissues or the adaptive responses to tissues to physical stress
A
- movement and alignment factors
- extrinsic factors (orthotics)
- psychological factors
- physiological factors
3
Q
The effect of physical stress on tissue adaptation
A
4
Q
The Effects of Prolonged Low Stress Lowers Thresholds for Subsequent Adaptation and Injury
A
5
Q
The Effect of Prolonged Low Stress Lowers Thresholds for subsequent adaptation and Injury
A
6
Q
Physical Stress level is composite of what 3 primary values?
A
- Magnitiude (of pressure)
- Time: duration, repitition rate
- direction: tension, compression, shearing, torsion
7
Q
2 Primary questions to ask in an evaluation and treatment
A
- What are the factors that appear to be contributing to the excessive stress on the injured tissue?
- How can these contirbuting factors be modified to reduce stress on the tissue and allow the tissue to heal?
8
Q
Brief History of o&p
A
- major advances due to WWI , WWII, and vietnam, Iraq
- Post WWII research - PTB, TT, TF
- AFter vietnam = myoelectric and modular prostheses
- most advances in orthotics with Polio epidemic
9
Q
What makes for an ideal orthosis?
A
- Control - stabilization and motor control
- Comfort - device meets pts needs
- Cosmesis - will the pt wear it
- Cost - monetory, insurance, energy required
10
Q
Primary functions of Orthoses
A
- Correct or prevent deformity
- protect weakened ms segment
- unload a limb or joint
- rest/immobilize
- assist with motion
- enhance gait
- alleviate pain
11
Q
5 Prerequisites of functional gait
A
- stability in stance
- clearance during swing
- swing phase pre-positioning (adequate loading)
- adaquate step length - timed activity or prox ms and pendulum effect of lower limb below knee)
- energy conservation
12
Q
3 Rockers of STANCE phase in gait
A
- Heel Rocker: initial contact to foot flat during loading response - deceleration of foot towrad floow (eccentric PF by DF)
- Ankle Rocker: ankle advacnes over the ankle foot complex - DF as talocrural joint rolls over stable foot (need 10deg DF)
- Toe Rocker: begins as heel rises and body weight rolls over MTP through push off in terminal stance - extension of MTPs
13
Q
Anatomical Assistive Devices
ANKLE
A
- Stirrup: M/L support, tolerated well, wraps around calcaneus
- Lace up: fxns like ankle tape, contains rear foot
- Active Ankle: allows PF/DF, discourages inversion
- Prophylactic: longer effect than taping
- CAM walker: (controlled ankle motion) adjustable ROM, rocker boot, post surgical, fxs, severe sprains, unloading of wounds etc
14
Q
Anatomical Assistive Devices
KNEE
A
- Prophylactic: decrease M/L damage to knee, conflicting evidence regarding efficacy (no change in injury rate, increased foot injuries)
- Post Operative: protected and controlled motion - can lock ROM to limit flex/ext
- Functional: attempt to control ML stability, anterior tibial translation and recurvatum 0 return to activity - prefab or custom
- PF: correct patellar position, mixed research, valgus control
- Unloading: decrease stress in OA knees, designed to distract joint surface at M or L knee, more effective than neoprene sleeves, condylar separation seen
15
Q
Anatomical Assitive Devices
HIP
A
- Hip Compression shorts: soft tissue injuries
- Post Dislocation:
- Congenital = Pavlik harness
- adults = hip ADD orthosis - both keep femoral head in acetabulum
16
Q
Leg Calve-Pertheses Disease
A
- AVN = loss of blood supply to femoral head
- Scottish - Rite Brace = keeps hips in ABD while still allowing for ambulation
- Toronto Orthosis
17
Q
Shoe Modifications for Neurological Conditions
A
- lifts
- metatarsal bars (shift pressure behind MT)
- last modifications (solid form around shoe)
- wedges
- depth changes
- rocker bottom
18
Q
FO = Foot Orthosis
Neurological Conditions
A
- Plastic foot - orthoses and supramalleolar orthoses (SMO) for excessive tone
- Diabetes shoes, arthritis
- modify weight transfer
- Accomodate deformities
*
19
Q
AFO = Ankle Foot Orthosis
indications, contra indications
A
- General indications
- flexible deformity
- weakness of foot and ankle
- need for stability
- Contraindications
- fixed deformity
- open wound
- Types
- Metal and Leather
- Plastic
- Conventional
- Patient Long Term
- hyperextension before/after DAFO
- better initial contact
- limit hyperextension
- better stepping
- low tone pronation
20
Q
Metal and Leather AFOs
A
- conventionial
- provides very good support
- relies on well constructed shoe
- used if:
- plastic cannot support deformity
- flucuating edema
21
Q
Plastic AFOs
Types and Principles
A
- may have contoured foot plate
- dynamic AFO (DAFO)
- support of arch/toes with custom
- tone reduction
- Molded AFO
- no support arch/toes
- wraps around malleoli depending on need
- Solid AFO
- no ankle motion allowed
- Hinged
- DF assist
22
Q
Solid AFO
WebRep
currentVote
noRating
noWeight
A
- no ankle motion allowed
- indications
- no control of DF
- excessive knee extension in WB
- Contraindications
- knee flex contracture
- need for ankle motion in development
- impacts ALL 3 ROCKERS
- heel rocker - impaired loading response, no PF to reach foot flat
- ankle rocker - dont have 20 DF locked at 90
- Toe rocker - stiff toe plate - no exension of toes
WebRep
currentVote
noRating
noWeight
23
Q
Semi-Rigid AFO
A
- trimlines just behind the malleoli will allow for increase of support and provide both DF positioning of the foot and mediolateral stability of the ankle
- much less motion is allowed
- pt cannot easily propel during push off
- most commonly used for pts with some extensor tone and/or with mediolateral instability of the ankle
24
Q
Hinged AFO
A
- allows ankle motion
- amount of motion limited by stop
- usually limits PF
- indications:
- voluntary DF for adequate toe clearance
- limited control of DF and PF
25
Q
DorsiFlexion Assist AFO
A
- Can be a spring (conventional)
- assists with DF
- Elasticity of plastic
- Indications
- adequate passive ROM >5deg
- weakness in DF
- some PF strength
- commonly used for flaccid foot drop
26
Q
Conventional Klenax and Double Adjustable
A
used when primary problem is DF weakness
Peroneal nerve palsy, CMT, PN
27
Q
Floor Reaction or Ground Reaction AFO
A
- promote knee extension
- limits DF
- contraindications
- fixed knee or ankle contracture (trying to facilitate motion)
28
Q
Knee Ankle Foot Orthosis
KAFO
A
- Controls and aligns knee/ankle
- indications
- voluntary hip and trunk
- when excessive movement at knee in stance cant be controlled with AFO
- Contraindications
- Unable to meet energy demands
- lack of strength
- open wounds in area of orthosis
29
Q
Craig Scott KAFO
A
- used with SCI bilaterally
- swing to or swing thru
- designed for balance in stance
- bail lock - locks when walking, unlock to sit
30
Q
Stance Control KAFO
SCKAFO
A
- prescribed for quad weakness
- knee is locked in ext during during stance
- free knee flexion and extension in swing
- some elbow resisted flexion during initial contact
31
Q
Hip Knee Ankle Foot Orthoses
HKAFO
A
indications
- full or partial loss of voluntary control of the trunk and lower extremities
- need to stabilize the trunk
Contraindications
- unable to meet energy demands
- inadequate thoracic, cervical, and UE fxn
- hip flexion contracture
Standing HKAFO
- spina bifida, CP, developmental delay
- parapodiums
- standing shells
- good for weight bearing and preventing contractures, ambulation also
32
Q
Standing HKAFO
A
- Spina Bifida
- CP
- Developmental delay
- parapodiums
- standing shells
33
Q
Reciprocal-Gait Orthosis
RGO
A
- uses dual cable system to couple flexion of one hip with extension of the other hip
- AFOs and knee joints offset posteriorly with lateral ring locks
- rigid pelvic band
- may have plastic molded TLSO attached
34
Q
Hip Guidance Orthosis
HGO
A
- Closed fitting rigid body orthosis
- low friction hip joint
- fixed ankle shoe plate with 6 deg of DF
- rocker sole
- designed to reduce energy in walking and some thing has better ground clearance and smoother gait than RGO
35
Q
Important Things to Monitor with Orthoses
A
- Wearing Schedule
- Skin care
- Orthosis Care
- Clean soap and water
- Problems
- skin/orthosis breakdown
- pain
- swelling/discoloration
36
Q
Foot Function
A
- adapt to uneven terrain and act as a rigid lever for push off
- absorb rotation of LE
- offer balance
- offer protection
- inability to perform these tasks causes a problem up the kinetic chain
- need foot orthosis bc: support, control, cushion
37
Q
2 primary types of foot orthoses
A
- corrective/functional
- accomodative - more cushioning
38
Q
Soft Foot Orthoses
A
- reduce pressure
- tend to be thicker and require a deeper shoe
- PLASTAZOTE = most common material - closed cell polyethylene thermoplastic
- disadvantage = retains heat from foot
39
Q
Semi-Rigid Foot Orthoses
A
- firmer materials than soft
- incorporate posting techniques
- usually full length
- purpose:
- improve weight transfer
- support and stabilize deformities of the foot and LE
- to relieve pressure
- most frequent used
- NICKLEPLAST = common
- derometer = measure of density
40
Q
Rigid Foot Orthoses
A
- Advantages
- thin
- 3/4 length (can slide in shoe though)
- useful in dress shoes
- SUBORTHOLENE
- Disadvantages
- limited impact reduction
- increased pressure areas
- highly skilled fabrication
- materials often crack with high forces
- contraindicated for highly active
- may result in stress fx, impingement or neuroma
41
Q
Shell
A
Can be modified - basic starter for modifcation
42
Q
Post
RF 3-5 degrees normal)
A
- Medial post to prevent collapsing down
- Internal post - add post to cast
- External post - add to orthotic, more modifiable
- 1/4 in material = 2-3 deg post
43
Q
Flanges
A
like a wing - widening of the orthotic shell
44
Q
Fore Foot Ext/ Morton’s Ext
(metatarsalgia)
A
longer where first MTP is
good for turf toe - prevent ext of 1st MTP
45
Q
Scaphoid Pad
A
increases arch height
46
Q
Met Pad/ Met Bar
(metatarsalgia)
A
- unload metatarsal heads
- creates shelf for joints to decrease load
- increase transverse arch
47
Q
Cut out
A
remove areas of pressure (PF 1st)
48
Q
Basyily
A
Over the counter customizable - like stickers that you add or remove
49
Q
Foot Orthoses and Gait
A
- posted non-molded = best at reducing peak RF eversion and tibial IR in non injured
- non-posted molded and posted molded = reduction in loading rate and vertical impact forces when compared to controls and posted non-molded
- neuromuscular control paradigm - inconclusive
50
Q
Effectiveness of Sham, Prefab and Custom
A
- Sham didnt work
- similar response in prefab and custom
- long term = didnt have any advantage
- think of orthotics as a temporary device
51
Q
Foot Orthoses as an Intervention
A
Treatment DIrection Test (TDT)
- determine the suitability of an orthosis
- determine the activities that the athlete has difficulty performing or provoke pain
- determine possible harmful or excessive motions and attemp to alter these motions via strapping, taping, or temp felt orthosis
- reasses the painful activity with the modification
- the greater the improvement the more likely orthoses would be beneficial
- using pads and taping to alter asterisk signs
- TDT for excessive pronators:
- low dye taping to control navicular hieght
- prefab OTC inserts
- orthopedic felt temporary orthoses
52
Q
Shoe Recommendation
Under Pronator
A
- stitch lasted
- curve lasted
- neutral heel cup
- moderate to soft cushioning
- lateral flex in midfoot
53
Q
Shoe Recommendation
Over Pronator
A
- Board lasted
- straight lasted
- wide forefoot
- moderate to firm cushioning
- sitff midfoot
54
Q
Common Mechanisms of Action
Spinal Orthoses
A
- reduce gross spinal motion
- stabilize individual motion segments
- apply closed chain force systems to correct or prevent deformity
- protect surgical constructs by preventing bending and twisting
- require careful detail and follow up adjustments
55
Q
Effects and Negatives of Spinal Orthoses
A
Effects:
- trunk support
- motion restriciton
- modification of skeletal alignment
Negatives:
- atrophy, weakness, dependence
- discomfort
- respiratory difficulty
56
Q
Sacroiliac Corsets
A
- only support SIJ
- emcompass pelvis but not lower trunk
- increase abdominal pressure only slightly
- best for mild SIJ dysfunction
57
Q
Lumbosacral Orthoses
LSO
A
- most frequently prescribed orthosis for LBP
- fortified with rigid and flexible stays
- limit much but not all lumbar motion
- increase intracavity pressure
- transmit 3 point pressure systems to lumbar spine
- often used for acute LBP
- questionable efficacy for chronic LBP
58
Q
Jewett Hyperextension or
CASH TLSO
A
- used for patients with compression fractures of low thoracic and lumbar spine
- limits trunk flexion with 3 point pressure system
59
Q
Taylor-Knight TLSO
A
- Limits spinal motion in both coronal and sagittal planes
- has thoracic and pelvic bands connected by paraspinal bars and a set of lateral bars
- originally designed for patient with TB
- now primarily used for LBP
- stable, noncompression fractures of lumbar spine
60
Q
Cervical Orthoses
General
A
- comfortable to wear
- soft collar-does not restrict motion in any plane
- kinesthetic reminder after whiplash or neck pain
- molded soft collar
- may contrubute to forward head posture
61
Q
Philadelphia Collar
A
- most recognized reinforcement collar
- low trimlines do not effectively immobilize C-spine nor prevent lateral flexion or rotation
*
62
Q
Aspen 4-Post
A
- CTO
- higher trimlines for more control
63
Q
Cervical Halo
A
- For complete control of cervical and upper thoracic spine
- used in 3 ways:
- min movmnt during surg
- control motion after surg
- conservative tx post non displaced upper cervical vertebral fractures
- Rehab considerations
- some may be “top heavy”
- post control strategies needed after removal
- if pt falls w/ halo, check for bleeding at pin sites
64
Q
Scoliosis
Etiology
A
- idipathic in 65% of cases (infantile, juvenile or adolescent)
- congenital w/ vert /rib abnormalities
- neuromuscular 10% (CP, SB, SMA)
- Myopathic (MD, arthrogryposis)
- indicence:
- 2% has >/= 10 degrees
- .2% has > 20 degrees
- .1% has > 40 degrees
- 50% of curves > 15 deg do not progress
65
Q
Scoliosis
Anatomical Abnormalities and Clinical Findings
A
- structural - does not change with position
- functional - changes depending on cause
- frontal plane curvature noted observation -rib hump
- subjective complaints of soft tissue and/or joint pain
- SOB if very severe
diagnositc tests: Xrays with measurement of curve
66
Q
Measuring Cobb Angle
A
67
Q
Treatment of and Controlling
Scoliosis
A
Treatment
- medical intervention of NSAID for p!
- 5 deg over 6mo
- 30-45deg = bracing
- >50 deg = surgery
controlling scoliosis
- exercise - no proven benefit
- e-stim - questionable results with curves>30 degress
- bracing
- fusion
68
Q
Treatment of Associated P! and Dysfunction with Scoliosis
A
- p! controlling modalities
- mobilization of appropriate segments as needed, stability of other segments
- restoration of ROM as tolerated
- restoration of muscle flexibility
- restoration of ms strength of periscapular and trunk/hip stabilizers
- patient ed w/ posture, body mechanics and fitness
69
Q
Indications with Scoliosis
A
- 10-20 deg = observe
- 20-30 deg = observe. possible brace
- 30-40 deg = orthosis
- 40-50 deg = surgery - try to delay spinal fusion until child has as much trunk height as possible
70
Q
Milwaukee Brace
CTLSO
A
71
Q
Boston Brace TLSO
A
To be worn Full TIME
72
Q
Charleston Bending Brace
TLSO
A
- Worn only at night
- places trunk in overcorrected side psition
- not compatible with walking etc
- stabilizing force at trochanter and a laterally directed force at the apex of the curve
- most effective with single curves
73
Q
Providence Scoliosis System
A
- Worn only at night
- employs over correction in molded plastic appliance
- uses series of corrective pads to apply hyper correction
- fabricated with CAD/CAM technology
- applies to wider range of curves than charleston and double curves
74
Q
Dynamic Scoliosis Brace
SpineCor
A
- constructed from flexible materials
- dynamic forces to maintain spinal deform
- re-educates body to return to norm posture
- made of a free moving configuration
- wear 20 hrs/day for at least 18 months
- efficacy not as good as rigid orthoses
75
Q
A
76
Q
Purpose of UE orthoses
A
- prevent/correct deformity
- support/protect or immobilze the joint
- assist weak mvmnt
- provide rest to joint
- stress relief
- transfer movement from one joint to another
- assist in muscle re-ed
77
Q
Splint Design Principles
A
- needs and expectations of pt
- position
- areas to be suppoted
- distribution of support
- total contact?
- small area of support?
*
78
Q
Mechanical Considerations
Wrist/Hand Splinting
A
apply force perpendicular to segment
use leverage
disseminate the applied force
minimize friction
allow full motion at non affected joints
79
Q
Wrist and Hand Splint
Common Pathologies
A
- post-fracture
- tendonopathies - tennis elbow
- carpal tunnel
- instability of wrist
- arthritis
80
Q
Static Splint
A
immobilize and protect
allow tissues to rest
81
Q
Dynamic Splinting
A
control motion
allow motion
substitute for muscle
82
Q
A
