Orthotics Flashcards
orthosis:
an external appliance worn to restrict or assist motion or to transfer load from one area to another
generic terminology refers to the:
body part affected
orthotics:
the evaluation, fabrication, and custom fitting of ORTHOPEDIC BRACES
prosthetics:
the evaluation, fabrication, and custom fitting of ARTIFICIAL BODY PART
Orthotists and prosthetists are the allied health professionals responsible for the evaluation, fabrication and custom fitting of:
ORTHOPEDIC devices
When are custom orthotics required? Who can fabricate them?
for long-term or complex cases, these items should be fabricated by the CERTIFIED ORTHOTIST
What are the 5 objectives of orthotic treatment.
- provide support and/or stability
- prevent and/or correct deformities
- provide joint alignment
- improve function/gait
- use the least control necessary for the expected function
**the objectives of orthotics are based on the principles of structure and stability are necessary for function.
Orthotics are fabricated using the __________ concept and the ____________concept.
3-point pressure, functional chain
What is the point pressure concept?
external support to correct deformity or provide support uses a system of two stabilizing forces with a counter-force to correct the deformity
What is the functional chain concept?
in order to provide function (movement) in a joint, the joints proximal and distal must be stabilized
What does FO stand for (lower extremity)?
foot orthotic
What does UCBL stand for (lower extremity)?
university of California Biomechanics Lab (shoe insert)
What does SMO stand for (lower extremity)?
supermalleolar orthotic
What does AFO stand for (lower extremity)?
ankle foot orthotic
What does KO stand for (lower extremity)?
knee orthotic
What does KAFO stand for (lower extremity)?
knee ankle foot orthotic
What does HO stand for (lower extremity)?
hip orthotic
What does HKAFO stand for (lower extremity)?
hip knee ankle foot orthotic
What does HO stand for (upper extremity)?
hand orhtotic
What does WHO stand for (upper extremity)?
wrist hand orthotic
What does EO stand for (upper extremity)?
elbow orthotic
What does SEWHO stand for (upper extremity)?
shoulder elbow wrist hand orthotic
What does LSO stand for?
lumbar sacral orthotic
What does TLSO stand for?
thoracic lumbar sacral orthotic
What does CO stand for?
cervical orthotic
What does CTLSO stand for?
cervical thoracic lumbar sacral orthotic
What are cervical orthotics normally used for?
to stabilize the spinal segments rather than to allow mobility.
What are CO made with soft of pliable materials are used for? What stages of healing is it used for? What motions does it allow/restrict?
soft tissue conditions, used for protection and support (acute, subacute phases). Allows rotation but restricts flexion, extension, and side-bending.
What are CO made with rigid stable devices are normally used for?
to stabilize bony elements or correct bony deformities
What motions does the semi-rigid CO orthotics restrict? What is it also called?
restrict cervical motion following non-operative trauma and surgical reconstruction. AKA Philadelphia collar.
What does SOMI stand for?
sternal occipital mandibular immobilizer
What features does the SOMI have?
provides flexion, neutral or hypertension positioning and immobilization. Has mandibular and occipital supports that are totally adjustable. The removable chin plate allows for patient eating and hygiene.
What is the Minerva Brace?
It’s a firm sternal and shoulder anchorage with three point pressure i.e. mandible. occiput and forehead, giving greater control over flexion/retroflexion, as well as lateral head movement
What are the indications for the Minerva Brace?
stable burst fractures,
light wedge fractures following traction,
Jefferson’s fracture w/o transverse ligament injury,
Occipital condyle avulsion fracture,
following reduction of atlanto-axial rotary subluxation with the atlas not being displaced more than 5mm from the dens anteriorly and rotated 35-45 degrees with respect to the axis,
odontoid fracture extending in the body of the axis (3months)
What is the “Halo” and what are additional indications (aside from the Minerva brace indications).
The Halo is fixed by secrews into the cranium.
Odontioid fractures above the synchondrosis level,
stable hangman’s fractures,
facet subluxations following reduction by traction (10-12 weeks),
unilateral facet dislocations following reduction by traction (12 weeks),
bilateral facet dislocations following reduction by traction or surgically (12 weeks),
first attempt at treating atlanto-occipital dislocations
When is the elastic lumbar corset used?
Provides intra-abdominal support, ideal for mild-moderate low back pain and low back compression as well as abdominal compression.
The Hoke design corset offers _____ support with ____ force points. It also offers _______ control.
greater, more, lower thoracic
Boston overlap orthosis is used for ______ treatment. Where does it compress? What type of movement does it limit?
spondylolysis. It provides total contact orthosis compressing all soft tissues, including the abdominal muscles. It limits flexion anteriorly in the sagittal plane
What does CASH stand for?
cruciform anterior spinal hyperextension
What levels of fractures does the CASH orthosis treat? Does it restrict the ribs?
T10-L2, the ribs are not restricted
How many pressure points does the Jewett Hyperextension brace have? What are the indications for this brace.
It is a 3-poing pressure systmen with 1 posterior and 2 anterior pads.
symptomatic relief of compression fractures not due to osteoporosis,
immobilizations for use after surgical stabilization of thoracolumbar fractures,
limits flexion and extension between T6-L1,
ineffective in limiting lateral bending and rotation of the upper lumbar spine
Which is more effective the Jewett brace or the CASH brace?
Jewett brace
The TLSO is also called a __________. What type of control does it offer? What type of injuries is this ideal for?
clamshell. It offers the best control in all planes of motion and increases intracavitary pressure. It is ideal for neurologic injuries and provides efficient force transmission as pressure is distributed over wide surface area.
What are some indications for TLSO?
immobilization for compression fractures from osteoporosis,
immobilization after surgical stabilization for spinal fractures,
bracing for idiopathic scoliosis,
immobilization for unstable spinal disorders for T3 to L3
What motions are restricted while using the TLSO?
side-bending, flexion & extension, and to come extent rotation
What is the main goal for scoliosis?
prevent further deformity and prevent or delay need for surgery
What determines the treatment of scoliosis?
the amount of curvature in the spine
With a scoliotic curve of 0-30 degrees, how is it treated?
treated with signs of progression
With a scoliotic curve of 30-45 degrees, how is it treated?
orthotic intervention
With a scoliotic curve greater than 45 degrees, how is it treated?
surgical intervention
Milwaukee brace or CTLSO is used to:
maintain post-op correction in patients with scoliosis secondary to polio
What is the Boston TLSO?
thoracolumbar-pelvic mold with built in lumbar flexion
What orthosis is used at night to correct scoliosis; it holds the patient in a maximum side-bending correction?
Charleston bending orthosis
What types of movements does a dynamic knee orthosis control?
AP translation, rotation, medial-lateral bending
What does the UCBL (university of California Biomechanics Lab Shoe Insert)?
controls hyperpronation, calcaneal valgus, forefoot adduction/abduction, stabilizes subtalar and mid-tarsal joints
What does the Solid Ankle AFO do?
Provides full control of foot/ankle complex in all planes. Knee control through muscle action and posterior shell coming up from solid ankle. Lateral ankle part curves up and around malleolus. Foot plate allows flexible forefoot.
What does the Wrap AFO do?
Provides MAXIMUM CONTROL. Wraps around the dorsum of the foot/instep, provides additional PF control, maintains calcaneus seated properly, one or 2 piece.
What does the articulated AFO do?
Can be designed to allow various ranges of ankle DF and/or PF. Knee controlled by active motion and posterior upright. Foot controlled by long foot plate. Patient should achieve at least 5 degrees of passive DF ROM in subtalar neutral before using articulated AFO.
What does the Posterior Leaf-Spring do?
DF assist with decreased PF control. Used for compensating for weak ankle dorsiflexors by resisting ankle plantar flexion at heel strike and during swing phase with no mediolateral control.
What does the Floor Reaction AFO (FRAFO) do?
Produces knee extension moment in stance. Used to prevent crouch gait.
SWASH (standing walking and sitting hip) orthosis do?
Prevents scissoring gait, promotes independent sitting, limits adduction during sleep, controls hip position post-op, maintains muscle length, may prevent hip dislocation due to strong adductors.
To provide stabilization for the ankle where should the quarter height be?
over the malleoli –> high-quarter
In regards to a shoe, what is the shank?
the longitudinal plate to reinforce the sole
