Orthotics Flashcards
What is an orthosis?
Rigid/semi-rigid device used for support, alignment, prevention/correction, improve function & restrict motion
What are L-codes used for?
- Billing & coding
- Not always recognized by insurance carriers
- Reimbursement rates differ
What are the categories of MCOS?
Modified Orthosis classification system (MCOS)
- Articular (does cross jt)→ shoulder, elbow, wrist, foot,
- Non-articular (doesn’t cross jt)→ humerus, forearm, metacarpal, phalanx
What are some design descriptor words used?
- digit based
- hand based
- thumb based
- forearm based
- arm based
- circumferential
- gutter
- radial
- ulnar
- dorsal
- volar
- anterior
- posterior
What is a static orthoses?
immobilizes/blocks joint & allows mvmt at another
elongates
What is a serial static orthoses?
applied with tissues at max length; accommodate soft tissue elongation
→ circumferential; worn for long periods of time
What is a dynamic orthoses?
static base with mobilizing attachments
- rubber bands
- springs
- neoprene
- elastic cord
flexible
What is static progressive orthoses?
Low load force to tissue’s max end range until tissues accommodate; no further stress to tissues
* nylon cord
* strapping
* turnbuckles
**similar to dynamic splints
What are common objectives for immobilization splints?
- system relief AFTER injury/overuse
- protection
- position of edematous structures
- max functional hand use
- maintain tissue length→ prevent contracture
- JT alignment
- Block/transfer power of mvmmt
- reduce tone and/or contracture of spastic M
articular & non articular
What are common objectives for mobilization splints?
- remodeling
- elongation of soft tissue/contractures/adhesions/musculotendinous tightness
- ↑ PROM
- realign jt
- substitute for weakness/absent motion
- maintain fracture reduction
- provide resistance for therex
What are some considerations for mobilization splints?
- age
- motivation
- psychological status
- associated trauma/disease
- advocational/vocational demands
- quality f joint ROM & end feel
- A/PROM
- time since injury/ repair
What are some common objectives for restriction splints?
- limit motion after nerve/tendon injury & repair
- limit motion after bone-ligament injury repair
- provide & improve jt stability & alignment
- assist in functional hand use
What is the significance of bony prominences for fabricating?
- considered when fabricating orthoses
- vulnerable areas (min soft tissue covering)
- avoid pressure over these areas (material/strapping)
- pt education is important→ skins checks & avoid pressure sores
What are warning signs to bony prominences?
pain, redness and skin breakdown
What are some symptoms of nerve compression?
- burning
- itching
- numbness
- tingling
- paresthesia
- motor control changes
What can the cause of compromised circulation be due to?
- medical history
- splint material
- strapping
What are signs of impaired circulation?
- color changes
- throbbing
- temperature changes
What are the stages of wound healing?
- Inflammatory stage→ fragile ting (early)
- Fibroplasia (Proliferative) stage → mobilzation (later stages)
- maturation (remodeling) stage→ mobilization & restriction
What are some factors that affect wound healing?
- age
- nutrition
- tobacco use
- alcohol use
- medical conditions
- edema
- steroids
- radiation therapy
- infection
overlapping time frames for specific orthoses in the inflammatory stage; what is more important than exercise?
protection and stability
Why is timing complicated in tissue remodeling and orthotics?
- degree of tissue trauma
- health of tissues
- health of patient
- presences of infection
What is elastic behavior?
REMODELING can increase length of previously contracted tissue
what is plastic behavior?
lengthening of tissue fibers beyond their ELASTIC LIMITS can cause TEAR/RUPTURE
T/F Splints are levers
True
What is force?
action/influence that either arrests, produces or changes direction of motion
What are the types of forces used in orthotic fabrication?
- torque
- elastic force
- friction force
What is a lever?
Rigid structures through which a force can be applied to produce rotational motion about fixed axis
What are the 3 components of a lever?
- fulcrum
- effort arm (EA)
- resistance arm (RA)
What is torque?
type of force; applied to joint via leverage
rigid structures thru which force can be applied to produce rotational motion about fixed axis
What are the 3 components of torque?
- fulcrum
*effort arm (EA) - resistance arm (RA)
T/F Most orthotics are first class lever systems
True
What occurs in a first class lever?
Axis is located between force & resistance
What occurs in a second class lever?
Resistance in the middle with axis at one end and force at the other end
What occurs in a third class lever?
Has force in middle with resistance and axis at opposite ends
How is torque applied in orthotics?
fulcrum: anatomical axis of target joint
EA: segment of splint that applied effort force to either stabilize.mobilize structure
RA: segment that resists effort to force
EF & RF: acting on fixed axis; oppose torque
T/F: Effort arm of splint affects MA depending on how splint is bolded to body
true
T/F EA comfort depends on adequate length and depth of othoric
True
T/F: For orthoics the angle of appication should be 90 degree
true
What is compression?
Squeezing type of force; preoperational to perpendicular force
What are components to compression?
Surface Area: consistent, compression can be reduced by decreasing the perpendicular force
Force: constant, compression can be reduced by increasing surface area over distribute force
What is shear stress?
the force applied parallel to the surface
* inversely proportional to angle of application
* accompanied by other stresses
What is tensile stress?
(opposite of compression)
distraction
greatest force is applied perpendicular to surface
What is bending stress?
tension + compression + shear
What is torsion stress?
- produced by rotational force applied to rod/cylinder
- proportional distance from longitudinal point of force application
** simultaneous compression, tension and shear stresses
What are some handling characteristics for splint materials?
- conformabilitiy
- resistiance to stretch
- memory
- rigidity
- bonding
- heating & working times
What are some physical characteristics for splint?
- thickness
- perforations
- plastic materials
- rubber (rubber-like)
- elastic
What is the process of fabrication?
pattern creation
refine pattern
options for materials
evaluate fit while molding
strapping & components
splint finishing touches
What are components to referals?
- purpose
- type
- desired joint position
- goal(S)
- wearing info
Components to patient education?
Purpose of splint
how to don/doff
Precuations
wearing instructions
proper splint care
scheduling splint check/adj
