Orthotics Flashcards
1
Q
Orthosis is commonly known as
it is an orthopedic device that is applied …
A
a brace or splint
externally to the limb or body
2
Q
What is an orthotist
what do they do
A
health pros who provide care to pts w/ neuromuscular and muskulo impairments that contribute to functional limitations and disability
they design, frabricate, and fit pt for an orthosis
2
Q
Purpose of orthotics
A
provide support, protection and replacement of lost function
3
Q
Responsibilities of an orthotist
A
1 evaluate pt for needs
2 design device
3 select material and component
4 fabricate the device
5 evaluate fit
6 educate pt
4
Q
Prosthesis
purpose
it can ____ or _____
A
an artifical body part replacement
retrieve function or cosmetic
external or internal
5
Q
Difference between orthotic / prosthetic
A
O: added onto body
P: replacement
6
Q
What is a prosthesis
what do they do
A
health pro who provides care to pt w/ partial or total absence of a limb
design, fabricate, and fit pt for prosthesis
7
Q
Responsibilities of an prosthetist
A
1 design device
2 select material and component
3 fabricate device
4 evaluate fit
5 educate pt
8
Q
Examples of pros in rehab team
A
PT, nurse, dietitian, social worker, physician
9
Q
Assessment for lower extremity orthosis - body structure and function
A
joint
alignment of limb
leg length
sensory assessment
skin condition/ vascular supply
motor function
9
Q
Things that are assessed for ICF
A
body structure and function, activities (functional limitations), participation (restrictions)
10
Q
Assessment for lower extremity orthosis - body structure and function.
joint specific tests (ALOT)
A
ROM - goni, prom, contracture, thomas test, flexion, extension of hip, thomas test, ober test, hip joint stability, knee joint stability MCL ACL LCL, ankle joint stability
11
Q
GRF has nothing to do with
A
angulation
11
Q
Normal hip alignment angle of inclination
A
125 degrees
12
Q
JRF is max in coxa ____
A
valga
13
Q
Children with anteversion have in-toeing and often prefer
A
W sitting
14
Q
Assessment for lower extremity orthosis - body structure and function.
alignment of limb segment
A
hip alignment (valgum, varum, recurvatum, normal)
knee alignment
ankle and forefoot alignment
15
Q
Valgum and varum only affect the knee not the ____
A
BOS
16
Q
Assessment for lower extremity orthosis - body structure and function.
sensory assessment
A
pt eyes closed, have them answer yes when they feel a point
17
Q
Assessment for lower extremity orthosis - body structure and function.
leg length
A
differentiate leg discrepancies, asses segmental and total leg length
17
Q
Assessment for lower extremity orthosis - body structure and function.
skin condition/ vascular supply
A
skin color
hydration
temperature
wounds
prolonged arterial capillary refill time
18
Q
Assessment for lower extremity orthosis - body structure and function.
motor function
A
muscle tone
spasticity in UMN
flaccid in LMN
muscle strength and endurance
dynamic strength
19
Q
Muscle tone
A
resistance to passive movement
20
Q
Negative affects for orthosis
A
atrophy of immobilized muscles
carry more weight
21
We want ____ orthotic trx for the pt
minimal
22
Gait efficiency is more important than reduction in
compensatory gait deficit
23
Steppage gait
symptoms
causes
foot drop
drop foot and toes while walking
neurom disorder, impaired dorsifl
24
Injury to C2 - C3 level of impairement?
Rehab potential?
-usually fatal as a result of inability to breathe
-totally dependent for all care
25
Injury to C4 level of impairement?
Rehab potential?
-quadriplegia and breathing difficulty
-dependent for all cares; usually needs a ventilator
26
Injury to C6 level of impairment?
Rehab potential?
-quadriplegia with some shoulder and elbow and wrist function
-may be able to help feed, groom, and dress self, dependent on other transfers
27
Injury to C5 level of impairement?
Rehab potential?
-quadriplegia with some shoulder and elbow function
-may be able to feed self with AD, usually does not need ventilator but other types of respiratory support
28
Injury to C7 level of impairment?
Rehab potential?
-quadriplegia with some shoulder and elbow, wrist, hand function
-may be able to propel wheelchair inside on smooth surfaces, drive with adaptations, bowel and bladder programs
29
Injury to C8 level of impairement?
Rehab potential?
-quadriplegia with normal arm function; hand weakness
-may be able to propel wheelchair inside on smooth surfaces, drive with adaptations, bowel and bladder programs
30
Injury to T1-T6 level of impairment?
Rehab potential?
-paraplegia with loss of function below mid-chest; full control of arms
-independent with self care and in wheelchair; able to be employed full time
31
The 7 Steps of the Gait Cycle
Categorize into Stance vs Swing phase
Stance phase
Heel Strike (initial contact)
Loading response (flat foot)
Midstance
Terminal stance (heel off)
Preswing (toe off)
Swing phase
Initial and Mid swing
Terminal swing
31
Injury to T6-T12 level of impairment?
Rehab potential?
-paraplegia with loss of function below the waist; good control of torso
-good sitting balance; greater ability for operation of a wheelchair and athletic activities
32
Injury to L1-L5 level of impairment?
Rehab potential?
-paraplegia with varying degrees of muscle involvement in the legs
-may be able to walk short distances with braces and AD
33
Massachusettes General Hospital functional amb classification
1: non functional amb
2: require assistance
3: require light touch assistance
4: need of verbal cueing or occasional assist
5: indep amb of level surfaces
6: indep amb in all surfaces
34
Crouch gait symptoms (3)
it is often seen in combo with
results from
-exaggerated knee and hip flexion
-persistent flexion of knee during stance
-overact of hammy and weak calf
- combo with toe walking
-spastic diplegic cerebral palsy
35
Stiff knee/hip gait cause
results from
insufficient flexion of knee during swing
CP
36
Antalgic gait
results from
lateral lean of trunk to bring COG over joint to reduce loading
pain or fracture of hip joint
36
Hemiplegic gait symptoms (4)
results from
1 LE held in extension
2 unilateral weakness and spasticity
3 UE held in flexion
4 cirumduction
stroke, CVA
37
Glut max gait
result from
backward lean of trunk (scared of falling forwards)
paralysis of glut max
38
Purpose of documentation prescription guidelines
what does it record
define anatomic segment that requires orthotic trx
describe biomechanical control needed for trx
functional limitation (sensational, contractures)
physical impairments
general patient information
39
Anatomic segments fro which an orthotic device is being considered (3)
Volitional force
Hypertonicity
Proprioception
40
Biomechanics control functions
F
A
R
S
V
H
L
free
assisit
resisit
stop
variable
hold
lock
41
Spinal levels for ADL and bed skills
C1-C3
42
Spinal levels for wheelchair skills (independent with manual wheelchair)
C5
43
Spinal levels for transfer skills (independent without sliding board)
C7
44
Spinal levels for independent in light housekeeping and driving with hand controlled cars
C8-T1
45
Spinal levels for household ambulation
T9-T12
46
Spinal levels for functional ambulation
L1-L5
47
The materials in O&P are tested for (4)
strength
stiffness
durability
density
48
Leather is a good material to use because (3)
-does not create allergies (good for people who are highly allergic)
-dimensional stability
-moldability
48
Steal can be negative because of the
good because
extra weight
stress occurs without an increase in stretch, durability
49
Wood is good because it
does not create any allergies and is strong
49
Titanium and magnesium are ______
and have the _____
expensive, strength of steel/ length of aluminum
50
Low temp thermo plastics can be
weaker than
problem?
usually used for
less then 176 degrees F can be applied directly to the body
high temp
will soften and lose shape if left in hot car
UE
51
High temp thermo plastics are used for
LE orthotics
51
Low temperature thermo plastics less than ____ degrees F
300
52
Applied over a positive model in liquid and then chemically cured
thermosetting
52
Most common laminates
acrylic (#1), polyester, epoxy
53
Open cell foamed plastics
Closed cell
cells are interrelated (sponge)
cells are separated (less likely to absorb body fluids such as urine or perspiration)
54
Where would you place the three points of pressure to correct genu valgum on a knee orthosis?
laterally above knee
medially at knee
laterally below knee
54
Viscoelastic polymers have
stress relaxation and creep (memory foam)
55
Flexible deformity
Fixed deformity
can be fixed manually
can adjust or provide comfort or work around it, cannot be fixed
56
CAD/CAM
fabrication?
positives
they have a high
computer aided design/ manufacteror
CNC machine carves cast
simplicity, low cost
return rate
57
4 points of pressure is used for
prevent hyperextension in genurecurvatum, sagittal plane translatory motion in unstable knee
57
Examples of LE orthosis
Foot, ankle foot, knee ankle foot, hip knee ankle foot, knee, hip
57
The principle for orthotic design for LE
3 points of pressure
58
To control a proximal joint it is not always necessary to
make an orthosis that extends beyond that joint proximally
59
Orthotic weight is determined by
the material and how much of the limb is encompassed by the device
60
Able to get out of a wheelchair or bed and walk for a reasonable distance - may use AD
community walker
61
Able to walk within home with relative independence and need help to get out of bed or wheelchair
Household walker
62
No molding, tracing is _______
conventional
63
AFO, no braces are ______
molded
63
Local vs central manufacturing which is more expensive
local most expensive
64
+/- with conventional
Pt doomed to where same shoe all the time but better control of leg
64
Hybrid
components of traditional and molded
65
Hybrid is usually in ____ shoes
athletic shoes
66
Limb cuffs, shells, and shoe insert are usually _______ with _______
molded, articulations (hinged, moving joints)
67
67
Blucher vs Bal pattern of shoe anatomy
which shoes have Blucher
blucher better: has better opening can put shoe on more comfy, all athletic shoes usually have this
bal: NO
68
Proper fitting of a shoe is important for
Ill fitting shoes may cause
diabetes, arthritis, other foot disorders
bunions, hammertoes, claw, mallet, neuromos
69
Types of children corrective shoes
conventional, straight, outflare, inflare, reverse
70
Pediatric foot (in toeing) is due to
positional factors utero and during sleep, muscle imbalance
70
Cause of flexible flat foot
trx
hereditary ligamentous laxity
a shoe that corrects heel valgus, support arch, pronate forefoot
70
Trx for metatarsus adductus
internal tibial torsion
internal femroal torsion
out flared shoe
Dennis Browne bars
no trx, encourage x sitiign
71
Reasons for toe walking
trx
utero or congenital shortening of Achilles tendon, early signs of CP, MD
up until age 4: stretching AFO
71
Out toeing is due to
trx
sleeping in frog position/ soft tissue contracture
no footwear treatment
72
Severe valgus of the heel
trx
may persist in adolescence into
calcaneovalgus in pediatrics
stretching / serial casting for sever cases
pes planus
73
Trx of clubfoot or equinovarus
serial casting, surgery, dennis brown bars
74
Trx of hallux valgus (bunion)
orthotics, comfy shoes
75
Walking shoes should have
thomas heel, shock absorption heel and sole
76
Special considerations for pregnancy conditions:
older adults:
edema, LBP, changes in COM, no high heels
walking or running shoes
77
Used to protect feet that are vulnerable due to vascular insufficiency, neuropathy or deformity
thermold footwear
77
Basketball vs running shoe
B: mediolateral stability
R: more cushion
78
Advantage of wearing socks
shock absorption, shield skin, prevent skin irritation
79
Temporary protective shoe for pt with sensitive or ulcerated feet
what do they allow
plastazote / heeling sandal
ambulation without pressure on the healing area
80
Lifts and leg discrepancy shoes are for
leg length discrepancy of 9mm or more
81
Leg length discrepencies can be due to
shortening on one side or lengthening on other side (PF contracture)
82
Barton wedge is for
severe flexible pronation deformities or supination
83
Heel wedging used to
medial heel wedge:
lateral:
alter lines of stress
flexible valgus of calc
flexible varus of calc
84
Sole wedging is for
inversion/eversion effect of forefoot
85
Metatarsal bars, rigid leather rocker sole and extended crepe rocker bar are located, what do they reduce, what pt are they for
posterior to met heads, reduce pressure at met head during push off, for pt with transmeta amputation, diabetes
86
Leather around the deforimity area is cut off and replaced with a softer material
blowout patch
87
irritation of plantar digital nerves around the head of MTs due to presure and or atrophy of MT fat pad
trx
metatarsalgia
shoe with wide width, high toe box
88
Trx for inflammation of sesamoid
transverse MT bar, rocker sole
89
Trx of morton's syndrome
shoe with long medial counter, thomas heel
90
Trx for hallux valgus bunion, hammertoe, claw, mallet toes
long and wide shoe
91
Trx for pes planus
pes cavus
plantar fasciatis
thomas heel
firm heel counter
high heel to reduce tension
92
THKAFO
trunk hip knee ankle foot orthosis
93
PRQS for safe, energy efficient functional gait
enough stability of LE tolerate weight
clearance of foot during swing
prep for initial contact
control motion ankle knee hip joint
94
tibia advances over the ankle foot
from heel rise to push off
ankle rocker
toe rocker
95
What happens during heel rocker
eccentric contraction of quad, tib anterior prevents foot slap, protects knee against GRF
96
AFO functions 3
assist resist block
97
Df assist PF assist conventional double upright
prevent foot drop
98
Conventional AFO uses
thermoplastic
99
Models of AFO
UCBL, SMO, DAFO
100
Immobilizers are good for
after surgery
101
Anterior floor reaction AFO good for (2)
bad for
pt with weak quad, fixed flexion contracture
recurvatum cases
102
Prophylactic knee orthoses are for
Functional knee orthoses are for
attempt to prevent injury
to provide additional protection
103
Functions of dynamic knee orthoses
gentle, controlled, adjustable constant force, low load, for nighttime use
104
Lenox Hill brace
supports moderate to severe knee instabilities for both non operative and post operative knee reconstruction pts
105
Patellofemoral joint orthoses used to
control tracking
105
Knee guard that helps reduce medial or lateral instability
McDavid knee guard
105
Compare and contrast conventional vs thermoplastic KAFO
conventional: strong durable, heavy, less cosmetic
thermoplastic: light weight, interchangeable shoes
106
Compare and contrast conventional vs thermoplastic KAFO
indications
c: significant obesity, uncontrolled edema
t: control of transverse plane motion is needed
107
Compare and contrast conventional vs thermoplastic KAFO
contraindications
c: control of transverse plane motion is needed
i: obese, edema
108
The offset joint and basic drop ring or pawl locks are contrain in the presence of a
knee flexion contracture
109
light weight variation of KAFO
indications
Craig-Scot orthosis
parapkegia T10 SCI
110
HKAFO common for (3)
polio, SCI, CP
110
When bilateral KAFOs are used pt cannot .....
pt cannot ambulate w/o AD, need to be able to stand wb
111
Center rotation of hip is located
little above greater trochanter
111
Pavlik Harness
includes
to treat young babies with developmental dysplasia of the hip
chest, shoulder, calf, and front leg strap
112
A system that incorporates a rigid body brace, hip joint, stable knees ankle and shoe plate
THKAFO - parawalkers (hip guidance orthosis)
113
THKAFO that uses a dual cable system couple flexion of one hip with extension of other
usually used for
used in combo with
Reciprocating gait orthosis RGO
active individual, not for inactive pt
crutches or walker
114
Indications for RGO
spina bifida, MD, paraplegia
115
Parapodim
designed to enable sitting good for spina bifida
116
Negative side effects of spine orthosis
weakness and atrophy, tightness/ contracture, psychological dependence
117
Corsets are for
not good for
____ limiting spine orthosis
management of LBP or herniation of nucleus pulposa
severe cases
least
118
Chairback orthosis does not limit
frontal plane
119
Combo of williams and chairback
what does it control
knight orthosis: sagital coronal control
120
Williams orthosis does not limit
sagittal plane
121
Highest level of limitation CO
Least
halo vest
collar
122
collars and Philadelphia CO does not limit
collar CO also does not limit
rotation
weight support
123
Molded Type CO limits what movements the most
fl, ext, side bending, rotation
124
halo vest CO limts what the most
fl, ext, side bending, rotation, weight support
125
what limits flexion CO the most
SOMI, four poster, molded type, halo vest
126
3 important orthotics for the management of scoliosis
Milwaukee (thoracic curvature), Under arm , and Charleston Bending brace (night time bending)
127
Charleston bending brace is for
nighttime in reverse position of scoliosis
127
Spine and LE will never be made from
low temp thermo not strong enough
128
Splint vs orthosis are
diff
interchangeable terms
s: short term
o: long term
129
Static vs dynamic splints
s: maintain joint in one position
d: apply force to correct deformities
130
Freq of splints
surgical
tendon repair
unstable fracture
s: static splint 6 days gentle passive
t: static 6-7 days gentle passive mvmt
u: immob in cast 4-6 weeks then static splint
131
Usually recomm for those awaiting hernia surgery or undergone hernia removal surgery
elastic truss, umbilical truss
132
ESTIM ortho
for?
stim of common peroneal nerve - foot drop
133
Why are hand and wrist splints made of low temp thermoplastics
molded directly to pt hand, less expensive, easily adjustable, done in one visit
