Orthotics Flashcards
Orthosis is a Device Used to:
- correct malalignment and prevent deformity (additional)
- restrict or assist motion
- transfer load to improve function
- reduce pain
Major Impairments Requiring Lower Limb Orthoses
- Congenital
- CP
- Spina Bifida
- Long bone malformations
- hemophilia
- osteogenesis imperfecta
- club foot
- charcot-marie tooth dx
- Disease
- stroke
- muscular dystrophy
- arthritis
- multiple sclerosis
- Legg-calve-perthes disease
- Poliomyelitis
- Trauma
- SCI
- fracture
- TBI
- Muscle, cartilage, tendon rupture
Lower-Limb Orthoses: Shoes
Foundation for orthoses
Reduce pressure areas
Worn with traditional leather orthopedic shoes or with sneakers
Can be internal or external
Lower-Limb Orthoses: Blucher opening
Shoe with vamps that open wide apart from anterior margin for ease of application
Lower-Limb Orthoses: Balmoral opening
shoe: has stitched down vamps, not suitable for orthotic wear.
Lower-Limb Orthoses: Foot orthoses - metatarsal pad
located posterior to MT heads
move pressure from MT heads to shafts
allow push off in weak or inflexible feet
Lower-Limb Orthoses: Cushion-heel
cushions and absorbs forces at heel strike
used to relieve strain on _plantar fascia in plantar fascitis _
Heel Spur pad
similar to cushion heel
Longitudinal Arch Supports
prevent depression of the subtalar joint and _correct for pes planus (flat foot) _
Lower-Limb Orthoses: UCBL insert
“University of California Biomechanics Laboratory” insert
Semirigid plastic molded (casted) insert to correct for flexible pes planus
(1/2-length insert)
Lower-Limb Orthoses: Scaphoid pad
longitudinal arch support below scaphoid
Lower-Limb Orthoses: Thomas heel
a heel wedge with an extended anterior medial border used to support the longitudinal arch and correct for flexible pes planus
Lower-Limb Orthoses: Rearfoot posting
alters the position of the subtalar joint STJ or rearfoot from _heel strike to foot flat. _
must be dynamic, control but not eliminate STJ motion
Lower-Limb Orthoses: Rearfoot posting: Varus Post
(medial wedge)
limits or controls EVERSION of calcaneus and IR of tibia after heel strike.
Reduces calcaneal eversion during running.
(pronation)
Lower-Limb Orthoses: Rearfoot posting: Valgus Post
(lateral wedge)
controls the calcaneus and STJ that are excessively inverted and supinated at heel strike.
Lower-Limb Orthoses: Forefoot positioning
Medial wedge: For forefoot varus
Lateral wedge: For forefoot valgus
CONTRAINDICATED IN INSENSITIVE FOOT
Lower-Limb Orthoses: Heel lifts/platform
Accommodates for leg-length discrepancy
Can be inside shoe (up to 3/8”) or attached to outer sole
Accommodates for limitation in ankle DF
Lower-Limb Orthoses: Rocker bar
Located proximal to met heads
Longer, convex met bar
Improves weight shift onto metatarsals and can assist DF
Lower-Limb Orthoses: Rocker bottom
Builds up sole of the shoe over the met heads and improves push-off in weak or inflexible feet
May also be used with insensitive feet
4 Components of Ankle Foot Orthosis
shoe attachment
ankle control
uprights
proximal leg band
Lower-Limb Orthoses: AFOs - Shoe attachments
foot plate vs, stirrup
-
Foot plate:
- Moulded plastic shoe insert - allows application of the brace before insertion into the shoes, ease of changing shoes of same heel height.
- Can assist with tone reduction (e.g. extend toes, putting stretch through foot)
-
Stirrup: Metal attachment rivite to sole of shoe
- Split stirrups allow for shoe interchange, solid stirrups are fixed permanently to the shoe and provide for maximum stability
Lower-Limb Orthoses: AFOs - Ankle controls
Free Motion vs. Solid Ankle vs Limited Motion
-
Free motion
- med-lat stability
- allows free movement DF and PF
-
Solid ankle:
- _allows no movement _
- indicated w/ severe pain or instability
-
Limited Motion
- _restriction in one or both direction _
- many types
- Dorsiflexion Assistance
Lower-Limb Orthoses: AFOs - Ankle controls, BiCAAL
Bichannel Adjustable Ankle Lock (BiCAAL)
ankle joint w. ant/post channels that can be fit with pins to reduce motion or springs to assist motion
Lower-Limb Orthoses: AFOs - Ankle controls - anterior stop
- DF stop
- Limited ankle DF
- Can be used to control knee buckling or excessive knee flexion during early stance
Lower-Limb Orthoses: AFOs - Ankle controls - posterior stop
PF stop. free dorsiflexion
Limits ankle PF
Can be used to _control for hyperextension _
Lower-Limb Orthoses: AFOs - Ankle controls - DF assist
Spring assist (Klenzak housing): Double upright metal AFO witha single anterior channel for a spring assist to aid DF
Posterior leaf spring (PLS): Plastic AFO that inserts into the shoe. Widely used to prevent foot drop
Lower-Limb Orthoses: AFOs - Ankle controls - T straps
Control for varus/valgus forces at ankle
Medial strap buckles around lateral upright and corrects for valgus
Lateral strap buckles around medial upright and corrects for varus
Lower-Limb Orthoses: AFOs - Uprights and attachments - Conventional
Double metal uprights attached to a calf band, hinged ankle joint allowing PF/DF
Provides max support
Easy to alter if condition on changing (e.g. edema)
Lower-Limb Orthoses: AFOs - Uprights and attachments - Molded
Made of molded plastic
Lighter, more cosmetic
CONTRAINDICATED FOR PATIENTS WITH CHANGING LEG VOLUME
Lower-Limb Orthoses: AFOs - Uprights and attachments - Molded - PLS
Flexible, narrow posterior shell and functions as DF assist. Holds foot at 90 degrees during swing, displaced during stance, no med/lat stability
Requires pt to have good med/lat stability
Lower-Limb Orthoses: AFOs - Uprights and attachments - Molded - Modified
Wider posterior shell
Trimlines just posterior to malleoli
Foot plate includes more of med and lat borders of foot
More med/lat stability
Lower-Limb Orthoses: AFOs - Uprights and attachments - Molded - Solid ankle
Widest posterior shell
Trimlines anterior to malleoli
Controls DF, PF, inv, ever
Lower-Limb Orthoses: AFOs - Uprights and attachments - Molded - Spiral
Winds around calk
Provides ltd control in all planes
Lower-Limb Orthoses: AFOs - Uprights and attachments - Molded - Floor reaction AFO
Assists with knee extn during stance and PF with calf band and/or ankle positioning. Places extension force closer to knee than other AFOs with anterior padded shell.
Lower-Limb Orthoses: AFOs - Uprights and attachments - Specialized patellar-tendon-bearing brim
Weight distribution on the patellar shelf similar to PTB prosthetic socket
Reduces WB forces through foot
Lower-Limb Orthoses: AFOs - Uprights and attachments - Specialized tone-reducing orthosis
Moulded plastic AFO which applies constant pressure to spastic or hypertonic muscles (PFs, invers)
Snug fit is essential to achieve benefits of reciprocal inhibition
Lower-Limb Orthoses: KAFOs - Hinge joint
Hinge joint provides med/lat/hyperextension control
Offset: hinge placed post to WB line - assists extn & stabilizes knee at early stance. May have difficulty on ramps where knee may flex inadvertently.
Lower-Limb Orthoses: KAFOs - Locks
-
Drop ring lock - Ring drops over joint when knee in full extn
- Retention button may be added to hold ring up, permit gait training with knee unlocked
-
Pawl lock with bail release - The pawl is a spring-loaded posterior lever/ring that allows the pt to unlock the knee by pulling up or hooking the pawl on the back of a chait and pushing it up.
- Adds bulk and may unlock inadvertently with posterior knee pressure.
Lower-Limb Orthoses: KAFOs - Knee stability
Sagittal stability acheived by straps to provide posteriorly directed force.
Anterior strap (e.g. knee cap) attaches by 4 buckles to metal uprights. May restrict sitting, increasing difficulty in donning.
Pretibial, suprapatellar or both.
Frontal controls (genu varum/valgum) - posterior plastic shell. Older braces use valgum (medial) or varum (lateral) correction straps which buckle around opposite upright. Less effective than shell.
Lower-Limb Orthoses: KAFOs - Thigh bands
Quadrilateral or ischial WB brim: reduces WB through limb
Patten bottom: Distal attachment added to keep foot off the floor - provides 100% unweighting of limb, lift is required on opposite side. Used for Legg-Calve-Perthes disease.
Lower-Limb Orthoses: KAFOs - Craig-Scott
Specialized KAFO
Designed specifically for people with paraplegia
Allows person to stand with posterior trunk lean
Shoe attachments with reinforced foot plates, BiCAAL ankles joints set in slight DF, pretibial band, pawl locks with bail release and single thigh band.
Lower-Limb Orthoses: KAFOs - Oregon orthotic system
Combination of plastic and metal components allows for triplanar control (sagittal, frontal and transverse)
Lower-Limb Orthoses: KAFOs - Fracture braces
A KAFO designed with a calf or thigh shell that encompasses the fracture site and provides support
Lower-Limb Orthoses: FES
If pt has full ROM and good functional endurance can use FES.
In ltd use for foot drop and scoliosis.
Lower-Limb Orthoses: Standing frames
Allos standing without crutches
May be stationary or attached to a wheeled base
Lower-Limb Orthoses: Parapodium
Allows standing without crutches
Also allows for ease in sitting with addition of hip and knee joints that can be unlocked (e.g. for kids with myelodysplasia).
Walking achieved by rocking base across the floor.
Primarily used by kids.
Lower-Limb Orthoses: Swedish knee cage
Provides mild control for knee hyperextension
(pad at pop fossa attached to a suprapatellar and pretibial pad)
Lower-Limb Orthoses: HKAFOs - Hip joint
Metal hinge joint
Controls abd/add/rotation
Controls hip flecion when locked
Typically with drop ring lock
Orthosis is heavy, locked hip restricts gait pattern to either swing-to or swing-through
Lower-Limb Orthoses: HKAFOs - Pelvic attachments
Leather covered metal pelvic band attaches HFAFO to pelvis between greater troch and iliac crest
Adds to difficulting in donning and doffing
As weight and increases overall energy expenditure during ambulation
Lower-Limb Orthoses: THKAFOs - RGO
Trunk band added HKAFO
Reciprocating gait orthosis:
Plastic molded solid ankle with locked knees, plastic thight shells, hip joint with pelvic and trunk bands.
Hips connectedd by steel cables which allow for a preciprocal gait pattern (either 4 or 2 point)
_When pt leans fwd on supporting hip it forces it into extension while the opposite leg is pushed into flexion. _
Allows limb advancement.
Lower-Limb Orthoses: Denis Browne splint
Bar that connects two shoes which can swivel
To correct club foot or pes equinovarus in young children
Lower-Limb Orthoses: Frejka pillow
Keeps hips abducted
Used for hip dysplasia or other conditions with tight adductors in young children
Lower-Limb Orthoses: Toronto hip abduction orthosis
Abducts the hip with rigid bar
Used in treatment of Legg-Calve-Perthes disease
Spinal Orthoses: Corset
Made of fabric, may have metal uprights within material
Provides abnominal compression
Increases intra-abdominal pressures
Assists respiration in people with SCI
Releives pain in mid-low back disorders
SIJ support (e.g. pregnancy)
Spinal Orthoses: LSO - Knight brace
Flexion, extension and lateral control
Includes pelvic and thoracic bands to anchor orthosis with two posterior uprights, two lateral uprights and an anterior corset
Spinal Orthoses: LSO - Plastic lumbosacral jacket
Provides max support by spreading forces over larger area
More cosmetic but hotter
Spinal Orthoses: TLSO - Taylor brace
Controls flexion and extension through 3-pt design
Includes components of a LS FEL (Knight) with addition of axillary shoulder straps to limit upper trunk flexion
Spinal Orthoses: TLSO - Plastic thoracolumbosacral jacket
Provides max support and controls all motions
Used for people recovering from SCI
Allows early mobilization and functional training
Spinal Orthoses: TLSO - Jewett
Limits flexion but encourages hyperextension (lordosis)
Used for compression fractures of the spine
Spinal Orthoses: Cervical - Soft collar
Minimal contol
For CxSp pain, whiplash
Spinal Orthoses: Cervical - Four-poster orthosis
Two plates - occipital and thoracic
Two anterior and two posterior posts to stabilize head
For moderate control in people with fracture or SCI
Spinal Orthoses: Cervical - Halo orthosis
Attaches to skull by screws
4 uprights connect from halo to thoracic band or plastic jacket
Full restriction of all CxSp motion
Provides max control for people with CxSp fracture/SCI
Allows for early mobilization/functional training
Pt will wear halo until spine becomes stable
Spinal Orthoses: Cervical - Minerva orthosis
Rigid plastic
Uses forehead band without screws
Max control of cervical motions
Spinal Orthoses: Specialized - Milwaukee orthosis
CTLSO
Controls scoliosis
Has molded plastic jacket, 1 anterior & 2 posterior uprights attaching to neck/chest ring
Pads and straps used to apply pressure to areas of convexity
Bulky, less cosmetic
May be used for all kyphotic and scoliotic curves of 40deg or less
Spinal Orthoses: Specialized - Boston orthosis
TLSO
Low profile plastic orthosis for scoliosis
More cosmetic
Can be worn under clothing
Used for mid-thoracic of lower scoliosis curves of 40deg or less
Also used to treat spondylolisthesis and condtions of severe trunk weakness (e.g. MD)
Upper Limb Orthoses: Resting “cock-up” splint
Palmar splint
Positions wrist in and hand in functional position
- Wrist can be held in neutral or 10-20deg extn
- Fingers supported, all phalanges slightly flexed, thumb in partial opposition and abduction
- For pts with RA, carpal #s, Colle’s #, carpal tunnel, stroke with paralysis etc
Upper Limb Orthoses: Dorsal wrist splint
Frees palm for feeling and grasping by use of grips which curve around over the 2nd and 5th met heads
Allows for the attachment of dorsal devices (e.g. rubber bands) to make it a dynamic device
Upper Limb Orthoses: Airplane splint
Positions arm in 90deg abduction, 90deg elbow flxn
Weight of outstretch arm born on padded lateral trunk bar and iliac crest band
A strap holds device across trunk
Use to immobilize shoulder after # or injury when strapping to chest is not desirable or with burns
Upper Limb Orthoses: Wrist-driven prehension orthosis
“Flexor hinge orthosis”
Assists pt in using wrist extensors to produce grip in absence of active flexion
e.g. facilitates tenodesis grasp with quadriplegia
Upper Limb Orthoses: Motor driven flexor hinge orthosis
Complex control system which allows for grasp
Not in widespread use
