Orthotics Flashcards
What is an orthosis?
An external appliance worn to restrict or assist motion or to transfer load from one area to another (brace is synonym)
What is a splint?
An orthosis intended for temporary use
What is the difference between an orthotist and a pedorthist?
Orthotist - designs, fabricates and fits orthosis of limbs and turns
Pedorthist - designs, fabricates, and fits only shoes or foot orthosis
What do the following acronyms stand for? FO AFO KAFO HKAFO THKAFO
FO - foot orthosis (inside or outside of shoe)
AFO - ankle-foot orthosis (encompass the foot and terminate below knee)
KAFO - Knee-ankle-foot orthosis (shoe/foot to thigh)
HKAFO - Hip KAFO (has pelvic band that surrounds lower trunk
THKAFO - Trunk HKAFO (common in paraplegics)
What is the purpose of shoes with orthosis.
Foundation for most LE orthoses
Transfer body weight to ground
Reduce pressure on sensitive deformed structures
Foundation for AFO’s or more extensive bracing
What type of lacing is preferred for orthotics?
Blucher (open) lace stay
Describe internal and external modifications in foot orthosis.
Internal - affixed inside the shoe
External - attached to sole or heel of shoe
What are the purposes of foot orthosis?
Enhance function by relieving pain
Improve transition during stance phase (altering rollover point in late stance, equalize foot and leg lengths)
With internal modifications, is it more effective for foot orthoses to be closer or farther from the foot?
Closer
What is the difference between an insert and an internal modification?
Insert - allows for use in multiple shoes with same heel height (may slip or lose correct positioning)
Internal Modification - guarantee desired placement (limit person to one shoe)
What type of orthoses is used for Pes Planus?
Scaphoid Pad (prevents flattening of arch)
Which muscles have increased activation with arch supports?
Anterior tib, and peroneus longus
Give an example of a full length foot insert.
UCBL (University of California Biomechanics Laboratory)
What type of pad supports Pes Cavus?
Metarsal Pad
(Apex is under metatarsal shafts, transfers stress from metatarsal heads to the metatarsal shafts and is effective in reducing plantar pressure)
Good for diabetic neuropathy
Do AFO’s need to be worn with a shoe?
Yes
Can have internal modifications for foot control
With AFO’s, what does the term articulated mean?
Has a hinge (can change settings)
What are most AFO’s prescribed for?
Controling ankle motion (limit PF) Dorsiflexor weakness (can have posterior leaf spring)
Where does a joint in a hinged AFO stop?
Allows DF, but stops at neutral before ankle plantarflexes
What type of AFO limits all foot and ankle movement?
Solid AFO
-Controls medial-lateral motion
When do you want to use a solid AFO?
When spasticity is present (a spring can cause clonus or increase spasticity)
Where is the floor reaction or ground reaction force from an AFO?
Posteriorly directed near the knee
resists knee flexion, promotes extension
Who are the primary candidates for an AFO?
(Basically any diagnosis that results in foot drop) Peripheral neuropathy Hemiplegia Incomp SCI MS
What are the types of knee control in a KAFO?
- Hinge (medial/lateral and hyperextension restriction, allows knee flexion)
- Offset Joint (Hinge placed posteriorly to midline of leg, stabilizes knee in extension during early stance phase of gait)
- Drop Ring Lock (Most common) - When knee fully extends, ring drops preventing bending
When would you use a Craig-Scott KAFO?
In adults with paraplegia
- allows patient to stand with sufficient backward lean to prevent pitching forward at hip or trunk
- gait pattern is usually swing-to or swing through with crutches or walker
When doe a KAFO become an HKAFO?
When a pelvic band is added
-Usually lodged between greater trochanter and iliac crest
What does the HKAFO do at the hip joint specifically?
Prevents abduction, adduction, and hip rotation
If necessary, a two-position lock stabilizes patient in extension for standing and walking and in 90 degrees hip flexion for sitting
Which type of brace is seldom worn after a patient discharges from a rehab program due to being very heavy and difficult to don?
THKAFO
What needs to happen to walk in a reciprocating gait orthosis?
Shift weight
Tuck the pelvis by extending upper thorax
Press on crutches
Allow the other leg to swing through
Name some examples of a trunk orthoses.
Corset Rigid orthoses (TLSO)
What is the purpose of a corset?
Abdominal compression only
What is the main use for cervical orthoses?
Post-surgical healing for spinal stability
What types of orthoses are best for minimal, moderate, and maximal control of the cervical spine?
Minimal - Soft foam rubber collar, Philadelphia
Moderate - Four-post orthoses
Maximal - Minerva, Halo
What patient population can a scoliosis orthoses (TLSO) be used?
Children and adolescents
When is the scoliosis orthoses MOST effective?
Curves less than 35 degree Cobb angle
Curves in the midthoracic or more inferior portions of trunk
How often does a person using a scoliosis brace need to wear it per day?
Classic protocol is 23 hours per day
What does a PT want to consider for orthotic prescription?
Patient’s impairments and limitations (tone/spasticity, strength blah blah blah)
Prognosis (orthotic must be able to adapt)
Patient’s lifestyle (more active = more wear and tear = sturdier material)
Patients concern with appearance
Name a couple things to look for with a static examination while standing.
Shoes - fit well, sole and heel rest flat on floor (except distal portion)
Orthotic ankle joint - Should be at distal tip of medial malleolus
Calf band, shell, brim - should terminate before fibular head (doesn’t intrude on popliteal fossa)
Mechanical Knee joint - should be in line with anatomical knee
Hip joint - set slightly above and anterior to greater trochanter
Pelvic band - should conform to contours of torso
