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BMSc > Orthotics > Flashcards

Orthotics Flashcards

1
Q

What is Orthotics?

A

The science that deals with the use of specialised mechanical devices to support or supplement weakened or abnormal joints or limbs.

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2
Q

What is an Orthosis?

A

An externally applied device (brace, splint, orthotic) that can improve function, reduce pain and/or prevent deformity

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3
Q

What is an Orthotist?

A

Registered health care professional who specialises in the assessment of the whole body for biomechanical problems, and if appropriate may prescribe, measure, fit or review an orthosis.

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4
Q

Why are the majority of orthotics made for the lower limb?

A

Due to the development of medicines.

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5
Q

List the types of lower limb orthotics available?

A 
Foot orthosis 
Footwear
AFO - ankle foot orthosis 
KO - knee orthosis 
KAFO - knee ankle foot orthosis 
HKAFO - hip knee ankle foot orthosis
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6
Q

What are the 3 common abnormal biomechanics problems with regards to the foot?

A

Valgus deformity
- everted frontal plane position

Varus deformity
- inverted frontal plane deformity

Equinus deformity
- plantar-flexed position in sagittal plane

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7
Q

What is a foot orthosis?

A

A moulded walking base used inside footwear (insoles, heel cups).

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8
Q

Is a foot orthosis always custom made for the patient?

A

No, it can also be pre-moulded.

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9
Q

What are the functional potentials of a foot orthosis?

A
  • re-distribution and reduction of plantar pressures
  • relieve pain
  • improve function
  • prevent structural deformity
  • correct mobile deformity
  • accommodate fixed deformity
  • limit or prevent joint motion
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10
Q

The function of a foot orthosis depends on the deformity of the patient. What does this mean?

A

If the patient has a MOBILE deformity - the foot orthosis should CORRECT the deformity.

If the patient has a FIXED deformity - the foot orthosis should ACCOMMODATE the deformity.

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11
Q

What does a ‘mobile deformity’ mean?

A

The body part can be manipulated into a ‘normal’ alignment.

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12
Q

What does a ‘fixed deformity’ mean?

A

The body part cannot be manipulated into a ‘normal’ alignment.

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13
Q

What stages form the assessment phase of a patient for an orthosis?

A

1) referral info and relevant Hx
2) physical assessment (ROM, muscle powers, sensation, proprioception, circulation, muscle tone)
2) static and dynamic gait assessment
4) aims and objectives of patient and clinician

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14
Q

How is a mobile valgus foot deformity treated?

A

(everted in frontal plane)

1) manipulate the foot to a corrected position and hold the foot by applying 3 point forces (2 lateral, 1 medial)
2) insert a medial wedge on insole or footwear

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15
Q

How is a fixed valgus deformity treated?

A

(everted in frontal plane)

1) accept the foot position and accommodate to achiever greater stability
2) lateral wedge on insole or footwear

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16
Q

How is a mobile varus foot deformity treated?

A

(inverted in frontal plane)

1) manipulate the foot to a corrected position and hold the foot by applying 3 forces (2 medial, 1 lateral)
2) lateral wedge on insole or footwear

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17
Q

Is an equinus foot deformity usually mobile or fixed?

A

Fixed (can happen after a stroke)

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18
Q

How is a mobile equinus foot deformity treated?

A

(plantar-flexed in sagittal plane)

Manipulate the foot to a corrected position and hold the foot by applying 3 forces (1 under the foot, 1 into the anterior ankle, 1 behind the knee).

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19
Q

How is a fixed equinus foot deformity treated?

A

(plantar-flexed in sagittal plane)

accommodate the deformity by inserting a heel raise wedge which follows the contour of the foot whilst ensuring the knee isn’t made unstable.

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20
Q

If an equinus foot deformity is not adequately accommodated, what can happen?

A

Hyperextension of the knee.

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21
Q

How is a fixed varus foot deformity treated?

A

(plantar-flexed in sagittal plane)

Accommodate the deformity by inserting a medial wedge on the insole or footwear.

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22
Q

List the different types of footwear adaptations?

A

Heel raises
Wedges
Flares
Rocker soles

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23
Q

What are the uses of a shoe/heel raise?

A

To accommodate fixed equinus foot or leg length discrepancy.

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24
Q

What are the uses of shoe wedges?

A

To correct mobile or accommodate fixed varus/valgus foot.

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25
Q

What is the use of a shoe flare?

A

To increase stability from a varus/valgus foot.

26
Q

What are the uses of a rocker sole on a shoe?

A

Increase stiffness of the sole

Increase toe spring

Shift the GRF posteriorly.

27
Q

What is an AFO?

A

Externally applied device that extends from just below the knee, around the ankle and across the sole of the foot.

28
Q

What are the functional potentials of an AFO?

A
  • correction of the MSK system
  • maintenance of a position
  • assist motion about a joint
  • resist motion about a joint
  • protection
  • improve walking speed and cadence
  • reduce energy expenditure
29
Q

What are the 4 different types of AFO?

A

solid AFO
posterior leaf spring AFO
varus/valgus control AFO
jointed AFO

(depends on patients functional loss/gait deviations)

30
Q

In what ways can the mechanical characteristics of an AFO be altered once made?

A

increasing/decreasing medial/lateral trimlines

increasing/decreasing material thickness

changing cross section shape

adding reinforcement/stiffeners

material choice

31
Q

Why is a heel height assessment important to be carried out with regards to an AFO?

A

Altering the heel height of shoes will influence the GRF around the knee and can increase or decrease stability.

32
Q

What biomechanical principles is an AFO based upon?

A

lever arm moments

three point forces for correction

33
Q

What 3 point forces are used in an AFO for a valgus ankle deformity?

A

1 lateral foot
1 lateral knee
1 medial ankle

34
Q

What 3 point forces are used in an AFO for a varus ankle deformity?

A

1 medial foot
1 medial knee
1 lateral ankle

35
Q

What is a KO?

A

Externally applied device that extends from mid-thigh to mid-calf.

36
Q

Is a KO always custom made?

A

No, they can be pre-maufactured.

37
Q

What are the functional potentials of a KO?

A
  • relieve pain
  • improve function
  • prevent structural deformity
  • correct mobile deformity
  • limit or prevent joint motion
38
Q

What motions can a KO control?

A 
flexion 
hyperextension 
ant/post instability 
med/lat instability 
rotation
39
Q

What are the most common reasons for fitting a KO?

A

OA
post-surgery
ligament injury
mild instability

40
Q

Why must the deformity only be mild for a KO to be suitable?

A

Due to short lever arms.

41
Q

What 3 forces are required in a KO to correct medial instability?

A

i.e. mild valgus deformity

1 medial knee
1 lateral thigh
1 lateral calf

42
Q

What 3 forces are required in a KO to correct lateral instability?

A

i.e. mild varus deformity

1 lateral knee
1 medial thigh
1 medial calf

43
Q

What 3 forces are required in a KO to correct hyperextension of the knee?

A

1 posterior knee
1 anterior thigh
1 anterior calf

44
Q

What is a KAFO?

A

Externally applied device extending from the thigh to the foot.

45
Q

What is a KAFO commonly referred to as?

A

A calliper

46
Q

What are the functional potentials of a KAFO?

A
  • correction of the MSK system
  • maintenance of position
  • assist motion about a joint/joints
  • resist motion about a joint/joints
  • protection
  • improve walking speed and cadence
  • reduce energy expenditure
47
Q

What considerations must be taken into account to determine what type of KAFO should be prescribed for a patient?

A 
patient age, weight, activity level 
general health 
occupation 
lower limb function 
goals and expectations 
upper limb function
48
Q

What are the different types of appearance of a KAFO?

A

CONVENTIONAL
- metal and leather (heavy in weight and hard bearing)

COSMETIC
- thermoplastic (lightweight, durable)

49
Q

What are the different materials which can be used for the side bars of a KAFO?

A

Steel
- heavy and hard bearing

Dural

  • aluminium alloy
  • softer and lighter material
50
Q

What are the different types of knee locks which can be used for a KAFO?

A

Free
- no locking mechanism

Drop locks
- when the knee is in extension, gravity causes a ring to drop and joint to lock

Manual drop locks
- when the knee is in extension, a ring needs to be moved by hand to lock

Semi automatic locks
- when the knee is in extension, a spring activates a ring to lock

Bale locks
- bar or cord activated ring lock joint

Polycentric locks
- more than one joint centre

Spline joints
- incremented joint to allow fixed setting, can be used in contracture Mx

51
Q

The KAFO is required to take the BW through the side bars, to reduce the weight through the leg. What are the 2 ways in design that this can be achieved?

A

Quad top
- ischial tuberosity rests on a ledge outside socket

Ischial containment
- ischial tuberosity rests within socket

52
Q

What 3 forces are required in a KAFO to correct medial instability?

A

i.e. valgus deformity

1 medial knee
1 lateral top thigh
1 lateral ankle

53
Q

What 3 forces are required in a KAFO to correct lateral instability?

A

i.e. varus deformity

1 lateral knee
1 medial top thigh
1 medial ankle

54
Q

What is a HKAFO?

A

A KAFO with the addition of a hip joint and pelvic band

55
Q

When is the use of a HKAFO indicated?

A

to stabilise the hip and lower spine in cases where the patient is weak or paralysed

56
Q

Give an example of a HKAFO?

A

Hip guidance orthosis (HGO) - consists of bilateral KAFOs linked via specially designed low friction hip joints

57
Q

What are the 2 general categories of upper limb orthotics?

A

Static and Dynamic

58
Q

List the different types of upper limb orthotics?

A 
finger orthosis 
hand orthosis 
WHO - wrist hand orthosis 
Elbow orthosis 
EWHO - elbow wrist hand orthosis 
shoulder orthosis
59
Q

What is the most common static upper limb orthosis?

A

WHO - wrist hand orthosis

prevents movement at specific joints

60
Q

When is a WHO used?

A

To prevent contracture development

61
Q

What is a dynamic upper limb orthosis, how does it work?

A

The orthosis has springs and moving components, which holds the arm in corrected position while allowing active movements at specific joints.

BMSc (6 decks)

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