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CJ Orthotics & Prosthetics > ORTHOTICS > Flashcards

ORTHOTICS Flashcards

1
Q

Stress Equation

A

Physical Stress = force/area

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2
Q

Factors that Affect the level of physical stress on tissues or the adaptive responses to tissues to physical stress

A
  • movement and alignment factors
  • extrinsic factors (orthotics)
  • psychological factors
  • physiological factors
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3
Q

The effect of physical stress on tissue adaptation

A
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4
Q

The Effects of Prolonged Low Stress Lowers Thresholds for Subsequent Adaptation and Injury

A
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5
Q

The Effect of Prolonged Low Stress Lowers Thresholds for subsequent adaptation and Injury

A
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6
Q

Physical Stress level is composite of what 3 primary values?

A
  1. Magnitiude (of pressure)
  2. Time: duration, repitition rate
  3. direction: tension, compression, shearing, torsion
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7
Q

2 Primary questions to ask in an evaluation and treatment

A
  1. What are the factors that appear to be contributing to the excessive stress on the injured tissue?
  2. How can these contirbuting factors be modified to reduce stress on the tissue and allow the tissue to heal?
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8
Q

Brief History of o&p

A
  • major advances due to WWI , WWII, and vietnam, Iraq
  • Post WWII research - PTB, TT, TF
  • AFter vietnam = myoelectric and modular prostheses
  • most advances in orthotics with Polio epidemic
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9
Q

What makes for an ideal orthosis?

A
  • Control - stabilization and motor control
  • Comfort - device meets pts needs
  • Cosmesis - will the pt wear it
  • Cost - monetory, insurance, energy required
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10
Q

Primary functions of Orthoses

A
  • Correct or prevent deformity
  • protect weakened ms segment
  • unload a limb or joint
  • rest/immobilize
  • assist with motion
  • enhance gait
  • alleviate pain
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11
Q

5 Prerequisites of functional gait

A
  1. stability in stance
  2. clearance during swing
  3. swing phase pre-positioning (adequate loading)
  4. adaquate step length - timed activity or prox ms and pendulum effect of lower limb below knee)
  5. energy conservation
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12
Q

3 Rockers of STANCE phase in gait

A
  • Heel Rocker: initial contact to foot flat during loading response - deceleration of foot towrad floow (eccentric PF by DF)
  • Ankle Rocker: ankle advacnes over the ankle foot complex - DF as talocrural joint rolls over stable foot (need 10deg DF)
  • Toe Rocker: begins as heel rises and body weight rolls over MTP through push off in terminal stance - extension of MTPs
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13
Q

Anatomical Assistive Devices

ANKLE

A
  • Stirrup: M/L support, tolerated well, wraps around calcaneus
  • Lace up: fxns like ankle tape, contains rear foot
  • Active Ankle: allows PF/DF, discourages inversion
  • Prophylactic: longer effect than taping
  • CAM walker: (controlled ankle motion) adjustable ROM, rocker boot, post surgical, fxs, severe sprains, unloading of wounds etc
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14
Q

Anatomical Assistive Devices

KNEE

A
  • Prophylactic: decrease M/L damage to knee, conflicting evidence regarding efficacy (no change in injury rate, increased foot injuries)
  • Post Operative: protected and controlled motion - can lock ROM to limit flex/ext
  • Functional: attempt to control ML stability, anterior tibial translation and recurvatum 0 return to activity - prefab or custom
  • PF: correct patellar position, mixed research, valgus control
  • Unloading: decrease stress in OA knees, designed to distract joint surface at M or L knee, more effective than neoprene sleeves, condylar separation seen
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15
Q

Anatomical Assitive Devices

HIP

A
  • Hip Compression shorts: soft tissue injuries
  • Post Dislocation:
    • Congenital = Pavlik harness
    • adults = hip ADD orthosis - both keep femoral head in acetabulum
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16
Q

Leg Calve-Pertheses Disease

A
  • AVN = loss of blood supply to femoral head
  • Scottish - Rite Brace = keeps hips in ABD while still allowing for ambulation
  • Toronto Orthosis
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17
Q

Shoe Modifications for Neurological Conditions

A
  • lifts
  • metatarsal bars (shift pressure behind MT)
  • last modifications (solid form around shoe)
  • wedges
  • depth changes
  • rocker bottom
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18
Q

FO = Foot Orthosis

Neurological Conditions

A
  • Plastic foot - orthoses and supramalleolar orthoses (SMO) for excessive tone
  • Diabetes shoes, arthritis
  • modify weight transfer
  • Accomodate deformities
    *
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19
Q

AFO = Ankle Foot Orthosis

indications, contra indications

A
  • General indications
    • flexible deformity
    • weakness of foot and ankle
    • need for stability
  • Contraindications
    • fixed deformity
    • open wound
  • Types
    • Metal and Leather
    • Plastic
    • Conventional
  • Patient Long Term
    • hyperextension before/after DAFO
    • better initial contact
    • limit hyperextension
    • better stepping
    • low tone pronation
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20
Q

Metal and Leather AFOs

A
  • conventionial
  • provides very good support
  • relies on well constructed shoe
  • used if:
    • plastic cannot support deformity
    • flucuating edema
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21
Q

Plastic AFOs

Types and Principles

A
  • may have contoured foot plate
    • dynamic AFO (DAFO)
    • support of arch/toes with custom
    • tone reduction
  • Molded AFO
    • no support arch/toes
  • wraps around malleoli depending on need
  • Solid AFO
    • no ankle motion allowed
  • Hinged
  • DF assist
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22
Q

Solid AFO

WebRep

currentVote

noRating

noWeight

A
  • no ankle motion allowed
  • indications
    • no control of DF
    • excessive knee extension in WB
  • Contraindications
    • knee flex contracture
    • need for ankle motion in development
  • impacts ALL 3 ROCKERS
    • heel rocker - impaired loading response, no PF to reach foot flat
    • ankle rocker - dont have 20 DF locked at 90
    • Toe rocker - stiff toe plate - no exension of toes

WebRep

currentVote

noRating

noWeight

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23
Q

Semi-Rigid AFO

A
  • trimlines just behind the malleoli will allow for increase of support and provide both DF positioning of the foot and mediolateral stability of the ankle
  • much less motion is allowed
  • pt cannot easily propel during push off
  • most commonly used for pts with some extensor tone and/or with mediolateral instability of the ankle
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24
Q

Hinged AFO

A
  • allows ankle motion
  • amount of motion limited by stop
  • usually limits PF
  • indications:
    • voluntary DF for adequate toe clearance
    • limited control of DF and PF
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25
Q

DorsiFlexion Assist AFO

A
  • Can be a spring (conventional)
  • assists with DF
  • Elasticity of plastic
  • Indications
    • adequate passive ROM >5deg
    • weakness in DF
    • some PF strength
    • commonly used for flaccid foot drop
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26
Q

Conventional Klenax and Double Adjustable

A

used when primary problem is DF weakness

Peroneal nerve palsy, CMT, PN

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27
Q

Floor Reaction or Ground Reaction AFO

A
  • promote knee extension
  • limits DF
  • contraindications
    • fixed knee or ankle contracture (trying to facilitate motion)
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28
Q

Knee Ankle Foot Orthosis

KAFO

A
  • Controls and aligns knee/ankle
  • indications
    • voluntary hip and trunk
    • when excessive movement at knee in stance cant be controlled with AFO
  • Contraindications
    • Unable to meet energy demands
    • lack of strength
    • open wounds in area of orthosis
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29
Q

Craig Scott KAFO

A
  • used with SCI bilaterally
  • swing to or swing thru
  • designed for balance in stance
  • bail lock - locks when walking, unlock to sit
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30
Q

Stance Control KAFO

SCKAFO

A
  • prescribed for quad weakness
  • knee is locked in ext during during stance
  • free knee flexion and extension in swing
  • some elbow resisted flexion during initial contact
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31
Q

Hip Knee Ankle Foot Orthoses

HKAFO

A

indications

  • full or partial loss of voluntary control of the trunk and lower extremities
  • need to stabilize the trunk

Contraindications

  • unable to meet energy demands
  • inadequate thoracic, cervical, and UE fxn
  • hip flexion contracture

Standing HKAFO

  • spina bifida, CP, developmental delay
  • parapodiums
  • standing shells
  • good for weight bearing and preventing contractures, ambulation also
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32
Q

Standing HKAFO

A
  • Spina Bifida
  • CP
  • Developmental delay
  • parapodiums
  • standing shells
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33
Q

Reciprocal-Gait Orthosis

RGO

A
  • uses dual cable system to couple flexion of one hip with extension of the other hip
  • AFOs and knee joints offset posteriorly with lateral ring locks
  • rigid pelvic band
  • may have plastic molded TLSO attached
34
Q

Hip Guidance Orthosis

HGO

A
  • Closed fitting rigid body orthosis
  • low friction hip joint
  • fixed ankle shoe plate with 6 deg of DF
  • rocker sole
  • designed to reduce energy in walking and some thing has better ground clearance and smoother gait than RGO
35
Q

Important Things to Monitor with Orthoses

A
  • Wearing Schedule
  • Skin care
  • Orthosis Care
  • Clean soap and water
  • Problems
    • skin/orthosis breakdown
    • pain
    • swelling/discoloration
36
Q

Foot Function

A
  • adapt to uneven terrain and act as a rigid lever for push off
  • absorb rotation of LE
  • offer balance
  • offer protection
  • inability to perform these tasks causes a problem up the kinetic chain
  • need foot orthosis bc: support, control, cushion
37
Q

2 primary types of foot orthoses

A
  1. corrective/functional
  2. accomodative - more cushioning
38
Q

Soft Foot Orthoses

A
  • reduce pressure
  • tend to be thicker and require a deeper shoe
  • PLASTAZOTE = most common material - closed cell polyethylene thermoplastic
  • disadvantage = retains heat from foot
39
Q

Semi-Rigid Foot Orthoses

A
  • firmer materials than soft
  • incorporate posting techniques
  • usually full length
  • purpose:
    • improve weight transfer
    • support and stabilize deformities of the foot and LE
    • to relieve pressure
  • most frequent used
  • NICKLEPLAST = common
  • derometer = measure of density
40
Q

Rigid Foot Orthoses

A
  • Advantages
    • thin
    • 3/4 length (can slide in shoe though)
    • useful in dress shoes
    • SUBORTHOLENE
  • Disadvantages
    • limited impact reduction
    • increased pressure areas
    • highly skilled fabrication
    • materials often crack with high forces
    • contraindicated for highly active
    • may result in stress fx, impingement or neuroma
41
Q

Shell

A

Can be modified - basic starter for modifcation

42
Q

Post

RF 3-5 degrees normal)

A
  • Medial post to prevent collapsing down
  • Internal post - add post to cast
  • External post - add to orthotic, more modifiable
  • 1/4 in material = 2-3 deg post
43
Q

Flanges

A

like a wing - widening of the orthotic shell

44
Q

Fore Foot Ext/ Morton’s Ext

(metatarsalgia)

A

longer where first MTP is

good for turf toe - prevent ext of 1st MTP

45
Q

Scaphoid Pad

A

increases arch height

46
Q

Met Pad/ Met Bar

(metatarsalgia)

A
  • unload metatarsal heads
  • creates shelf for joints to decrease load
  • increase transverse arch
47
Q

Cut out

A

remove areas of pressure (PF 1st)

48
Q

Basyily

A

Over the counter customizable - like stickers that you add or remove

49
Q

Foot Orthoses and Gait

A
  • posted non-molded = best at reducing peak RF eversion and tibial IR in non injured
  • non-posted molded and posted molded = reduction in loading rate and vertical impact forces when compared to controls and posted non-molded
  • neuromuscular control paradigm - inconclusive
50
Q

Effectiveness of Sham, Prefab and Custom

A
  • Sham didnt work
  • similar response in prefab and custom
  • long term = didnt have any advantage
  • think of orthotics as a temporary device
51
Q

Foot Orthoses as an Intervention

A

Treatment DIrection Test (TDT)

  • determine the suitability of an orthosis
  • determine the activities that the athlete has difficulty performing or provoke pain
  • determine possible harmful or excessive motions and attemp to alter these motions via strapping, taping, or temp felt orthosis
  • reasses the painful activity with the modification
  • the greater the improvement the more likely orthoses would be beneficial
  • using pads and taping to alter asterisk signs
  • TDT for excessive pronators:
    • low dye taping to control navicular hieght
    • prefab OTC inserts
    • orthopedic felt temporary orthoses
52
Q

Shoe Recommendation

Under Pronator

A
  • stitch lasted
  • curve lasted
  • neutral heel cup
  • moderate to soft cushioning
  • lateral flex in midfoot
53
Q

Shoe Recommendation

Over Pronator

A
  • Board lasted
  • straight lasted
  • wide forefoot
  • moderate to firm cushioning
  • sitff midfoot
54
Q

Common Mechanisms of Action

Spinal Orthoses

A
  1. reduce gross spinal motion
  2. stabilize individual motion segments
  3. apply closed chain force systems to correct or prevent deformity
  4. protect surgical constructs by preventing bending and twisting
  5. require careful detail and follow up adjustments
55
Q

Effects and Negatives of Spinal Orthoses

A

Effects:

  • trunk support
  • motion restriciton
  • modification of skeletal alignment

Negatives:

  • atrophy, weakness, dependence
  • discomfort
  • respiratory difficulty
56
Q

Sacroiliac Corsets

A
  • only support SIJ
  • emcompass pelvis but not lower trunk
  • increase abdominal pressure only slightly
  • best for mild SIJ dysfunction
57
Q

Lumbosacral Orthoses

LSO

A
  • most frequently prescribed orthosis for LBP
  • fortified with rigid and flexible stays
  • limit much but not all lumbar motion
  • increase intracavity pressure
  • transmit 3 point pressure systems to lumbar spine
  • often used for acute LBP
  • questionable efficacy for chronic LBP
58
Q

Jewett Hyperextension or

CASH TLSO

A
  • used for patients with compression fractures of low thoracic and lumbar spine
  • limits trunk flexion with 3 point pressure system
59
Q

Taylor-Knight TLSO

A
  • Limits spinal motion in both coronal and sagittal planes
  • has thoracic and pelvic bands connected by paraspinal bars and a set of lateral bars
  • originally designed for patient with TB
  • now primarily used for LBP
  • stable, noncompression fractures of lumbar spine
60
Q

Cervical Orthoses

General

A
  • comfortable to wear
  • soft collar-does not restrict motion in any plane
  • kinesthetic reminder after whiplash or neck pain
  • molded soft collar
  • may contrubute to forward head posture
61
Q

Philadelphia Collar

A
  • most recognized reinforcement collar
  • low trimlines do not effectively immobilize C-spine nor prevent lateral flexion or rotation
    *
62
Q

Aspen 4-Post

A
  • CTO
  • higher trimlines for more control
63
Q

Cervical Halo

A
  • For complete control of cervical and upper thoracic spine
  • used in 3 ways:
    • min movmnt during surg
    • control motion after surg
    • conservative tx post non displaced upper cervical vertebral fractures
  • Rehab considerations
    • some may be “top heavy”
    • post control strategies needed after removal
    • if pt falls w/ halo, check for bleeding at pin sites
64
Q

Scoliosis

Etiology

A
  • idipathic in 65% of cases (infantile, juvenile or adolescent)
  • congenital w/ vert /rib abnormalities
  • neuromuscular 10% (CP, SB, SMA)
  • Myopathic (MD, arthrogryposis)
  • indicence:
    • 2% has >/= 10 degrees
    • .2% has > 20 degrees
    • .1% has > 40 degrees
  • 50% of curves > 15 deg do not progress
65
Q

Scoliosis

Anatomical Abnormalities and Clinical Findings

A
  • structural - does not change with position
  • functional - changes depending on cause
  • frontal plane curvature noted observation -rib hump
  • subjective complaints of soft tissue and/or joint pain
  • SOB if very severe

diagnositc tests: Xrays with measurement of curve

66
Q

Measuring Cobb Angle

A
67
Q

Treatment of and Controlling

Scoliosis

A

Treatment

  • medical intervention of NSAID for p!
  • 5 deg over 6mo
  • 30-45deg = bracing
  • >50 deg = surgery

controlling scoliosis

  • exercise - no proven benefit
  • e-stim - questionable results with curves>30 degress
  • bracing
  • fusion
68
Q

Treatment of Associated P! and Dysfunction with Scoliosis

A
  • p! controlling modalities
  • mobilization of appropriate segments as needed, stability of other segments
  • restoration of ROM as tolerated
  • restoration of muscle flexibility
  • restoration of ms strength of periscapular and trunk/hip stabilizers
  • patient ed w/ posture, body mechanics and fitness
69
Q

Indications with Scoliosis

A
  • 10-20 deg = observe
  • 20-30 deg = observe. possible brace
  • 30-40 deg = orthosis
  • 40-50 deg = surgery - try to delay spinal fusion until child has as much trunk height as possible
70
Q

Milwaukee Brace

CTLSO

A
71
Q

Boston Brace TLSO

A

To be worn Full TIME

72
Q

Charleston Bending Brace

TLSO

A
  • Worn only at night
  • places trunk in overcorrected side psition
  • not compatible with walking etc
  • stabilizing force at trochanter and a laterally directed force at the apex of the curve
  • most effective with single curves
73
Q

Providence Scoliosis System

A
  • Worn only at night
  • employs over correction in molded plastic appliance
  • uses series of corrective pads to apply hyper correction
  • fabricated with CAD/CAM technology
  • applies to wider range of curves than charleston and double curves
74
Q

Dynamic Scoliosis Brace

SpineCor

A
  • constructed from flexible materials
  • dynamic forces to maintain spinal deform
  • re-educates body to return to norm posture
  • made of a free moving configuration
  • wear 20 hrs/day for at least 18 months
  • efficacy not as good as rigid orthoses
75
Q
A
76
Q

Purpose of UE orthoses

A
  • prevent/correct deformity
  • support/protect or immobilze the joint
  • assist weak mvmnt
  • provide rest to joint
  • stress relief
  • transfer movement from one joint to another
  • assist in muscle re-ed
77
Q

Splint Design Principles

A
  • needs and expectations of pt
  • position
  • areas to be suppoted
  • distribution of support
  • total contact?
  • small area of support?
    *
78
Q

Mechanical Considerations

Wrist/Hand Splinting

A

apply force perpendicular to segment

use leverage

disseminate the applied force

minimize friction

allow full motion at non affected joints

79
Q

Wrist and Hand Splint

Common Pathologies

A
  • post-fracture
  • tendonopathies - tennis elbow
  • carpal tunnel
  • instability of wrist
  • arthritis
80
Q

Static Splint

A

immobilize and protect

allow tissues to rest

81
Q

Dynamic Splinting

A

control motion

allow motion

substitute for muscle

82
Q
A

CJ Orthotics & Prosthetics (10 decks)

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