Orthotics Flashcards
Physical presentation of someone with CMT
- Claw toes
- pes cavus
- equinus/varus
- callusing on the 1st and 5th
- motor and sensory loss
- stork legs (inverted champagne bottle)
- intrinsic wasting of hands and feet
- muscle weakness (foot drop)
- progressive
- bilateral
- distal to proximal
Orthotic Goals for MS
- replace weakened muscle
- improve balance
- prevent deformities
- accomodate fatigue through lightweight options
ABI (acquired brain injury)
- closed, open, penetrating injury to the brain resulting in contusion
- can result in flacidity or spasticity
- upper motor neuron lesion
Tarsal tunnel syndrome
tibial nerve gets impinged in flexor retinaculum (medial aspect of the foot inferior to the malleoli and anterior to TP, FDL, FHL
- symptoms include numbness and tingling with digits 1-3,
- commonly seen with flat feet, pes plano valgus
hammer toes
-flexion of the PIP caused by inappropriate footweark and seen with OA
Charcot Marie Tooth
-genetic disorder that affects the distal segments of the hands and feet resulting in progressive muscle and sensory loss due to the destruction of the myelin sheath
fracture dislocation of extremity
fracture of the bone close to joint that results in dislocation of that joint.
Physical presentation of CP patient
- spasticity
- contracture
- crouch gait
- equinus, varus
- motor dysfunction
- scoliosis
Diplegia- pesplanovalgus crouch gait
Hemiplegia- equinus position of the ankle and UE flexor synergy
Can have speech, communication and learning disability
Physical presentation of OA patients
- hallux valgus of the big toe
- hammer or claw toes
- pronation of foot
- gross instability
- Trendelenburg gait
- antalgic gait
- Heberden nodes at DIP
Flexion synergies in upper limb
- elbow flexion
- wrist flexion
- finger flexion and adduction
- thumb flexion and adduction
- pronation
Extension synergies in lower limbs
- knee hyperextension
- ankle plantarflexion
- stj inversion
Amyotrophic lateral scoliosis
- motor neurons die causing symmetrical weakness from distal segments to proximal central
- orthotic management is to support and prevent contractures
complete vs incomplete fracture
complete fracture- 2 distinct fragments from fractured sites
incomplete- still some continuity of the bone at fracture site.
Orthotic goals for SB
- prevent deformity
- correct a deformity
- assist in ambulation, standing and transfers
- ulcer management
Orthotic Goals for CMT
- prevent deformity
- replace a weakened muscle
- protect unstable joints
RF varus and flexible FF valgus, what happens
Significant pronation is seen during stance. As the STJ begins to pronate the MTJ becomes mobile causing even more pronanation an dmaking the FF valgus flexible
Callus formation on the 1st and 2nd MH
Supination during toe off is achieved by
- forward pelvic rotation of the contralateral swing limb
- adequate achilles flexibility
- metatarsal head oblique orientation
- bone interposition
Functional elements of gait
limb stability
- challenged by the height of COM
- changing body segments
Progression
- forward fall of the body
- swing limb momentum
Energy conservation
- using momentum to substitute for muscle power
- displacement of the body in all planes (determination of gait)
Knee flexion LR-MSt
Determinant of gait that conserves energy by lowering vertical displacement of the CofG during LR-MSt
Knee flexion after knee strike decreases the vertical height of the CofG by 7/16
What are the determinants of Gait
- Pelvic rotation
- Lateral pelvic shift
- Pelvic tilt
- Knee flexion (stance flexion)
- Knee motion
- foot and ankle motion
Goals of orthosis stroke patient
- correct and prevent deformity
- protect unstable joint
- maintain joint ROM
- break synergies
- improve energy conservation
- promote weight bearing/ambulation improve safety
What are the intrinsic and extrinsic causes for excess pronation
Intrinsic
- FF Varus & 5th ray
- PF 5th ray
- RF Varus
- FF valgus & 1st ray
Extrinsic
- Tibial varum
- internal tibial and femoral version
- obesity
- muscle imbalance (spastic peroneals)
- small gastrocs
- muscle spasms (eg. RA)
Initial Swing
Definition: the thigh begins to advance as the foot comes off the floor (62-75 percent)
Kinematics
- A 5 degress PF
- K 60 degrees Flexion
- H 15 degrees flex
Kinetics
- A ext PF due to weight distribution of
- K thigh advancement and tibial inertia (flex torque)
- H tibial inertia maintain hip ext torque
Muscles
- A dorsiflexors
- K biceps femoris and sartorius
- H R.F. iliacus, adductor longus, gracilis
Treatment theories for scoliosis. Essential components when fabricating, fitting/ modifying
-Stable pelvic base
outrigger or extension to implement corrective forces
- force couples
- lumbar corrective forces apply pressure on transverse processes
- thoracic corrective forces apply pressure to ribs
compression stress
shortening forces perpendicular to cross sectional areas
tensile stress
lengthening forces
shear stress
oblique external load, stress in parallel to surface
young’s modulus
measurement of the slope of stress strain curve, in a measurement of the elastic deformation stage and in a measurement of stiffness
what are true/false and floating ribs
true- direct articulation (1-7)
false- indirect articulation (8-10)
floating- no articulation (11-12)
what does intercostal space contain
muscle fascia, vessels and nerves
femoral neuropathy
loss of function
spinal nerve and curves pass through
intervertebral foramina
axial skeleton
skull, spine, ribs sternum manubrium
appendicular skeleton
shoulder girdle, pelvic gridle and limbs
fibrous capsule
circumferential and encapsulates the entire acetabular rim and femoral neck. stabilizes the joint
acetabular labrum
surrounds the acetabulum and increases surface area of the socket but sacrifices mobility
acetabular labrum
surrounds the acetabulum and increases surface area of the socket but sacrifices mobility
transverse ligament
bridges the acetabular notch
ischiofemoral ligament
posterior
O: body of the ischium
I: medial to GT
Prevents extension and internal rotation
Intertrochanteric crest vs intertrocanteric line
crest is posterior
line is anterior
both connect the GT to the Lesser T
Iliofemoral ligament
Anterior
O: anterior inferior iliac spine
I: intertrochanteric line
Prevents extension and adduction
Pubofemoral ligament
Inferior medial
O: iliopubic eminence
I: inferior neck of the femur
Prevents abduction and some extension
Rib humb
Prominence of the ribs on the convexity side of the curve due to vertebral rotation and is measured by the forward bend test (Adams)
FF valgus
forefoot wrt to the rearfoot in an everted position
compensation
- STJ supination (LR-MSt) to bring the lateral side of the foot down
- callus formation is on the 1st and 5th MH
uncompensated
-BW on the medial aspect of the foot
complications
-lack of shock absorption and knee pain
Spina bifida
neural tube defect resulting in malformation of the neural tube. results in impairments below the lesion level. UPPER and LOWER
Cystica myelomeningocele
meninges and S.C protrude through the spinal column in a cystic sac. accompanied by neural deficit below the lesion level
cystica meningocele
meninges protrude through the spinal column while the spinal cord remain intact
occulta
meninges and SC remain intact. dimple and small tuft of hair are the only symptoms
Terminal Swing
the knee extends the limb to prepare to contact the ground for initial contact
Kinematics
A- Neutral
K- 5 degrees flexed
H- 20 degrees flexed
Kinetics
A- int df moment
K- tibial momentum causing external extension moment
H- tibial momentum causing external hip flexor moment
Muscle
A- dorsiflexors
K- quads
H- hamstrings decelerate and gluteals prepare for IC in frontal plane
Terminal Stance
forefoot provides the locker where the feet and limb move forward to allow progression of the stance limb
Kinematics
A- 10 degrees DF
K- 5 degrees F
H- 20 Extend
Kinetics
A- anterior
K- Anterior
H- Posterior
Muscle
A- PF, Tib post, Peroneals
K- Biceps Femoris
H- Illiofemoral Ligament, TFL
List ways to measure maturity and growth remaining for scoliosis patient
- riser sign
- Menarch 2 years after left of growth
- wrist bone
- vertebral epiphysis
Mid Swing
The thigh continues to advance and the knee begins to extend
Kinematics
A- Neutral
K- 25 degrees Flexed
H- 25 degrees Flexed
Kinetics
A- internal DF moment
K- tibial momentum creating knee extension moment
H- tibial momentum creating hip flexor moment
Muscles
A- DF
K- extension controlled by hamstring
H- controlled by hamstring
ligaments of the vertebral column
Anterior Longitudinal- Posterior Longitudinal Interspinous Intertransverse Supraspinous Ligamentum Nuchae Ligamentum Flavum
