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Unit 17 > Orthotics > Flashcards

Orthotics Flashcards

1
Q

what are the three main components of the definition of an orthosis

A

restrict motion

assist motion

transfer load

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2
Q

what are the four purposes of an orthosis

A

Stabilize a joint

Assist with movement of a joint

Protect a joint

Prevent deformity or injury

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3
Q

if someone is given an orthosis due to hx of injury of predicted deterioration which one of the four purposes of orthotics is this part of?

A

protect joint: this also includes post injury

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4
Q

explain three point pressure system

A

proximal and distal forces going the same way

middle force going the opposite way

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5
Q

if a three pressure point orthosis on the knee has its middle force directed in the medial direction is the brace offloading medially or laterally?

A

offloading the medial side!

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6
Q

what happens if you lengthen the orthoses

A

the lever arm of the orthoses grows so therefore the greater the offloading forces will be

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7
Q

according to janet is meniscal soft tissue or joint pathology

A

joint

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8
Q

give two examples of LMN pathology that may need bracing

A

ALS, peripheral nerve injury

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9
Q

what is a key part of the funcitonal assessment?

A

trial an orthosis early! Make sure you look at gait, balance, functional mobility with AND without orthoses

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10
Q

Name the 5 key areas of PT examination for someone who may need an orthoses

A

AROM, PROM: extremities and spine

jt integrity : mobility, stability, laxity

Tone: spasticity

Sensory integrity: superficial and deep

Integumentary integrity: skin quality, edema

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11
Q

what is one diagnoses you really want to look at integumentary integrity with?

A

pts on dialysis bc they will have fluctuating edema that will really effect the fit of the orthoses

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12
Q

who does implimenting the POC involve

A

you as the PT: make recommendation to physician and orthotist

physician: helps prescribe
orthotist: helps prescribe and modifies orthoses

patient and family: donning, wear schedule, skin checks, care, follow up

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13
Q

why might you order someone an articulating AFO but lock it?

A

maybe they can’t tolerate jt motion at this time, but w/their prognosis you believe they will so you want to give them that option.

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14
Q

portion of the orthosis that comes in contact w/the limb

A

interface: can be many different materials (plastic, leather, metal, fabric, carbon graphite)

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15
Q

what is the function of the interface

A

distribute forces onto the limb

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16
Q

what does janet say that should be true of joints of orthoses?

A

should be as close as possible lined up with the natural joint

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17
Q

what is the word for things that support or link the interface or attach components to one another?

what kind of material are they

A

structural components

plastic or metal

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18
Q

an orthosis can really help influence what on the body?

A

TKA: trochanter-knee ankle relationship/alignment

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19
Q

name the three external forces your body is always dealing with

A

gravity
inertia
GRF

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20
Q

define GRF

A

the force the ground is exerting on your body and is equal and opposite to how much your body is pushing into the ground

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21
Q

name the two internal forces

A

muscular

inert tissue

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22
Q

GRF is anterior to the knee whats the external moment

A

extension

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23
Q

GRF is anterior to the hip whats the external moment

A

flexion

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24
Q

GRF is posterior to the ankle whats the external moment

A

PF

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25
Q

what is the primary function of an AFO

A

control motion @ ankle and foot by limiting motion: DF, PF, inversion, eversion

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26
Q

what are the two motions that AFO’s can assist with

A

PF assistance for push off

DF assistance for swing clearance

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27
Q

allowing PF at the orthoses stabilizes the knee by giving what kind of moment?

A

EXTENSION

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28
Q

limiting PF reduces what at the knee

A

recurvarum

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29
Q

limiting DF stabilizes the knee into what?

A

extension

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30
Q

what is a MAFO

A

molded AFO: east coast thing for plastic AFO

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31
Q

what AFO material is really good at edema fluctuations, good for someone with poor sensation and needs a lot of control for spasticity?

A

metal! Also they’re very heavy duty which is great for durability but a con is that its very heavy

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32
Q

what AFO material makes the orthoses shoe dependent and has poor cosmesis

A

metal: also heavy

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33
Q

poor sensation/skin integrity
fluctuating edema
severe spasticity
heavy duty user

all all indications for what material AFO?

A

metal

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34
Q

why is a unilateral upright typically used?

A

just to keep it lighter for someone who doesn’t need quite as much stability (double vs. single shouldn’t really impact alignment too much)

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35
Q

where do most stirrups attach?

A

to the shoe

most common is the solid

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36
Q

the longer the foot plate part of the stirrup what does this mean for the pt

A

they would give the pt more control: extending the lever arm

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37
Q

true or false: joints on orthoses always allow motion

A

false: can limit motion through stops or assist with motion as well

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38
Q

what motion does a posterior stop reduce at the ankle?

A

PF

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39
Q

what is a posterior stop primarily used for?

A

clearance, doesn’t allow foot drop through limiting PF

also limits recurvatum

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40
Q

what is a DF stop primarily used for?

A

preventing knee buckling

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41
Q

DF assist is generally through what mechanism

A

spring compressed at heel strike to assist w/clearance during swing

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42
Q

what is the proper location for a T strap?

A

outside the bar!

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43
Q

how are T straps named?

A

by attachment location to shoe

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44
Q

Medial t-strap corrects what in terms of midfoot and hindfood motion

A

midfoot: pronation
Hindfoot: calcaneal valgus

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45
Q

lateral t-strap corrects what in terms of midfoot and hindfoot motion?

A

midfoot: supination
Hindfoot: calcaneal varus

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46
Q

name 6 advantages to MAFO’s

A

remember they’re plastic

  • cosmesis
  • lighter weight
  • more flexible
  • more choices for joints
  • BETTER ML CONTROL. MADE TO BE FULL CONTACT.
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47
Q

what is a precaution of a MAFO?

A

remember they’re plastic so poor skin integrity and decreased sensation

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48
Q

Name three disadvantages of MAFO’s

A

poor skin integrity is a precaution

less durable

high tone makes it difficult to control

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49
Q

what is the ankle set at in a solid AFO

A

predetermined angle and is NOT adjustable

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50
Q

Motion in a solid AFO is controlled by what three things?

A

rigidity of the plastic: chemical composition, thickness, reinforcements

trim lines

reinforcement

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51
Q

the more anterior the trim the more or less resistance?

A

the more anterior the tim line the MORE resistance/rigidity

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52
Q

where are the trim lines for these three kinds of solid AFO?

leaf spring
Rigid
Semi-rigid

A

leaf spring: posterior to malleoli therefore the least rigid/resistant

Rigid: anterior to malleoli therefore the most rigid/resistant

Semi-rigid: at malleoli

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53
Q

Ground reaction MAFO is primarily used with what population?

A

peds

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54
Q

what is the best choice in orthotic for isolated drop foot?

A

PLS (posterior leaf spring) : reduced trim lines for minimal rigidity, controls DF for swing, NO knee control, no need to control tone.

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55
Q

what is the purpose of a MAFO with flange

A

control eversion or inversion depending on where the flange is

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56
Q

Medial flange controls what motion?

A

everion/pronation

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57
Q

lateral flange controls what motion?

A

inversion/supination

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58
Q

what is the purpose of PTB?

A

limit amount of wt. transmitted through the foot

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59
Q

what is an anterior AFO used for?

A

isolated foot drop

We dont like this as much as a PLS for isolated foot drop because the anterior AFO allows some slipping of the foot in the shoe with gait which we don’t want

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60
Q

what is a pro of anterior AFO even if we don’t love it?

A

light weight
comfortable
can interchange shoes easily

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61
Q

what two materials are the articulations of orthoses made of?

A

plastic or metal

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62
Q

three advantages of the articulating AFO vs. solid for the correct patient

A

allow pt to use available ROM and strength

improve functional mobility

more ptions for assisting muscle groups

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63
Q

if your pt can handle is what kind of AFO should you be shooting for material wise and joint wise?

A

plastic

articulating

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64
Q

what is the major disadvantage to articulating MAFO’s vs. solid?

A

you have to blow out the lateral and medial malleoli to make a joint, so if someone really needs this stability they’re not going to be able to use an articulating AFO

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65
Q

what is a better choice for a flaccid limb or clonus? articulating or solid MAFO?

A

solid! need to give them support/stability into DF

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66
Q

what are the two functions you want to think about when you are picking a AFO joint?

A

stops and/or assists

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67
Q

name some characteristics of the Klenzak

A

Metal joint
single channel
posterior spring loaded
DF assist

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68
Q

what is the huge advantage and huge disadvantage of dual channel?

A

advantage: very adjustable, you can do whatever you want with the two channels to change the assist etc.
disadvantage: weight

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69
Q

Gillette/Tamarack joint provides what?

A

DF assist

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70
Q

what are the disadvantages of Gillette/Tamarack jt?

A

rubber band gets stretched

poor ML control

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71
Q

true or false, stops are always part of the joint itself?

A

false! they can be external as well

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72
Q

anteiror stop does what

A

limits DF, controls knee buckling

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73
Q

posterior stop does what?

A

limits PF, controls toe clearance and knee recurvatum

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74
Q

what is the biggest advantage of carbon fiber?

A

light weight!!

another big advantage is because of the foot plate you can use custom orthotics with it, you can’t do so with a plastic AFO bc its molded to your foot.

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75
Q

What orthoses is a poor choice for extreme spasticity, large calves, tall individuals, PF contracture, poor sensation

A

Carbon fiber

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76
Q

what are carbon fiber othroses mostly used for?

A

foot drop

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77
Q

are carbon fiber generally custom or off the shelf?

A

Off the shelf therefore they fit in most shoes

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78
Q

Ypsilon carbon fiber promotes what?

A

free ML and rotational ankle movements, someone who has a lot of ankle instability you’re not putting them in this.

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79
Q

what are shoe lifts mostly used for

A

lift on the uninvolved side to help with clearance on the involved side

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80
Q

toe glide definition

A

take leather on the top of the shoe so if they catch it it will slide rather than catch

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81
Q

COM moves in a what path?

A

sinusoidal

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82
Q

how many planes of motion is normal gait in?

A

three

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83
Q

smoother the path of COM = what for the energy expenditur?

A

less

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84
Q

normalizing gait deviations will decrease or increase energy expenditure?

A

decrease!

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85
Q

what does the evidence say for AFO vs. no AFO for s/p CVA

A

supported use of AFO

gains are greater for individuals w/ greater deficits and slower speeds

86
Q

what two things were there mixed findings with for use of orthoses?

A

gait symmetry
BOS

gait speed, energy of gait, endurance, balance, and confidence all noted improvement

87
Q

carbon fiber AFO vs. MAFO vs. no orthoses gait improvements

A

either type of AFO results in gait improvements over no AFO

88
Q

What does research suggest the timing of AFO’s should be

A

early use of AFO (while in IP) results in more improvement in

gait spatiotemporal parameters
6MWT
FIM

This means 3 weeks -6 months post CVA

89
Q

MAFO vs. carbon fiber vs. anterior AFO, which one has best results in general

A

MAFO

90
Q

what kind of pt is more likely to make greater gains from use of AFO?

A

more involved

91
Q

swedish knee cage is not indicated when?

indicated for who?

A

if knee buckling is a concern

indicated to prevent hyperextension

92
Q

how does a swedish knee cage work?

A

three point pressure system

93
Q

4 key biomechanical principles for orthoses

A

1) pressure distribution
2) equilibrium (3 point pressure)
3) lever arm principle
4) GRF and jt moments

94
Q

pressure = _____/______

A

pressure = force/area

95
Q

what is the point of the three point pressure system

A

achieving equilibrium around the joint

96
Q

to force knee into extension where are the three pressure points?

A

two posterior

one anterior

97
Q

what is the lever arm principle

A

the farther you are from the joint/axis of rotation the less force is needed to control it

98
Q

is a longer or shorter brace better for the lever arm principle

A

longer ones! more distance from the axis of rotation!

99
Q

name two times when GRF is the largest in the gait cycle

A

loading and push off

100
Q

if the GRF is lateral to the hip is that an ABD or ADD force?

A

ABD

101
Q

if the GRF is medial to the ankle is that a inversion or eversion moment?

A

inversion

102
Q

when the GRF is closer to the axis is the moment greater or less than if it were farther

A

less

103
Q

moment = _____x_____

A

moment = force x distance

104
Q

if your pt comes in with a brace but it is still not controlling the joint enough, what change cna you succest

A

employ lever arm rules: make the brace longer to control movement better

105
Q

if your pt comes in with an orthoses and their motion is controlled but they complain of pain at the points of contact what can you do/

A

increase the surface area of the pads

DO NOT CUSHION

106
Q

what is the major goal of KAFO

A

stability of the knee in all planes: extension, flexion, valgus, varus

107
Q

are KAFO’s common, why or why not?

A

they are uncommon

high rejection rate

108
Q

what level brace is normally used with polio and post polio, femoral nerve palsy, SCI?

A

KAFO

109
Q

if someone has knee instability into valgus or varus what level brace is used?

A

KAFO

110
Q

most proximal and distal forces act in the same direction as the what?

A

buttresses or posts

111
Q

other than genu recuvatum, varus valgus defomrities, or specific disease states, when are KAFO’s used

A

protection for healing tissue structures (force attenuation, restriction of joints)

femoral and tibial fx
inert tissue damage

112
Q

traditional double upright KAFO is made of what material?

A

metal

113
Q

what is the advantage of a hybrid or plastic KAFO

A

lighter

114
Q

an all plastic KAFO has what kind of shell?

A

supracondylar shell

115
Q

what are the 3 functions of the uprights?

A

redistribute load from distal components to proximal

provide M-L stability

CONNECT

116
Q

True or false: its okay if the metal uprights touch the pts skin?

A

FALSE! the bands and cuffs should be the only thing touching the pts skin

117
Q

the bands and shell are considered the ____ of the orthosis

A

interface: they are what contacts the skin

Generally there are two above the knee and one below it

118
Q

what is the purpose of the interface of KAFO’s?

A

distribute force throughout the limb

119
Q

shoe becomes part of the what for a metal brace?

A

interface!

120
Q

There are normally how many bands on a metal KAFO, where?

A

3 bands
2 above the knee: proximal and distal thigh

1 on calf: anterior or posterior

121
Q

bands on a metal KAFO are the equivalent of what on a plastic KAFO?

A

shell! for plastic the whole thing is the interface

Can be tibial or thigh shell

122
Q

what is the point of the weight bearing brim?

A

unload the distal limb by wt. bearing proximally

123
Q

there is a strap on the lateral upright of the KAFO, which then wraps around the knee. Is it attempting to control varus or valgus?

A

valgus

124
Q

What population are scott craig KAFO’s used in?

for what purpose

A

T4 and below paraplegics

wt. bearing upright, normally not a ton of mobilizing due to not allowing reciprocal gait pattern

125
Q

what is the big deal with RGO’s

A

reciprocal gait for T4 and below population

126
Q

what are major problems with traditional KAFO’s

A

heavy

their indicated in our weaknest patients and you need a ton of proximal functional strenght

there is poor motion except forward

longer term users have crazy UE problems.

127
Q

what does the stiffness of the shank on a shoe tell you?

A

how flexible it will be

128
Q

what is the vamp of the hshoe

A

up until the lacing

129
Q

what is the counter of the shoe

A

it cups the heel: you want this to be snug!

130
Q

who are extra depth shoes commonly used for (toe box and vamp is super high)

(also used in conjunction with custom molded orthoses)

A

pts with neuropathy: so their feet with deformities are not all squished in there

131
Q

what is the proper fit for a shoe in terms of the toe box and the persons oot

A

1/2 margin btwn end of the longest toe and end of toe box

132
Q

what do you have to think about shoe wise for AFO and KAFO’s?

A

proper heel height bc this will affect the entire alignment of the leg/brace

133
Q

internal vs. external shoe modification

A

internal = the shoe itself

external = sole of the shoe

134
Q

what is the major purpose of shoe modificaitons

A

accomodate for fixed deformities or fix flexible deformities

also transfer forces from insensate areas and modify weight transfer patterns

135
Q

what are the two major internal shoe modifications

A

lifts or heel wedges

padding

136
Q

what are you generally accommodating for with the heel lift?

A

PF contracture: w/o the lift youll get excessive pressure at the forefoot and maybe an ulcer

137
Q

why would you put padding at the tongue

heel counter?

A

tongue: to stop the persons foot from sliding in the shoe when they may not feel that happen

heel counter: cups the heel and we want it snug

138
Q

what is commonly used to treat metatarsalgia?

A

metatarsal pad: placed just proximal to the met heads

139
Q

where are metatarsal pads placed

A

just proximal to the met heads

140
Q

what is the purpose of metatarsal pads

A

shift weight from met heads to the shaft

141
Q

if you are using a medial wedge in a shoe for a FLEXIBLE deformity what are you trying to correct

A

overpronation

142
Q

if you are using a medial wedge in a shoe for a FIXED deformity what are you trying to correct

A

supination: bring the floor to them

143
Q

relief or grinding is an external or internal shoe modification

A

internal: to the shoe itself (even though that can be the sole)

144
Q 
lift 
metatarsal bars
wedge
heel flare
extra depth shoes

internal or external shoe modifications?

A

external: talking about the SOLE

145
Q

what is a ipsilateral lift used for

A

accomodate for leg length discrepancy

146
Q

> 3/8 shoe lift goes where?

A

outside the shoe

anything smaller than this can go inside the shoe

147
Q

what is a contralateral lift used for

A

limb clearance

148
Q

what is the purpose of a metatarsal bar? (placed proximal to the met heads)

A

unweight the met heads

149
Q

how is the metatarsal bar always oriented

A

on an angle because our met heads change as you move along the foot. more distal on the first ray, more proximal on the fifth

150
Q

if someone has a rearfoot varus would you use a medial or lateral wedge?

A

medial

151
Q

if someone has a forefoot varus would you use a medial or lateral wedge

A

medial

152
Q

lateral flare resists inversion or eversion

A

inversion

153
Q

medial flare resists inversion or eversion

A

eversion

154
Q

what is the purpose of a heel flare

A

added to the sole of the shoe to stop ML movement

155
Q

buttress vs. flare

A

buttress is more aggressive: sole extends to the counter

156
Q

what is different about SACH heels (external modification)

A

they make the heel compressible rather than blocking motion:

For shock attenuation!

157
Q

what shoe modification is used for shock attenuation

A

SACH heels

158
Q

lateral SACH heel allows what motion

A

supination(remember its squishy not a block of motion)

159
Q

medial SACH heel allows what motion

A

pronation (remember its squishy not a block)

160
Q

who are rocker bottoms used with

A

ankle fusion, allows smooth transfer of motion

161
Q

Pronation is

rearfoot: valgus/varus
forefoot: valgus/varus

A

rearfoot: valgus
forefoot: varus

162
Q

supination is

rearfoot: valgus/varus
forefoot: valgus/varus

A

rearfoot: varus
forefoot: valgus

163
Q

these three things are what

1) support or balance the foot to prevent need for compensation
2) provide shock absorption to redistribute pressures (common in diabetics)
3) plantar pressure relief

A

goals of foot orthotics

164
Q

orthotics are described by what three things

A

Physical properties: soft, semiridig, rigid

Fabrication: molded, nonmolded

goal: accomodating, corrective

165
Q

What is the main purpose of a semirigid orthotic

A

control motion

166
Q

What is the main purpose of a rigid orthotic

A

CORRECT FLEXIBLE DEFORMITY

167
Q

what is the main purpose of a soft orthotic

A

shock absorption and controlling abnormal ML motion

168
Q

is there evidence that foot orthotics correct proximal problems?

A

yes! effect moments on the knee and hips and reduce low back pain

169
Q

Scenario:47 yo with DM x15 years. He has limited DF to neutral. Heavy callous under 2 nd Metatarsal head with recent history of ulceration. Hallux valgus and curl toe deformity.

What do you give him?

A

Extra depth: large enough toe box and vamp because he has toe deformity

Want to redistribute forces because he has 2nd met head pain and limited DF: SOFT we want to distribute forces

Heel lift: because want to accommodate his contracture

Modification to the sole of the shoe: unweight the met heads. ROCKER BOTTOM, OR METATARSAL BAR

Any diabetic patient with neuropathy should have an orthotic

170
Q 
four functions of spinal orthoses
\_\_\_\_\_\_ support 
\_\_\_\_\_\_\_ control
spinal \_\_\_\_\_\_\_\_
partial weight transfer of the \_\_\_\_ to the \_\_\_\_\_ when upright
A

TRUNK support

MOTION control

Spinal RE-ALIGNMENT

partial wt. transfer of the HEAD to the TRUNK when upright

171
Q

true or false: bracing is more effective than exercise in scoliosis for prevention of deformity

A

true!

172
Q

what is the conclusion on the evidence for spinal orthoses in general?

A

lacking evidence for prophylatic, or post-fracture use

173
Q

What motion are cervical orthoses most effective at limiting.

then what?
least amount limiting?

A

flexion and extension

then side bending

then rotation

174
Q

TLSO most effective in controlling what motion

A

flexion and extension

then sidebending

then rotation

175
Q

all TLSO’s use what system and support the abs

A

3PPS

176
Q

true or false: TLSO’s purposefully have pressure on bony prominences to remind the pt to maintain posture

A

true

177
Q

chairback LSO controls what?

A

sagittal and frontal plane motion

178
Q

William hyperextension LSO controls what?

A

flexion and frontal motion

179
Q

when are clamshells most often used

A

SCI

Spinal fracture, scoliosis

180
Q

what kind of contact are clamshells?

A

total contact & custom molded so they have good control

181
Q

what is the recommended wear time for a Milwaukee brace

A

20 hours a day

182
Q

is Milwaukee brace or exercise shown to have better outcome at preventing deformity?

A

milwaukee brace

183
Q

what is UCLB designed to correct

A

hindfoot valgus

limit subtalar motion

184
Q

what does SMO limit

A

subtalar motion and midfoot pronation

185
Q

Stirrup brace resists what?

commonly used in what population

A

inversion

ankle sprains

186
Q

what population are lace up braces typically used in?

A

posterior tib dysfunction

severe ankle instability

USED TO STOP INVERSION/EVERSION

187
Q

Elastic supports used for what?

A

not much: not effective in limiting motion

188
Q

where is the evidence for ankle orthoses

A

post grade III ankle spain

rigid brace for posterior tib dysfunction

189
Q

when is CAM boot used

A

post grade III sprain

post surgical to protect incision site

post fracture

190
Q

true or false: there is support for prophylactic knee bracing?

A

false! actually increases risk of proximal or distal injury

instead focus on identifying risk based on individuals and train/strengthen

191
Q

what population are dial knee joints used in

A

post total joint replacement

post fracture

used for changing functional situation

192
Q

what is the deal with polycentric knees?

A

follows normal axis of rotation therefore a changing axis

193
Q

what are functional knee orthoses used for?

is there good evidence?

A

return to activity

prevent small movements but not large or ballistic movements, and little evidence to support prevention or re-injury

194
Q

unloading braces are used for who

are they effective?

A

OA

yes they are effective

195
Q

Are patellofemoral orthoses good at assisting with tracking problems/keeping patella within the trochlear groove?

A

nope, inconsistent evidence

196
Q

dynamic ROM braces are designed for what?

A

treatment of flexible knee contractures

197
Q

Match
Accomodate
Correct/fix

Fixed
Flexible

A

accomodate: fixed (soft orthoses)
correct: flexible (rigid orthoses)

198
Q

soft foot orthosis used for fixed or flexible deformity?

A

fixed: they’re accomodative!

199
Q

rigid foot orthosis used for fixed or flexible deformity

A

flexible: they’re trying to correct

200
Q

first priority for orthotic prescription

2nd?

A

1st: safety
2nd: less is more, give them the least amount of bracing they need to be safe

201
Q

what are three things you need to determine for an orthotic prescription

A

what level: AFO, KAFO

what material: plastic or metal

Specifics

202
Q

is metal or plastic always the preferred choice

A

plastic: unless its contraindicated use it!

203
Q

name all the things you can that would make you want to pick a metal brace over a plastic one

A 
insensate
fluctuating edema
high tone
decreased skin integrity/wound
heavy duty user
204
Q

does metal or plastic have better ML control at the ankle

A

plastic

205
Q

characteristics of articulating AFO

A

allow pt to use available ROM

Can improve function

greater adjustability

Heavier

more difficult to fabricate

206
Q

characteristics of solid AFO

A

lighter

more ML stability

less maintenance

better control of knee instability

less expensive

207
Q

are solid or articulating AFO’s heavier?

A

articulating

208
Q

if you’re talking about a solid AFO having min, mod or max resistance what are you really talking about

A

where the trim lines are

209
Q

if you don’t have full extension what lock cant you use

A

drop and bail locks

210
Q

if your pt hips/pelvis is not stable in the sagittal plane what kind of brace are you going to use?

what level orthosis
how many axis
lock?

A

HKAFO

SINGLE axis: allows for only flexion and extension

LOCKED!

Unit 17 (9 decks)

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