Orthotics Flashcards
1
Q
what are the three main components of the definition of an orthosis
A
restrict motion
assist motion
transfer load
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
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
4
Q
explain three point pressure system
A
proximal and distal forces going the same way
middle force going the opposite way
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!
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
7
Q
according to janet is meniscal soft tissue or joint pathology
A
joint
8
Q
give two examples of LMN pathology that may need bracing
A
ALS, peripheral nerve injury
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
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
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
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
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.
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)
15
Q
what is the function of the interface
A
distribute forces onto the limb
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
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
18
Q
an orthosis can really help influence what on the body?
A
TKA: trochanter-knee ankle relationship/alignment
19
Q
name the three external forces your body is always dealing with
A
gravity
inertia
GRF
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
21
Q
name the two internal forces
A
muscular
inert tissue
22
Q
GRF is anterior to the knee whats the external moment
A
extension
23
Q
GRF is anterior to the hip whats the external moment
A
flexion
24
Q
GRF is posterior to the ankle whats the external moment
A
PF
25
what is the primary function of an AFO
control motion @ ankle and foot by limiting motion: DF, PF, inversion, eversion
26
what are the two motions that AFO's can assist with
PF assistance for push off
DF assistance for swing clearance
27
allowing PF at the orthoses stabilizes the knee by giving what kind of moment?
EXTENSION
28
limiting PF reduces what at the knee
recurvarum
29
limiting DF stabilizes the knee into what?
extension
30
what is a MAFO
molded AFO: east coast thing for plastic AFO
31
what AFO material is really good at edema fluctuations, good for someone with poor sensation and needs a lot of control for spasticity?
metal! Also they're very heavy duty which is great for durability but a con is that its very heavy
32
what AFO material makes the orthoses shoe dependent and has poor cosmesis
metal: also heavy
33
poor sensation/skin integrity
fluctuating edema
severe spasticity
heavy duty user
all all indications for what material AFO?
metal
34
why is a unilateral upright typically used?
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)
35
where do most stirrups attach?
to the shoe
most common is the solid
36
the longer the foot plate part of the stirrup what does this mean for the pt
they would give the pt more control: extending the lever arm
37
true or false: joints on orthoses always allow motion
false: can limit motion through stops or assist with motion as well
38
what motion does a posterior stop reduce at the ankle?
PF
39
what is a posterior stop primarily used for?
clearance, doesn't allow foot drop through limiting PF
also limits recurvatum
40
what is a DF stop primarily used for?
preventing knee buckling
41
DF assist is generally through what mechanism
spring compressed at heel strike to assist w/clearance during swing
42
what is the proper location for a T strap?
outside the bar!
43
how are T straps named?
by attachment location to shoe
44
Medial t-strap corrects what in terms of midfoot and hindfood motion
midfoot: pronation
Hindfoot: calcaneal valgus
45
lateral t-strap corrects what in terms of midfoot and hindfoot motion?
midfoot: supination
Hindfoot: calcaneal varus
46
name 6 advantages to MAFO's
remember they're plastic
- cosmesis
- lighter weight
- more flexible
- more choices for joints
- BETTER ML CONTROL. MADE TO BE FULL CONTACT.
47
what is a precaution of a MAFO?
remember they're plastic so poor skin integrity and decreased sensation
48
Name three disadvantages of MAFO's
poor skin integrity is a precaution
less durable
high tone makes it difficult to control
49
what is the ankle set at in a solid AFO
predetermined angle and is NOT adjustable
50
Motion in a solid AFO is controlled by what three things?
rigidity of the plastic: chemical composition, thickness, reinforcements
trim lines
reinforcement
51
the more anterior the trim the more or less resistance?
the more anterior the tim line the MORE resistance/rigidity
52
where are the trim lines for these three kinds of solid AFO?
leaf spring
Rigid
Semi-rigid
leaf spring: posterior to malleoli therefore the least rigid/resistant
Rigid: anterior to malleoli therefore the most rigid/resistant
Semi-rigid: at malleoli
53
Ground reaction MAFO is primarily used with what population?
peds
54
what is the best choice in orthotic for isolated drop foot?
PLS (posterior leaf spring) : reduced trim lines for minimal rigidity, controls DF for swing, NO knee control, no need to control tone.
55
what is the purpose of a MAFO with flange
control eversion or inversion depending on where the flange is
56
Medial flange controls what motion?
everion/pronation
57
lateral flange controls what motion?
inversion/supination
58
what is the purpose of PTB?
limit amount of wt. transmitted through the foot
59
what is an anterior AFO used for?
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
60
what is a pro of anterior AFO even if we don't love it?
light weight
comfortable
can interchange shoes easily
61
what two materials are the articulations of orthoses made of?
plastic or metal
62
three advantages of the articulating AFO vs. solid for the correct patient
allow pt to use available ROM and strength
improve functional mobility
more ptions for assisting muscle groups
63
if your pt can handle is what kind of AFO should you be shooting for material wise and joint wise?
plastic
| articulating
64
what is the major disadvantage to articulating MAFO's vs. solid?
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
65
what is a better choice for a flaccid limb or clonus? articulating or solid MAFO?
solid! need to give them support/stability into DF
66
what are the two functions you want to think about when you are picking a AFO joint?
stops and/or assists
67
name some characteristics of the Klenzak
Metal joint
single channel
posterior spring loaded
DF assist
68
what is the huge advantage and huge disadvantage of dual channel?
advantage: very adjustable, you can do whatever you want with the two channels to change the assist etc.
disadvantage: weight
69
Gillette/Tamarack joint provides what?
DF assist
70
what are the disadvantages of Gillette/Tamarack jt?
rubber band gets stretched
poor ML control
71
true or false, stops are always part of the joint itself?
false! they can be external as well
72
anteiror stop does what
limits DF, controls knee buckling
73
posterior stop does what?
limits PF, controls toe clearance and knee recurvatum
74
what is the biggest advantage of carbon fiber?
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.
75
What orthoses is a poor choice for extreme spasticity, large calves, tall individuals, PF contracture, poor sensation
Carbon fiber
76
what are carbon fiber othroses mostly used for?
foot drop
77
are carbon fiber generally custom or off the shelf?
Off the shelf therefore they fit in most shoes
78
Ypsilon carbon fiber promotes what?
free ML and rotational ankle movements, someone who has a lot of ankle instability you're not putting them in this.
79
what are shoe lifts mostly used for
lift on the uninvolved side to help with clearance on the involved side
80
toe glide definition
take leather on the top of the shoe so if they catch it it will slide rather than catch
81
COM moves in a what path?
sinusoidal
82
how many planes of motion is normal gait in?
three
83
smoother the path of COM = what for the energy expenditur?
less
84
normalizing gait deviations will decrease or increase energy expenditure?
decrease!
85
what does the evidence say for AFO vs. no AFO for s/p CVA
supported use of AFO
gains are greater for individuals w/ greater deficits and slower speeds
86
what two things were there mixed findings with for use of orthoses?
gait symmetry
BOS
gait speed, energy of gait, endurance, balance, and confidence all noted improvement
87
carbon fiber AFO vs. MAFO vs. no orthoses gait improvements
either type of AFO results in gait improvements over no AFO
88
What does research suggest the timing of AFO's should be
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
MAFO vs. carbon fiber vs. anterior AFO, which one has best results in general
MAFO
90
what kind of pt is more likely to make greater gains from use of AFO?
more involved
91
swedish knee cage is not indicated when?
indicated for who?
if knee buckling is a concern
indicated to prevent hyperextension
92
how does a swedish knee cage work?
three point pressure system
93
4 key biomechanical principles for orthoses
1) pressure distribution
2) equilibrium (3 point pressure)
3) lever arm principle
4) GRF and jt moments
94
pressure = _____/______
pressure = force/area
95
what is the point of the three point pressure system
achieving equilibrium around the joint
96
to force knee into extension where are the three pressure points?
two posterior
| one anterior
97
what is the lever arm principle
the farther you are from the joint/axis of rotation the less force is needed to control it
98
is a longer or shorter brace better for the lever arm principle
longer ones! more distance from the axis of rotation!
99
name two times when GRF is the largest in the gait cycle
loading and push off
100
if the GRF is lateral to the hip is that an ABD or ADD force?
ABD
101
if the GRF is medial to the ankle is that a inversion or eversion moment?
inversion
102
when the GRF is closer to the axis is the moment greater or less than if it were farther
less
103
moment = _____x_____
moment = force x distance
104
if your pt comes in with a brace but it is still not controlling the joint enough, what change cna you succest
employ lever arm rules: make the brace longer to control movement better
105
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/
increase the surface area of the pads
DO NOT CUSHION
106
what is the major goal of KAFO
stability of the knee in all planes: extension, flexion, valgus, varus
107
are KAFO's common, why or why not?
they are uncommon
high rejection rate
108
what level brace is normally used with polio and post polio, femoral nerve palsy, SCI?
KAFO
109
if someone has knee instability into valgus or varus what level brace is used?
KAFO
110
most proximal and distal forces act in the same direction as the what?
buttresses or posts
111
other than genu recuvatum, varus valgus defomrities, or specific disease states, when are KAFO's used
protection for healing tissue structures (force attenuation, restriction of joints)
femoral and tibial fx
inert tissue damage
112
traditional double upright KAFO is made of what material?
metal
113
what is the advantage of a hybrid or plastic KAFO
lighter
114
an all plastic KAFO has what kind of shell?
supracondylar shell
115
what are the 3 functions of the uprights?
redistribute load from distal components to proximal
provide M-L stability
CONNECT
116
True or false: its okay if the metal uprights touch the pts skin?
FALSE! the bands and cuffs should be the only thing touching the pts skin
117
the bands and shell are considered the ____ of the orthosis
interface: they are what contacts the skin
Generally there are two above the knee and one below it
118
what is the purpose of the interface of KAFO's?
distribute force throughout the limb
119
shoe becomes part of the what for a metal brace?
interface!
120
There are normally how many bands on a metal KAFO, where?
3 bands
2 above the knee: proximal and distal thigh
1 on calf: anterior or posterior
121
bands on a metal KAFO are the equivalent of what on a plastic KAFO?
shell! for plastic the whole thing is the interface
Can be tibial or thigh shell
122
what is the point of the weight bearing brim?
unload the distal limb by wt. bearing proximally
123
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?
valgus
124
What population are scott craig KAFO's used in?
for what purpose
T4 and below paraplegics
wt. bearing upright, normally not a ton of mobilizing due to not allowing reciprocal gait pattern
125
what is the big deal with RGO's
reciprocal gait for T4 and below population
126
what are major problems with traditional KAFO's
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
what does the stiffness of the shank on a shoe tell you?
how flexible it will be
128
what is the vamp of the hshoe
up until the lacing
129
what is the counter of the shoe
it cups the heel: you want this to be snug!
130
who are extra depth shoes commonly used for (toe box and vamp is super high)
(also used in conjunction with custom molded orthoses)
pts with neuropathy: so their feet with deformities are not all squished in there
131
what is the proper fit for a shoe in terms of the toe box and the persons oot
1/2 margin btwn end of the longest toe and end of toe box
132
what do you have to think about shoe wise for AFO and KAFO's?
proper heel height bc this will affect the entire alignment of the leg/brace
133
internal vs. external shoe modification
internal = the shoe itself
external = sole of the shoe
134
what is the major purpose of shoe modificaitons
accomodate for fixed deformities or fix flexible deformities
| also transfer forces from insensate areas and modify weight transfer patterns
135
what are the two major internal shoe modifications
lifts or heel wedges
padding
136
what are you generally accommodating for with the heel lift?
PF contracture: w/o the lift youll get excessive pressure at the forefoot and maybe an ulcer
137
why would you put padding at the tongue
heel counter?
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
what is commonly used to treat metatarsalgia?
metatarsal pad: placed just proximal to the met heads
139
where are metatarsal pads placed
just proximal to the met heads
140
what is the purpose of metatarsal pads
shift weight from met heads to the shaft
141
if you are using a medial wedge in a shoe for a FLEXIBLE deformity what are you trying to correct
overpronation
142
if you are using a medial wedge in a shoe for a FIXED deformity what are you trying to correct
supination: bring the floor to them
143
relief or grinding is an external or internal shoe modification
internal: to the shoe itself (even though that can be the sole)
144
```
lift
metatarsal bars
wedge
heel flare
extra depth shoes
```
internal or external shoe modifications?
external: talking about the SOLE
145
what is a ipsilateral lift used for
accomodate for leg length discrepancy
146
>3/8 shoe lift goes where?
outside the shoe
anything smaller than this can go inside the shoe
147
what is a contralateral lift used for
limb clearance
148
what is the purpose of a metatarsal bar? (placed proximal to the met heads)
unweight the met heads
149
how is the metatarsal bar always oriented
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
if someone has a rearfoot varus would you use a medial or lateral wedge?
medial
151
if someone has a forefoot varus would you use a medial or lateral wedge
medial
152
lateral flare resists inversion or eversion
inversion
153
medial flare resists inversion or eversion
eversion
154
what is the purpose of a heel flare
added to the sole of the shoe to stop ML movement
155
buttress vs. flare
buttress is more aggressive: sole extends to the counter
156
what is different about SACH heels (external modification)
they make the heel compressible rather than blocking motion:
For shock attenuation!
157
what shoe modification is used for shock attenuation
SACH heels
158
lateral SACH heel allows what motion
supination(remember its squishy not a block of motion)
159
medial SACH heel allows what motion
pronation (remember its squishy not a block)
160
who are rocker bottoms used with
ankle fusion, allows smooth transfer of motion
161
Pronation is
rearfoot: valgus/varus
forefoot: valgus/varus
rearfoot: valgus
forefoot: varus
162
supination is
rearfoot: valgus/varus
forefoot: valgus/varus
rearfoot: varus
forefoot: valgus
163
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
goals of foot orthotics
164
orthotics are described by what three things
Physical properties: soft, semiridig, rigid
Fabrication: molded, nonmolded
goal: accomodating, corrective
165
What is the main purpose of a semirigid orthotic
control motion
166
What is the main purpose of a rigid orthotic
CORRECT FLEXIBLE DEFORMITY
167
what is the main purpose of a soft orthotic
shock absorption and controlling abnormal ML motion
168
is there evidence that foot orthotics correct proximal problems?
yes! effect moments on the knee and hips and reduce low back pain
169
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?
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
```
four functions of spinal orthoses
______ support
_______ control
spinal ________
partial weight transfer of the ____ to the _____ when upright
```
TRUNK support
MOTION control
Spinal RE-ALIGNMENT
partial wt. transfer of the HEAD to the TRUNK when upright
171
true or false: bracing is more effective than exercise in scoliosis for prevention of deformity
true!
172
what is the conclusion on the evidence for spinal orthoses in general?
lacking evidence for prophylatic, or post-fracture use
173
What motion are cervical orthoses most effective at limiting.
then what?
least amount limiting?
flexion and extension
then side bending
then rotation
174
TLSO most effective in controlling what motion
flexion and extension
then sidebending
then rotation
175
all TLSO's use what system and support the abs
3PPS
176
true or false: TLSO's purposefully have pressure on bony prominences to remind the pt to maintain posture
true
177
chairback LSO controls what?
sagittal and frontal plane motion
178
William hyperextension LSO controls what?
flexion and frontal motion
179
when are clamshells most often used
SCI
Spinal fracture, scoliosis
180
what kind of contact are clamshells?
total contact & custom molded so they have good control
181
what is the recommended wear time for a Milwaukee brace
20 hours a day
182
is Milwaukee brace or exercise shown to have better outcome at preventing deformity?
milwaukee brace
183
what is UCLB designed to correct
hindfoot valgus
limit subtalar motion
184
what does SMO limit
subtalar motion and midfoot pronation
185
Stirrup brace resists what?
commonly used in what population
inversion
ankle sprains
186
what population are lace up braces typically used in?
posterior tib dysfunction
severe ankle instability
USED TO STOP INVERSION/EVERSION
187
Elastic supports used for what?
not much: not effective in limiting motion
188
where is the evidence for ankle orthoses
post grade III ankle spain
rigid brace for posterior tib dysfunction
189
when is CAM boot used
post grade III sprain
post surgical to protect incision site
post fracture
190
true or false: there is support for prophylactic knee bracing?
false! actually increases risk of proximal or distal injury
instead focus on identifying risk based on individuals and train/strengthen
191
what population are dial knee joints used in
post total joint replacement
post fracture
used for changing functional situation
192
what is the deal with polycentric knees?
follows normal axis of rotation therefore a changing axis
193
what are functional knee orthoses used for?
is there good evidence?
return to activity
prevent small movements but not large or ballistic movements, and little evidence to support prevention or re-injury
194
unloading braces are used for who
are they effective?
OA
yes they are effective
195
Are patellofemoral orthoses good at assisting with tracking problems/keeping patella within the trochlear groove?
nope, inconsistent evidence
196
dynamic ROM braces are designed for what?
treatment of flexible knee contractures
197
Match
Accomodate
Correct/fix
Fixed
Flexible
accomodate: fixed (soft orthoses)
correct: flexible (rigid orthoses)
198
soft foot orthosis used for fixed or flexible deformity?
fixed: they're accomodative!
199
rigid foot orthosis used for fixed or flexible deformity
flexible: they're trying to correct
200
first priority for orthotic prescription
2nd?
1st: safety
2nd: less is more, give them the least amount of bracing they need to be safe
201
what are three things you need to determine for an orthotic prescription
what level: AFO, KAFO
what material: plastic or metal
Specifics
202
is metal or plastic always the preferred choice
plastic: unless its contraindicated use it!
203
name all the things you can that would make you want to pick a metal brace over a plastic one
```
insensate
fluctuating edema
high tone
decreased skin integrity/wound
heavy duty user
```
204
does metal or plastic have better ML control at the ankle
plastic
205
characteristics of articulating AFO
allow pt to use available ROM
Can improve function
greater adjustability
Heavier
more difficult to fabricate
206
characteristics of solid AFO
lighter
more ML stability
less maintenance
better control of knee instability
less expensive
207
are solid or articulating AFO's heavier?
articulating
208
if you're talking about a solid AFO having min, mod or max resistance what are you really talking about
where the trim lines are
209
if you don't have full extension what lock cant you use
drop and bail locks
210
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?
HKAFO
SINGLE axis: allows for only flexion and extension
LOCKED!
