Orthotics and Prosthetics Flashcards
Cervical Orthotics (4)
Halo: tri-planar MAX stabilization (90-95% immobilization)
Cervical orthosis w/ thoracic extension (SOMI or Lerman Minerva)
Semi-rigid: some stability, support and alignment
Soft: kinesthetic reminder
Lumbosacral Orthotics (3)
Knight: coronal and sagittal plane restrictions; decreases LL
Chairback: sagittal restriction and decreases LL
Corset/Flexible: kinesthetic reminder
Thoracolumbosacral Orthotics (4)
Rigid: Max immobilization w/o surgical intervention; restricts sagittal, coronal and transverse plane motions
Knight-Taylor: restricts coronal and sagittal plane, decreases LL, facilitates thoracic extension
Jewett Hyperextension: restricts TL flexion w/ minimal coronal plane restriction
CASH Hyperextension: restricts TL flexion and facilitates thoracic extension
Scoliosis Orthotic Requirements (3)
- Skeletal immaturity
- Curve between 20-40 degrees
- Documented progression
Types of Orthotics for Scoliosis
Worn 24/7:
- Boston Brace - gold standard for adolescent curves
- Milwaukee - for upper T & C curvatures
Worn only at night:
1. Charleston bending brace - for smaller, more flexible curves
Intrinsic Plus Position
MCP flexion, DIP/PIP extension, wrist extension (slight to 40deg) and thumb palmarly abducted
The extensor mechanism for the MCP’s is at risk for contracture and is more detrimental to function, which is why they are not allowed to be on slack w/ the MCP flexion; same goes for the PIP/DIP flexor tendons
Functional Hand Splint Position
wrist 20-30deg extension, thumb palmarly abducted, MCP 15-20deg flexion and IP’s slight flexion
PRAFO
pressure relieving and contracture prevention; not meant for WBing
SMO/DAFO
tone management in kids
provides fore-mid and rearfoot stabilty while allowing for PF and DF
Ground Reaction AFO
pre-tibial cuff facilitates knee extension
Tri-planar control & rigid foot plate for PF
Patellar Tendon Bearing AFO
unweights foot and heal and reduces axial loading
Solid Ankle AFO
max control in all planes of motion; trim lines ENCOMPASS malleoli
good for neurological gait (PF & inversion)
Semi-solid AFO
trim lines BISECT malleoli
minimal DF and M/L stability
Posterior Leaf Spring AFO
stores energy to assist w/ DF
Articulated AFO
PF stop - posterior channel pin - PF contracture or weak DF’s
DF stop - anterior channel pin - weak plantarflexors
DF assist - posterior channel spring - weak DF/toe drag
Metal Upright AFO
max stabilization provided; good for those who cant tolerate plastic
BUT comes w/ additional disadvantages
Locked Knee KAFO
max stability but causes functional leg length discrepency and increased energy expenditure
Posterior Offset KAFO
easier to lock w/o having to lean trunk as far forward; indicated if quads are weak
Stance Control
-requirements & contraindications
allows for stability during stance and knee flexion during swing, but these are larger and more expensive
Requirements: cognitive function & hip/knee flexion strength greater than 3/5
Contraindications: knee flexion contracture >10degrees, spasticity, uncorrectable varus/valgus >15deg, poor balance and ataxia
Gait w/ PF/DF stop or assist
PF stop = knee flexion moment at IC to reach foot flat
- a 0deg stop is > flexion moment than a 5deg stop
DF stop - knee extension moment in MS/TS
DF assist = foot forced into DF during swing phase
Ideal Residual Limb length
- transtibial and transfemoral
- what happens when it is shortened
Transtibial = 6-8 inches below patellar tendon
–> when residual limb shortens: decreased SA for WB, increased pressure, increased energy expenditure, increased discomfort
Transfemoral = 3 inches above knee
–> when residual limb shortens: decreased SA for WB, decreased stability due to loss of adductors, increased discomfort
Transtibial Socket Designs(4)
- Patellar tendon bearing - compresses PT and popliteal region
- Total contact - dissipates forces over entire surface
- Supracondylar-Suprapatellar - for short limbs b/c the trim lines come above the condyles to increase knee stability
- Joint and Corset - for short limbs to utilize lateral femoral shaft
Tranfemoral Socket Designs (3)
- Ischial containment - cups the ischium to create a bony lock to decrease lateral shift out of socket during stance
- Sub-ischial: usually indicated for the obese pt
- Quadrilateral - old socket design that the ischial containment was based off of; 4 walls w/ specific function & space for rectus muscles to grow w/o too much compression
Suspension Mechanisms (3)
- Roll on gel liner w/ pin
-disadv: socket may “fall off” during swing
OR roll on gel liner w/ suction
-disadv: difficult to put on if weakened grip - Anatomical suspension & cuffs: indicated for short residual limbs (transtibial) b/c socket is formed around condyles w/ a strap to secure it on
- disadv: must have adequate strength to secure strap - Skin fit suction (transfemoral b/c fewer bony structures): allows for good proprioception b/c skin directly in contact with the socket
K and F Levels
K - for foot/ankle
F - for knee
0 - no ability to ambulate or transfer; prosthetic device not medically necessary
1 - ability to amb/transfer on level surfaces at a fixed cadence
2 - ability to amb/transfer w/ low level environmental barriers at fixed cadence
3 - ability to ambulate with variable cadence
4 - no limitations; ability of ambulation that exceeds basic ambulation skills
SACH vs. Single Axis Foot
SACH = solid ankle cushion heel
- most basic foot; usually for transfers only
- disadv: dangerous knee flexion moment due to stiff heel
Single Axis
- decreased flexion moment and allows for slightly more mobility
- disadv: rapid foot flat, increased weight
**indicated for K/F 1 level patients
Multi-axial vs. Flexible Keel Foot
Flexible keel
- simple and basic, similar to SACH but allows for more mobility and inv/ev to accomodate to terrain
Multi-axial
- accomodates to terrain, allows for ALL planes of motion and decreases shearing forces
- disadv: low level
**indicated for K/F 2 level patients
Energy storing, dynamic response, flex foot and flex walk
Energy storing was the first foot to allow for variable cadence, now considered lower level than others
Flex foot/walk has the “J” shape
**indicated for K/F 3-4 level patients
Manual lock vs. Friction Knee
Manual lock
- simple design for transfers only
- disadv: knee will not collapse if patient falls, must manually lock
Friction knee
- allows for transfer and limited walking, acts as a “door hinge”
- disadv: increased maintenance, one speed
**indicated for K/F 1 level patients
Stance Control Knee
allows for mobility on low level terrain by providing support during stance
- added stability if patient missteps, light weight
- disadv: increased maintenance, increased gait deviations
**indicated for K/F 2 level patients
Hydraulic vs. Microprocessor Knee
Hydraulic:
- adv: less cost, increased lifespan, decreased weight, better control/use of muscles during gait
- disadv: increased mechanical adjustments
Microprocessor:
- adv: increased stumble recovery, slightly higher level of function
- disadv: shorter lifespan, increased cost and weight
**indicated for K/F 3-4 level patients
Pressure Tolerant areas for Transtibial Prosthetic Socket
- Patellar tendon
- lateral shaft of femur
- Pre-tibial areas (ant. tib and medial tibial flare)
- Gastroc
Pressure INtolerant areas for Transtibial Prosthetic Socket
- Fibular head
- Distal end of tib/fib
- Hamstring tendons
- Tibial crest (shin)
- distal aspect of patella
