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Musculoskeletal I > Orthotics and Prosthetics > Flashcards

Orthotics and Prosthetics Flashcards

1
Q

Cervical Orthotics (4)

A

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

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2
Q

Lumbosacral Orthotics (3)

A

Knight: coronal and sagittal plane restrictions; decreases LL

Chairback: sagittal restriction and decreases LL

Corset/Flexible: kinesthetic reminder

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3
Q

Thoracolumbosacral Orthotics (4)

A

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

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4
Q

Scoliosis Orthotic Requirements (3)

A
  1. Skeletal immaturity
  2. Curve between 20-40 degrees
  3. Documented progression
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5
Q

Types of Orthotics for Scoliosis

A

Worn 24/7:

  1. Boston Brace - gold standard for adolescent curves
  2. Milwaukee - for upper T & C curvatures

Worn only at night:
1. Charleston bending brace - for smaller, more flexible curves

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6
Q

Intrinsic Plus Position

A

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

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7
Q

Functional Hand Splint Position

A

wrist 20-30deg extension, thumb palmarly abducted, MCP 15-20deg flexion and IP’s slight flexion

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8
Q

PRAFO

A

pressure relieving and contracture prevention; not meant for WBing

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9
Q

SMO/DAFO

A

tone management in kids

provides fore-mid and rearfoot stabilty while allowing for PF and DF

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10
Q

Ground Reaction AFO

A

pre-tibial cuff facilitates knee extension

Tri-planar control & rigid foot plate for PF

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11
Q

Patellar Tendon Bearing AFO

A

unweights foot and heal and reduces axial loading

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12
Q

Solid Ankle AFO

A

max control in all planes of motion; trim lines ENCOMPASS malleoli

good for neurological gait (PF & inversion)

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13
Q

Semi-solid AFO

A

trim lines BISECT malleoli

minimal DF and M/L stability

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14
Q

Posterior Leaf Spring AFO

A

stores energy to assist w/ DF

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15
Q

Articulated AFO

A

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

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16
Q

Metal Upright AFO

A

max stabilization provided; good for those who cant tolerate plastic

BUT comes w/ additional disadvantages

17
Q

Locked Knee KAFO

A

max stability but causes functional leg length discrepency and increased energy expenditure

18
Q

Posterior Offset KAFO

A

easier to lock w/o having to lean trunk as far forward; indicated if quads are weak

19
Q

Stance Control

-requirements & contraindications

A

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

20
Q

Gait w/ PF/DF stop or assist

A

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

21
Q

Ideal Residual Limb length

  • transtibial and transfemoral
  • what happens when it is shortened
A

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

22
Q

Transtibial Socket Designs(4)

A
  1. Patellar tendon bearing - compresses PT and popliteal region
  2. Total contact - dissipates forces over entire surface
  3. Supracondylar-Suprapatellar - for short limbs b/c the trim lines come above the condyles to increase knee stability
  4. Joint and Corset - for short limbs to utilize lateral femoral shaft
23
Q

Tranfemoral Socket Designs (3)

A
  1. Ischial containment - cups the ischium to create a bony lock to decrease lateral shift out of socket during stance
  2. Sub-ischial: usually indicated for the obese pt
  3. 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
24
Q

Suspension Mechanisms (3)

A
  1. 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
  2. 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
  3. Skin fit suction (transfemoral b/c fewer bony structures): allows for good proprioception b/c skin directly in contact with the socket
25
Q

K and F Levels

A

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

26
Q

SACH vs. Single Axis Foot

A

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

27
Q

Multi-axial vs. Flexible Keel Foot

A

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

28
Q

Energy storing, dynamic response, flex foot and flex walk

A

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

29
Q

Manual lock vs. Friction Knee

A

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

30
Q

Stance Control Knee

A

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

31
Q

Hydraulic vs. Microprocessor Knee

A

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

32
Q

Pressure Tolerant areas for Transtibial Prosthetic Socket

A
  1. Patellar tendon
  2. lateral shaft of femur
  3. Pre-tibial areas (ant. tib and medial tibial flare)
  4. Gastroc
33
Q

Pressure INtolerant areas for Transtibial Prosthetic Socket

A
  1. Fibular head
  2. Distal end of tib/fib
  3. Hamstring tendons
  4. Tibial crest (shin)
  5. distal aspect of patella

Musculoskeletal I (11 decks)

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