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Orthotics for the Neuro Population Flashcards

1
Q

4 Factors in Decision Making for Orthoses

A

Advantages or Positive Outcomes
-How it iwll improve mobility & gait, influence tone, or protect a limb

Disadvantegs or Concessions
-How it complicates daily activity, mobility, or preferred activities. Energy cost and expnse

Indications that it’ll be Useful
-Match between the person’s caharaceristics and needs and what it provides

Circumstances/Characterstics of the Individual that make the device detrimental or contraindicated

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2
Q

Characteristics of an Ideal Orthosis

A

Maximizes stance phase stability
Minimizes abnormal alignment
Minimally compromises clearance
Maintains/reduce joint contractures

Meet individual’s mobility needs
Effectively positions for initial contact
Energy efficient

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3
Q

Orthotics:
Abnormal Joint Position

A

Orthotic will assist the ligamentous support and prevent unwanted movement from previous joint damage

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4
Q

Orthotics:
Limb Length

A

Orthotic will add a heel lift to help with unequal leg length

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5
Q

Orthotics:
Motor Control

A

Orthotic will prevent unwanted motion and assist the integumentary system

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6
Q

Orthotics:
Muscle performance

A

Orthotic will assist with endurance and weakness of the muscles

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7
Q

Orthotics:
Muscle Posture (Spasticity)

A

Orthotic will reduce Equinus/PF

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8
Q

Orthotics:
Sensory Loss

A

Orthotic will enhance stability due to loss of sensation

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9
Q

Requirements for Gait:
Range of Motion

A

Neutral DF and PF
Ideal 5 degrees of DF
Full Knee Extension passively

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10
Q

Requirements for Gait:
Synergistic vs. Muscular

A

Strong synergies require orthotist
Support for the swing & stance phases

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11
Q

Requirements for Gait:
Sensation

A

Tactile: inform orthotist
Proprioception: ankle (increased M/L support - trimlines)

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12
Q

Skin Protection:
Sock Wear

A

Athletic socks that covers the entire area of the orthotic

Keeps skin dry
No wrinkles!

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13
Q

Skin Protection:
Brace Checking

A

Check brace 20 min after 1st wear
1. Medial and Lateral Malleolus
2. First Ray
3. Calcaneus
4. Edges of the Orthotic

If any redness appears, request that the person does not wear the orthotic and seek assistance

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14
Q

What must you see after applying an Orthotic?

A

An immediate change in an individual’s gait or alignment (Stance or Swing phase)

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15
Q

Team Members for Orthoses:
Orthotist

A

Offers orthotic possibilities based on the patient, MD, PT

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16
Q

Team Members for Orthoses:
MD

A

Medications for spasticity
Considerations for E-Stim
Long Term Prognosis

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17
Q

Team Members for Orthoses:
PT

A

Gait Mechanics
Greatest Need/Problems
Stability vs Mobility
Joint Integrity

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18
Q

3 Needs for an Orthotic:
1st Need

A
  1. Gait Deviation

Swing Phase: drop foot gets an AFO, consider Leaf Spring vs DF assist

Stance Phase: Ankle instaiblity gets a Solid AFO / Hinged AFO
Ankle PF weakness or NM function gets a Solid AFO
(Can even help with knee hyperextension)

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19
Q

3 Needs for an Orthotic:
2nd Need

A
  1. Protection from Injury
    Decubitus Ulcer
    Joint protection from instability
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20
Q

3 Needs for an orthotic:
3rd Need

A
  1. Muscular Adaptations
    Maintain ROM
    Increase ROM
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21
Q

Ankle Foot Orthosis (AFO):
Description and Prescription

A

Adaptations of the trimline for more or less control

Prescribed for:
Weakness
Stroke / CP
Head Injury
Peripheral Neuropathy
Alignment Issue
Spinal Cord Injury
Progressive Disease

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22
Q

Orthosis:
Force Principles

A

3 Points with Force Principles
1. CF Posterior
2. F Primary
3. CF Plantar

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23
Q

Orthosis:
Comfort

A

An orthosis is most comfortable & effective when:

  1. Pressure = Force/Area
  2. Control direction of primary force and direction of counterforces
24
Q

Knee Ankle Foot Orthotics KAFO Materials

A
  1. Leather and Metal (Initial)
    Heavy and less malleable
  2. Thermoplastic (Middle)
    Easily molded and stronger
  3. Carbon Fiber (NOW)
    -Lightweight and durable
25
Uses for KAFOs
Spinal Cord Injury Muscular Dystrophy Pediatric Spina Bifida Polio Designed for limited community or household ambulation
26
Orthotics: Considerations in Decision Making
Body Structure Function Participation Stable Disease, improving or degenerative (MS, ALS)
27
Orthotic Priorities for Function: Gait training
PT ensures adequate fit and gait mechanics (Uneven surfaces, soft ground)
28
Orthotic Priorities for Function: Sit to Stand
PT increases GRF through limb but an AFO will decrease DF (Chair height will assist)
29
Orthotic Priorities for Function: Floor to Stand
Decrease in DF, inability to maneuver orthotic limb (Tall object to assist transfer)
30
Orthotic Priorities for Function: Balance
Reduced joint mobility: does the orthotic increase falls? (Environments that aren't conducive to an orthotic)
31
Orthotic Priorities for Function: Inclines/Stairs
PT responsible for safety and training with orthotic
32
Essential attributes of an Orthotic
Can be worn for long periods w/o damaging skin or pain for 6-8 hrs/day (work up to this) Easily donned & doffed Cosemesis Considerations for job & play
33
Areas of Critical Importance for Orthotics: Gait Cycle
Midstance (Single Support) Mid and Terminal Swing
34
AFO Types
Solid AFO (Anterior Leaf) Dynamic AFO (Flexibility) Hinged AFO (Require ROM) Ground Force AFO Leaf Spring AFO (Postioer Leaf)
35
Custom Molded Orthosis: Why are they important?
Provide optimal control of the limb & are important for patients with impaired sensation, hypertonicity, or risk of progressive deformity
36
Custom Molded Orthosis: How are they made?
Construction around a rectified model of the limb, to ensure pressure relief over vulnerable areas (prominences)
37
Types of Material for Orthotics
1. Thermoplastic Rigid AFO (Foot Drop/Weak) 2. Carbon Fiber Light Weight, Durable 3. Custom (Adaptable) Support joints
38
Off the Shelf Orthoses: Mass Manufactured
AFOs and Leaf Spring AFOs Limited in modification which can be a problem for foot deformities or sensory impariments
39
Leaf Spring AFO
For Drop Foot Designed to support the weight during swing phase to enhance limb clearance Assist controlled lowering during Loading response in stance and heel rocker
40
Dorsiflexion Assist Designs
Prepositions the foot for heel strike at IC due to impairment of the TA (Lack of Control) Limited Med/Lat stability during stance while allowing forward progression of the Tibia Contributes to push-off
41
Solid AFO
Resists PF during Swing Phase with fulcrum at Ant. Ankle Velcro strap Counterforce distally at MT heads and proximally at top of AFO (prevents Ev/Inv)
42
Disadvantages of Solid AFO
Interferes with all 3 rockers of gait in stance phase and limits transition into swing phase (shortens stride length by limiting progression of the tibia)
43
Hinged AFO
Allows sagittal motion at the ankle w/ orthosis joint Improves mobility with inclines and stairs Reduces risks of falls and has less negative impacts on postural control
44
Hinged AFO: Plantarflexion Stop
Prevents Spastic Quinus Permits DF Prevents Excessive PF
45
Alternative Styles to Hinged AFO
Increased trim lines for those with limited muscle control Higher foot counters to control inversion/eversion
46
Elastic vs. Pin Hinged AFO
Pin-type has Plantarflexion stop Elastic has Dorsiflexion check strap
47
Ground Reaction AFO (Anteiror Floor Reaction)
Help impaired motor control of the knee and weakness of the quadriceps Restricts Tibia rolling and stabilizes the knee in stance
48
Criteria for a Ground Reaction AFO
Poor Ankle suppport in stance Minimal DF during swing Knee flexion/collapse in MS
49
Tone Reducing Dynamic AFO
Stabilizes the Calcaneus and Rearfoot with ankle strap
50
Posterior Leaf Spring (Dynamic - Thermoplastic)
Assist limb clearance in swing for IC by heel Used for DF weakness, impaired control, LMN flaccidity or paralysis Mod-Severe Hypertonicity
51
Carbon Graphite AFO (Dynamic - Custom)
Assist limb clearance in swing for IC by heel Used for paralysis or impaired Dorsiflexors Mod-Severe Hypertonicity
52
Articulating Ankle (Dynamic - Thermoplastic)
Assist limb clearance in swing for IC by heel Permit Tibial Advancement (2nd rocker) in stance LMN Paralysis / Hypotonicity
53
Tone Inhibiting AFO (STATIC - Thermoplastic)
Controlled ankle position in stance for stability Significant hypertonicity w/ impaired control LMN Paralysis / Hypotonicity
54
Anterior Floor Static Reaction AFO (STATIC - Thermoplastic)
Stability in stance through ankle/knee copuling Weakness/Lack of control at the knee or ankle Ligamentous insufficiency or Genu Recurvatum
55
Assessment for an Orthotic
1. Alignment in standing w/o shoes 2. Calcaneal Flexibility vs Rigidity 3. Prone Flexibility (Gastroc/Soleus) 4. Subtalar Joint neutral

529 Neuro (12 decks)

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