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Unit 17 > Pediatric Orthoses > Flashcards

Pediatric Orthoses Flashcards

1
Q

how often can you justify needing a new brace for pediatric patients. how many months?

A

6 months

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2
Q

what are the two big considerations for the growth of pediatric patients

A

night-splinting: to prevent contracture in growing children

life of the orthotic: 6 months rather than 3 years

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3
Q

True or false: Ease of use and independence of donning is more important for pediatric patients than adult patients?

A

False! they generally have a parent around to help

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4
Q

what kind of brace materials can be used in pediatric patients rather than adult patients for temporary braces?

A

plastic because they are more malleable, against an adult they likely wouldn’t hold against forces

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5
Q

are off the shelf or custom orthoses more common in peds?

A

off the shelf because they have more flexible deformitiese

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6
Q

what don’t you expect with low tone feet?

A

don’t expect arches

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7
Q

what are two potential indicators for foot orthoses in pediatric patients

A

low tone feet

pronation with or without eversion

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8
Q

what are two precautions of using foot orthoses in pediatric patients?

A

sensory defensiveness

Level of evidence: not a lot of evidence longitudinally over time!

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9
Q

What is the defining characteristic of UCBL?

What kind of person is it mostly used in?

A

totally cups the heel, trim line goes up to malleoli

For someone who has unwanted flexibility in their foot or hindfoot is everted

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10
Q

what is one step up from the UCLB?

Characteristics of it?

A

cricket: flexible sillicone and then a hard plastic liner

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11
Q

what size orthotic do you order for a child?

A

next size up from what you measure due to growth

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12
Q

What is the difference in orthotic between when you are trying to deal with a flexible vs. fixed deformity

A

flexible deformity you may be able to go off the shelf.

A fixed deformity you need to ACCOMMODATE therefore you would do a custom orthoses

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13
Q

Where do SMO look like

what do they control

A

supramalleolar so above the ankle

control ML instability NOT DF

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14
Q

Who are SMO’s good for

A

people with ML instability with no need for DF assist in swing

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15
Q

what are three indications for SMO use?

A

pronation

ligamentous laxity

mild gastroc spasticity

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16
Q

Who would you definitely not use an SMO for?

A

persistent toe walking or PF contracture: doesn’t assist with DF

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17
Q

what kind of orthoses is the “surestep”

what is special about it

A

SMO

first ray is free for extension and push off vs. the other brand of the cascade

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18
Q

what kind of orthoses is the kiddie gait?

A

toe off

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19
Q

what are the two indications for toe-off/kiddigait orthoses?

A

foot drop (DF assist)

mild crouch

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20
Q

What are three precautions for Toeoff/kiddigait?

A

insufficient DF PROM (need 5 degrees)

quad spasticity

knee hyperextension

insufficient ML control

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21
Q

three indications for PSL?

A

foot drop (DF assist)

poor pushoff? potentiall

hemiplegic CP and insufficient power

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22
Q

PLS vs. solid AFO?

A

narrow trim lines, doesn’t come all the way to malleolo. So if the person needs ML control or has greater muscle tone the AFO is a better choice

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23
Q

2 precautions for use of PLS

A

low trimline: insufficient ML control

gastroc spasticity: its a little maliable

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24
Q

4 indications for articulating AFO

A

insufficient DF in swing

GASTROC SPASTICITY

active DF present

idiopathic toe walking: have DF and PF actively allowing tibial translation

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25
Q

2 precautions for articulating AFO

A

PF contracture: must address this first or they’ll just hang out in PF

severe proximal weakness: alignment may be compromised

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26
Q

solid vs. articulating AFO things to think about

A

if you have no active DF no need for articulating

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27
Q

Tamarack and ultraflex are what kind of orthoses

A

articulating AFO

28
Q

an ankle brace controlling knee hyperextension would stop what motion at the ankle?

A

PF: blocking posterior translation of tibia

29
Q

articulating knee braces still allow what

A

strengthening of the quads through squats

30
Q

4 indications for articulating AFO with free DF and PF block

A

toe-heel gait: not just toe walking, toe heel gait means they’re getting active DF at some point just not getting good heel strike

early heel rise

gastroc tone

knee hyperextension

31
Q

2 precautions for articulating AFO with free DF and PF blocked

A

gastroc contracture

persistent toe walking pattern

for both they need more help with getting DF than free bracing allows

32
Q

what is the purpose of check strap

A

can be tightened down to ankle orthoses a solid AFO

33
Q

4 indications for solid AFO

A

poor foot alignment in standing

PF spasticity

risk of PF contracture

PF paralysis: no DF or PF

34
Q

what orthoses would you use for an individual who is non ambulatory in a standing program

A

Solid AFO

35
Q

what activity is super difficult with solid AFO

A

stairs

36
Q

3 precautions of solid AFO

A

if they are able to independently ambulate without AD

potential for recovery of DF or ambulation

blocking of transfers, functional mobility such as stairs and floor mobility in kids!

37
Q

what kind of orthoses is a turbo/

A

solid AFO

38
Q

DRAFO is used for what?

A

accomodate contractures (she doesn’t like them)

39
Q

what does a floor reaction AFO look like?

A

part that opens and closes is anterior

40
Q

what are the 3 indications for floor reaction AFO?

A

crouched gait

PF weakness

hamstring spasticity

41
Q

2 precautions of floor reaction AFO

A

toe walking: brace still allows for PF

set the angle to accomodate knee contracture/functional standing position.

42
Q

if a child has crouched gait what kind of orthoses are you thinking abuot using witht hem

A

floor reaction AFO

solid AFO

43
Q

your pt is unable to maintain knee extension in standing what kind of orthoses do you want to use?

A

KAFO

44
Q

2 indications of KAFO, HKAFO’s, RGO use

A

inability to maintain knee extension in standing

weakness/paralysis

45
Q

2 precautions to KAFO’s and HKAFO’s/RGO’s

A

spasticity

align for A/P weight line

46
Q

what is the major consideration for HKAFO or RGO?

A

they’re super heavy!! decreases energy efficiency

47
Q

high level spina bifida would use what kind of orthses?

A

parapodium

48
Q

what is the major precaution of parapodium?

A

lots of points of contact, want to make sure skin integrity is good

49
Q

when would you consider a parapodium

A

independence with transfers not possible

50
Q

define
plagiocephaly
brachycephaly
scaphocephaly

A

plagiocephaly: flattness on one side more than the other
brachycephaly: flattened on posterior side
scaphocephay: long narrow head

51
Q

what age is the precaution for cranial molding helmets?

A

> 1 year

52
Q

when do you think about intervening for asymmetry of a babies head?

A

moderate or severe asymmetry: positioning education, refer to an orthotist to get a scan done, neurology

53
Q

what is the wear schedule goal for a hemet?

A

23 hrs/7days a week

54
Q

What are some things to keep in mind for cranial molding helmets?

A

skin checks! (red should go away in 30 minutes)

perspiration

Remove for an hour a day for PROM/ROM

work up to wear schedule

55
Q

red marks due to helmets should go away in what time frame?

A

30 minutes within taking it off

56
Q

true or false: it is okay to leave helmets on for bathing and swimming

A

false, take them off

57
Q

where do you typically start for a helmet wear schedule?

end?

A

1 hour on, 1 hr off, not during naps or night

23 hrs/day during all sleeping

58
Q

every time the helmet is removed you do what?

A

skin check!

59
Q

what is the goal of wear time for night splinting?

A

4-6 hours

60
Q

what are the three most commonly night splinted LE muscles

A

PF, knee flexors, ADD

61
Q

can you get over the shelf night splints?

A

yes! can also get custom

62
Q

what is the point of dynamic night splints?

A

the joint has a resistance function: it allows you to relax into the position that you can get to and applies resistance.

63
Q

what is the con of dynamic splints

A

they’re very expensive! only order it if you think your pt is going to use it

64
Q

where do you begin the wear time for nightsplinting?

A

1-2 hours increase by half an hour every day or every other day.

working up to 6 hours

65
Q

if they cannot sleep with nighsplint on what is a good alternative

A

4 hours after school

Unit 17 (9 decks)

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