Quiz 1 Flashcards
which type of orthotic plastic can be reheated?
thermoplastics
what type of plastic can NOT be reheated?
thermosetting
what is considered when designing an orthotic?
comfort cosmesis sensation durability weight cost ease of donning/doffing size and contour
how is bending moment determined
by the location and magnitude of the sheer forces
how are shear forces controlled
by strap location, strap tightness and width of the straps
the longer the orthosis……
the greater the leverage
what are the disadvantages of orthotics
- muscle atrophy
- joint contractures
- dependence
- skin issues
- poor cosmesis
- respiratory difficulties
what are flexible trunk orthoses (belts and corsets) mainly used for?
used mainly for symptom management in people with back pain
corsets are used to decrease pain by unloading the spine via increasing intra-abdominal pressure
sacroiliac belts increase passive stability`
what are postural training orthoses intended for?
improve body awareness; NOT correct deformity
goal of rigid spinal orthoses
limit spinal movement
protect the spine
facilitate healing
*** it uses a 3 point counter force system to control movement in the desired plane
what is the 3 column concept
wedge fractures involve the anterior column
burst fractures involve both the anterior and middle column
a fracture is labeled unstable if 2 adjacent columns are involved. They usually require surgical fixation, bracing or both
what are the 3 kinds of rigid LSOs
chairback
knight
bodyjack
what motion does a chairback LSO control?
controls flexion and extension
what kind of motion does a knight LSO control
controls flexion/extension and lateral flexion
what motion does a body jacket LSO control
controls all planes of motion
what levels of the spine doe TLSOs control
T5 - L4
What motion are TLSOs more effective at controlling than LSOs
TLSOs are better at controlling rotation
why is the lumbosacral region hard to stabilize?
this region has the greatest range for flexion/extension and bears the most load making it difficult to control
what TLSO controls flexion
the Jewett and the CASH
What TLSO controls flexion and extension
taylor spinal
what motion does the taylor knight spinal TLSO control
flexion/extension/lateral flexion
what population uses hyperextension braces and why
patients diagnosed with osteoporosis who had a compression fracture. the 3 point counterforce system prevents flexion
what are the indications for use of an occian back
for critically ill patients that have poor skin assessment
for patients unsafe to turn due to instability
for those not awake or alert within 24-48 hours after admission
for those with pre-existing burns, skin injuries or lacerations
** patients who want improved nighttime comfort
what is significant about the Philadelphia collar
stabilizes pt immediately after trauma
gives access to trach and carotid
waterproof
what is an advantage of the aspen vista collar?
it is adjustable to 6 different settings which reduces the need for inventory and also reduces skin breakdown while slicking away moisture
what orthosis proves the best stability for both the lower cervical and upper thoracic spine
CTOs
what device gives the most stable immobilizaton
the halo
it is the only way to stabilize the occiput to C2
what gives the most effective method of immobilizing C1-C2
the minerva which is a halo that does not drill into the skull
what is the purpose of bracing
to prevent progression of curve to a level as the patient grows
it is not intended to be curative
what is the eligibility for bracing
skeletally immature adolescents
risser scale of 0-2
which is the most common brace
the boston
it is a combination of a active/passive orthosis
it encourages the wearer to actively pull away from the pads into the reliefs
what is the criteria for stopping bracing
until skeletal maturity
- risser 4 status
- unchanged height over 6 months
- 18-24 months post menarche in females
skin instructions for orthosis
keep skin clean and dry
avoid lotions
wear fitted shirt underneath
inspect skin daily
donning and doffing
cervical need to be able to open mouth but not move head
lumbar should have it position as low as possible
Lists the goals of orthotics
- assist or stabilize a joint
- protect a joint
- prevent or correct a deformity
- improve function
- decrease pain
- control spasticity
- provide sensory feedback
extrinsic factors that affect knee stability
hip and ankle alignment
strength of the hip mm
ROM
varus/valgus moments during gait
intrinsic factors that affect knee stability
ligamentous instability angular deformities (varus, valgus, recurvatum) muscle imbalance (weak quads or hamstrings)
what are the indications for use of a KAFO
needed to achieve knee stability malalignment loss of ligamentous stabilit offloading of the knee or ankle pain reduction
contraindications for KAFO
not able to meet energy demands
lack of hip, trunk and UE strength to maintain standing balance and use the device
open wounds that would possibly be in contact with the orthosis
swelling
what motion is controlled in the sagittal plane by a KAFO
knee flexion
what is controlled in the frontal plane by a KAFO
knee valgus
what are the advantages to locking the orthotic
gives more stability and overall mobility
what are the disadvantages to locking
it takes more energy for movement and causes gait deviations as well as compensatory motions
what does the free motion knee joint allow
it allows flexion and extension while preventing hyperextension
it is good for people with adequate muscle strength but who have instability or recurvatum
where is the knee component of an offset joint
it is posterior to the anatomical joint center which allows it to increased extension moment for stability in stance
also decreases pressure on the patella pad
what is the most common type of knee joint
the drop lock
what needs to happen for the drop lock to be in place
need to get full knee extension in standing first
what type of knee joint is used when changes in condition are expected
an adjustable/dial lock
mainly used in patients with knee flexion contractures that have been improving with stretching
what is the biomechanical design of a stance control orthotic
it locks the knee in extension at initial contact and unlocks the knee on heel rise in the transition from terminal stance to preswing
advantages of stance control
stability during stance
provides knee flexion during swing
minimizes gait devations
less energy cost
disadvantages of stance control
increased size of components
increased cost
criteria for selction of orthosis is specific
-knee flex contracture less than 10 degrees, no leg length discrepancy, must be less than 200 lbs
what type of orthotic uses a swing to or swing through gait
the scott-craig KAFO
it is specific to SCI and has a PF stop
what is the criteria to have a C- brace?
must have lower limb weakness of the quads and the inability to maintain knee extension during stance phase
usually used for someone with incomplete paraplegia or polio
what are the indications for HKAFOs
complete or partial loss of hip, knee and ankle musculature
prevention of contractures
instability in standing
contraindications for HKAFO
instability in meeting energy demands
inadequate trunk and UE strength to safely use orthotic
fixed hip or knee flexion contractures
(need extension to stabilize and lock orthotic)
what are the benefits of a parapodium
used to meet the developmental needs of children
enables hands free standing
adjustable
hip and knee joints unlock for sitting
typically used for children with spina bifida
disadvantages of HKFAOs
difficulty to don/doff
high strength and balance is needed
not the primary means of locomotion
what is the primary use of a HKAFO
used for exercise and position change
what does a RGO allow for
allows for reciprocal gait orthosis
the cable system enables a coupling mechanism at the hips
the cyclical tension and release is what creates the reciprocal gait
what do you need for a reciprocal gait if you do not have functional hip flexor strength?
you need lateral trunk sway/shift with trunk extension/rotation to begin the process of reciprocal gait
what is developmental hip dysplagia
a congenital condition which causes hip dislocation, subluxation and hip instability
what can be used for hip dysplagia in children
a pavlick harness which allows the child to still kick and easily manage their diapers
puts them in 110 degrees of hip flexion
what is the next step after the palvick harness if further correction is needed
a rhino cruiser is a rigid plastic hip orthosis that maintains hip abduction in an ambulatory toddler
it is used between 6-24 months of age
what happens in legg-calve-perthes disease
there is a loss of blood supply to the femoral head
the current prescription it to contain the femoral head in the acetabulum as it reforms
what is a SWASH and how is it significant
Standing Walking And Sitting Hip orthosis
used in children with CP who have excessive adductor tone and abductor weakness therefore it prevents scissoring
what is a hip SPICA used for
limits excursion of the hip after muscular strains, bruises and hip pointers
what is the most common knee joint orthosis
polycentric which is designed to decrease migration by mimicking the anatomical knee joint
indications for a functional knee orthosis
severe instability of the ligaments in the knee
post reconstruction surgery control
provides proprioception
what is the goal of patellofemoral orthoses
designed to centralized patellar tracking
what are the indications for a infrapatellar strap
chondromalacia
patella tendonitis
osgood-schlatter disease
what are the 3 overuse injury factors
training errors
footwear
biomechanical
what causes faulty transverse plane movements in the lower extremity
the way the foot hits the ground effects the entire chaine
ex: faulty pronation can create abnormal transverse plane movements causing injury
is pronation a normal part of gait
YES!!!! pronation is a normal component of gait
what motion does the ankle joint allow
dorsiflexion and plantarflexion
what motions does the subtalar and mid-tarsal joints allow
supination and pronation (tri-plane motions)
what are the components of pronation
dorsiflexion
eversion
abduction
what are the components of supination
inversion
plantarflexion
adduction
what is the role of pronation
acts as a shock absorber
allows the foot to adapt to uneven surfaces by unlocking the midfoot joints
what causes poor pronation
results from compensatory movement of the foot due to congenital malalignment of the subtalar joint
how is subtalar neutral defined
by the position of maximum congruency of talonavicular joint
what is the goal of a foot othotic
to bring the supporting surface (ground) up to the foot in its subtalar neutral position to reduce excessive or prolonged pronatory movement
what is the overall purpose of orthotics
reduce the “snowball” effect in proximal joints and reduce any imbalances up the chain
what motion occurs in the ankle to compensate for limited dorsiflexion
may cause increase in pronation at the subtalar and midtarsal joints
when would you suggest foot orthotics
if a patients foot is overpronating from a foot structure issue
what is the difference between semi-rigid and rigid foot orthotics
semi-rigid offers more comfort, has a quicker turn around and is more cost effective
rigid has precise control, greater accuracy and durability
When is surgery required for a patient with scoliosis
when they have a curve of 45-50 degrees
