Slings Flashcards
General Rationale for Using Slings and Orthoses
- Positioning (Bed rest -> prevent contractures, Positioning to prevent deformity &/or maintain optimal joint alignment, Potential to inhibit tone (controversial))
- Protection/Healing (Immobilization, Movement control, Ex: Knee brace for ACL)
- Improve balance/function through correction or re-establishment of approprtiate BOS
- Improve function of weak limb
- Feedback (tactile or proprioceptive)
General Types of Slings
What is an alternative to a sling?
E Stim for Shoulder Subluxation
Shoulder abduction and basic sling: Purpose and Pros/Cons
- Goal is to protect and stabilize shoulder and rotator cuff.
- May have added abductor ‘pillow’ and wrist support.
Pros:
* “Off shelf”
* Supports entire forearm
Cons:
* If patient has neglect, arm is hidden.
* Wrist and hand may swell if patient does not use.
* Inhibits trunk rotation with ambulation
Hemisling: Purpose and Pros/Cons
- Protect shoulder
- Typically used post stroke or post TBI, though could be used for any population requiring support of the shoulder/forearm/wrist
Pros:
* “Off shelf“
* easy to don/doff
* Wrist can be supported
Cons:
* If patient has neglect, arm is hidden.
* Encourages flexion synergy pattern post stroke/elbow contraction
* Wrist and hand may swell if patient does not use.
* Inhibits trunk rotation with ambulation
TBI and Stroke may result in similar impairments
Giv-Mohr Dynamic Hemisling: Purpose and Pros/Cons
- Provides approximation and support to subluxed shoulder
Pros:
* Allows for arm swing and possible trunk rotation during gait.
* Provides approximation of GH joint
* If person has neglect, arm is not ‘hidden’
* Swinging of arm may promote blood flow
* Available ‘off shelf”
Cons:
* Hand dependent and may swell
When moving slings ____, when sitting slings ____
- on
- off
Splint definition
Some variability, but typically an orthosis intended for temporary use
Stiffer othorthotic material =
less mobility but more support
What is this?
Spring Leaf Orthosis
What is this? What does it do?
- Swedish knee cage
- Stops people from snapping back into extension; weak quads
What is this called? What is the purpose?
LEMA strap
Helps with weak dorsiflexion
Indications for Ankle Foot Orthosis
- Indicated when assist is required for ankle-knee positioning (proprioception, strength, or coordination deficits) or control during gait
Examples:
* Foot drop (Dorsiflexion weakness)
* Tendency to hyperextend knee secondary to mild-moderate plantar flexor spasticity
AFO Requirements
- Strength: Requires 3+/5 knee extension strength or Quad spasticity to stabilize knee during stance phase
- Sensation: Intact proprioception and control of the knee
Other important AFO considerations
- Heel cushion or shoe type canbe selected to help the impactofheel strike
- Proximal end of orthosis fit 1” distal to fibular head to prevent pressure on fibularis (peroneal) nerve.
Dorsiflexion Assist brace: Purpose and Pros/Cons
Purpose:
* Assists with DF during swing phase
* Allows for ‘normalized’ gait pattern for person with no ankle instability, good proprioception and no PF spasticity
Pros:
* Cost-available ‘off-shelf’
* Normalizes gait pattern
* May be preferred to Posterior Leaf AFO
* Good for peripheral nerve injuries
Cons:
* No ankle stability provided
* May not be appropriate for CNS lesions or heavier patients
* Must be worn with tie shoes
Patient must have at least 3/5 strength in ankle dorsiflexion as this device provides only light assist
Floor (or Ground) Reaction AFO or Carbon Fiber AFO: Purpose and Pros/Cons
- Prevent knee buckling during stance phase (e.g. weak quadriceps muscles without medial-lateral instability)
- Over-lengthened heel cords
- Crouch gait
- DF assist
Pros:
* Encourages knee extension moment to prevent knee forward buckling
* allows clearance in swing phase
* decreases crouch gait
* keeps torso vertical and center of mass in middle of foot
* Some are able to be don/doffed with one hand
Cons:
* Difficult going up hills
* Some are custom and unable to be easily modified
* Limited M/L support
Good for people that buckle or walk in a crouch
Knee Ankle Foot Orthosis (KAFO)
Purpose:
- <3+/5 Quad Strength; Severe knee hyperextension; M/L instability at the knee/ankle
Biomechanics:
* AFO section provides M/L stability of Foot/Ankle, DF control in swing phase, ground reaction forces on knee, knee joint and thigh extension provide M/L knee support
* locked knee joints provide max sagittal plane support; unlocks for sitting
- Can change type of knee joint and type of ‘locking’ mechanism for knee joint; typically locked into extension during stance and throughout gait
- Ankle joint is usually locked / fixed
Diagnoses that may require KAFOs = MS, Post-Polio, low level SCI
Reciprocating Gait Orthosis (RGO)
Purpose:
Mid-thoracic to high lumbar parapalegia
Biomechanics:
* RGO is HKAFO with cable system that pairs hip flexion in one leg with hip extension in opposite leg, facilitating swing phase of gait
* The patient must be able to shift their weight away from swing leg
Facilitation of Gait using Exoskeleton
- Looks likeRGO; however, motorized controls to facilitate sit to/from stand transitions and reciprocal gait for patients with limited LE function
May benefit:
* Guillain-Barre
* Multiple Sclerosis
* Spinal Cord Injury
* Stroke
FDA approved for SCI C7 and below (need hand function to manage controls)
Need to be a “good candidate”:
- spasticity may impair ability to utilize
- safety considerations (cognitive ability, fracture potential, skin integrity)
