Splinting/orthoses Flashcards
T/F: STs can make orthoses.
False: only OT, PT, dentists for teeth, and certified orthotists (COs)
Sensorimotor/rehab/biomechanical: this approach allows a person who had a stroke to grasp the walker by using orthoses that are adapted to assist with grasp
rehabilitation approach
Sensorimotor/rehab/biomechanical: goal of orthosis is to decrease amount of tone
sensorimotor
Sensorimotor/rehab/biomechanical: helps a person who had a tendon repair that resulted in flexor contractures of the CP joints regain full ROM
biomechanical
6 orthotic divisions=
identification of articular/nonarticular, location, direction, purpose, type, total number of joints
6 orthotic divisions: identification of articular/nonarticular
weather or not it affects articular structures (joints)
6 orthotic divisions: location
classifies according to location of primary anatomic parts included in the orthosis
6 orthotic divisions: direction
ONLY APPLICABLE TO ARTICULAR ORTHOSES…ex: flex,ext,opposition….ex: index small finger PIP flexion orthosis
6 orthotic divisions: purpose (4)
- mobilization (move primary and secondary joints)
- immobilization (not moving PRI or SEC joints)
- restriction-limit a specific aspect of joint ROM for the primary joints
- torque- create motion of PRI joints situated beyond the orthosis itself
6 orthotic divisions: type
specifies secondary joints included in orthosis, these joints are in the design to affect joints that are proximal distal or adjacent to the primary joint (there are different joint levels which are explained more in the book)
6 orthotic divisions: total number of joints
ex: if elbow orthosis includes the wrist and MCPs as secondary joints, the orthosis would be called elbow flexion immobilization orthosis type 2
Orthotic designs (5)
static, serial static, dropout (dont have to know), dynamic, static progressive
Orthotic designs: static
aka immobilization-can maintain a position to hold anatomical structures at the end of available ROM, thus exerting a mobilizing effect on a joint (remodels in lengthened/shortened (?) form)
Orthotic designs: serial static
requires the remolding of a static orthosis-holds the joint(s) at the limit of tolerable range, thus promoting tissue remodeling
Orthotic designs:dynamic
mobilization!! have self-adjusting or elastic components which may include wire, bands, or springs
Orthotic designs: static progressive
types of dynamic orthoses, they use inelastic things like hook and loop tapes, outrigger line, progressive hinges, turnbuckles, and screws inelastic bc it allows client to adjust the amount of tension so as to prevent overstretching the tissue
client centered assessments: (4)
- MAM (manual ability measure)
- COPM
- DASH (disabilities of arm and shoulder)
- PRWE (patient rated wrist eval)
client centered assessments: MAM 36
36 item self-report, client rates items on a 4 pt scale based upon their ability to complete tasks, includes visual analog pain scale and column asking if task can be completed with noninvolved hand
client centered assessments: DASH
disabilities of arm shoulder and hand-condition specific tool, 30 questions addressing function within performance areas- rate on 1-5 (unable)
client centered assessments: PRWE
condition specific, client rates pain and function in 15 preselected items
client centered assessments: COPM
Canadian occ perf model client centered, interests, and satisfaction with occupations, interview based, can be used to measure outcomes
Low temp thermoplastics vs high temp
- Low temp thermoplastics (LTT) most commonly used, soften in heated water bt 135- and 180 F, can be placed on skin while plastic is moldable
- high temp- become soft when warmed to >250F and cant touch a persons skin when moldable or else can burn
orthotic properties: (6)
memory, drapability, elasticity, bodng, perforations, color
orthotic properties: memory
describes a materials ability to return to its preheated (original) shape size and thickness when reheated
orthotic properties: drapability
degree of ease with which a material conforms to the underlying shape without manual assistance
orthotic properties: elasticity
resistance to stretch and its tendency to return to original shape after stretch
orthotic properties: bonding
degree to which material sticks to itself when properly heated
orthotic properties: perforations
allow for air exchange in underlying skin, should not really be stretched a lot
orthotic properties: color
might affect persons acceptance and satisfaction with splint and compliance with wearing- darker color appear cleaner, colored might be used to help person with unilateral neglect
explain the orthotic making process:
Orthotic patterns, fit pattern to client, building orthoses from pattern which involves heating and cutting, and reheating, positioning the client, molding orthosis to client, making adjustments, strapping, padding and avoiding pressure areas, edge finishing, reinforcement (read for more pg 36)
things to observe from a clinical exam
Observation of upper quarter-how person carries UE, reduced reciprocal arm swing, guarding postures, involuntary movements like tremors or tics, hand arches, creases, thin smooth finger pads, nails, edema
pain assessments (4)
- Verbal or visual analog scale
- body diagram
- DASH
- McGill pain questionaire
pain assessments: verbal/visual analog scale
0-10 smiley face pics…3-point change in score is necessary to establish a true pain intensity change
pain assessments: body diagram
outline of body and person marks pain
pain assessments: DASH
quick dask-arm shoulders
pain assessments: McGill pain questionnaire
more formal= McGill Pain questionnaire (MPQ) includes pain rating index, total number of word descriptors, and present pain index,
nerve evaluations=
2-point discrimination, monofilament test, tinel test which involves tapping over entrapment site to determine if entrapment is present or tapping nerve distal to proximal-phalens test (flexing to see color change)
Factors that may influence compliance to getting splint
age, occupation, expected environments, ADL, responsibilities, client adherence and motivation, and cognitive status
Conditions needing a wrist orthotic
Carpal Tunnel, rad nerve palsy colitz design, wrist/colles fx, RA, CRPS
Conditions needing a thumb orthotic
dequervains and scaphoid fc (wrist based) cmc oa, skiers thumb/ gamekeepers ucl sprain (hand based)
Conditons needing a hand immobilization
RA, burns, CRPS, dupuytrens is usually hand based not wrist
explain functional position
to relieve stress on the wrist and hand joints, the resting hand orthosis positions the hand in a functional or mid-joint position- one FP that is suggested is placing the writ in 20-30 degrees of extension, the thumb in 45 degrees of palmar abduction, the MCPs in 35-45 degrees of flexion, and all PIPs and DIPs in slight flexion
explain intrinsic plus position
-Intrinsic plus/anti-deformity position-places wrist in 15-20 degrees of extension, the thumb midway between radial and palmar abduction, the thumb IP joint in full extension, the MCPs at 60-70 degrees of flexion, and the PIP and DIPs in full extension
check ppt
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