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Treatment > Splinting, Orthotics, and Prosthetics > Flashcards

Splinting, Orthotics, and Prosthetics Flashcards

1
Q

Oval 8

A

Used to manage: mallet finger, swan neck and boutonniere deformities, trigger finger and trigger thumb, lateral deviation, arthritis, fractures and hypermobility

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2
Q

Spring loaded extension splint (LMB)

A

FO
Ideal for finger flexion tightness and boutonniere deformities
It produces extension of the joints of the fingers and/or thumb.

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3
Q

Dressing tree

A

A dressing tree is a term that indicates a system of hooks and pegs that can help people with an upper limb difference put on and take off, or don and doff, their prostheses without the help of others.
dressing trees can also help with clothes

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4
Q

Orthotic

A

A device applied to restore function or prevent deformity often by protecting the limb

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5
Q

Prosthetic

A

Usually indicates a replacement of a body part
Artificial limb, hip/knee replacement

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6
Q

Rules regarding orthotics and prosthetics

A
  1. If you don’t know what you are doing stay away or get help.
  2. No two patients have the same needs or problem (even if the diagnosis is the same).
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7
Q

Wolfe’s Law

A

Soft tissue responds to the forces placed upon it

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8
Q

Custom vs. Prefabbed orthotic

A

Once you touch the client you are responsible!
Custom: more expensive, used if wearing for a long period of time
Prefabbed: prefabricated, over the counter, only worn for a couple weeks
Precut becomes custom

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9
Q

Factors that can result in differences between patients and orthotics

A

Pathology and anatomy
Other disorders ect
Physiological function prior to injury
Psychosocial issues
Goals for that client

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10
Q

Amputation levels

A
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11
Q

Interscapulothoracic amputation

A

All of part of scapula is amputated along with the arm; can include clavicle

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12
Q

Four types of UE prosthetics

A

Cosmetic
Body Powered
Myoelectric
Hybrid

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13
Q

Cosmetic prosthetic

A

Use the term passive functional for insurance to cover it.
These prostheses are lightweight and while they do not have active movement, they may improve a person’s function by providing a surface for stabilizing or carrying objects.

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14
Q

Body powered UE prosthetics

A

$15,000
Cable driven
Internal or external
Driven by patient’s residual movement
- must have sufficient musculature and ROM
Advantages:
- pretty low tech
- gives good proprioceptive feedback.
- can get dirty or wet
Disadvantages:
- decreased grip compared to myoelectrics
- force is exerted on risidual limb
- can be difficult to control for high levels of amputation.
- restrictive harness

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15
Q

Myoelectric prosthetics

A

External powered
$80,000.00 and up
Triggered by a muscle contraction or pressure that activates a switch
Switch can be external or internal
All you need is one point
Often helpful to consult an OT or PT before the amputation occurs
Don’t like to get dirty or wet
Have to be charged

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16
Q

Hybrid prosthetic

A

Has both a body powered and myoelectric component

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17
Q

How to apply prosthetic

A

Vacuum (negative pressure)
Harness: figure 8 or figure 9 are the most common

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18
Q

Socket

A

Use of stump socks
- for molding (wrapping)
- for volume difference
- for protection
- to absorb perspiration

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19
Q

Shoulder units

A

Usually manually or friction operated

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20
Q

Elbow prosthetic

A

Myoelectric
Friction
Locking
Manual or cable operated

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21
Q

Wrist prosthetic

A

Hinges
Ball and socket
Fricking, locking, myoelectric

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22
Q

Terminal device

A

VO - voluntary opening
- Opens with effort and closes with relaxation
VC - voluntary closing
- Closes with effort and opens with relaxation

Depends on which muscle contractions are stronger

Hooks, hands or other
Goal is a three-point pinch

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23
Q

Role of OT/PT in orthotics

A

Correct fit and type
- Pre surgery consult
Educate the client
- Terminology
- Expectations
Prep the stump
- Desensitization starting day 1 after surgery
- Molding
Application
- Don and doff
Functional use

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24
Q

Prefabbed orthotics pros and cons

A

PROS
- Cheaper
- Less time and effort
- Immediate feedback
- Lots to choose from
- The “sports” look
- Still requires skill and knowledge
CONS
- Fit is compromised
- Little control over position
- Expensive to stock a bunch
- Fit the “average”

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25
Q

Custom orthotic pros

A

Fit the client
- Doesn’t immobilize all
Requires skill
Better compliance
More expensive

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26
Q

FO

A

Finger orthotic

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27
Q

HFO

A

finger hand orthotic

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28
Q

HO

A

hand orthotic

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29
Q

WHO

A

wrist hand orthotic

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30
Q

WHFO

A

wrist hand finger orthotic

31
Q

EWHFO

A

elbow wrist hand finger orthotic

32
Q

EO

A

elbow orthotic

33
Q

SEWHFO

A

shoulder elbow wrist hand finger orthotic

34
Q

Resting hand orthotic

A

WHFO
Resting pan
Antideformity
Antispasticity

35
Q

Cock-up orthotic

A

Dorsal or volar based
Wrist immobilizer
WHO

36
Q

Thumb spica

A

WHFO

37
Q

CMC splint

A

HO

38
Q

Static orthotic

A

Doesn’t move
Protect, rest, position

39
Q

Static articulated orthotic

A

They can be hinged and locked (don joy)
- If they hold the joint still, they are hinged static

40
Q

Static progressive orthotic

A

This type applies force to the stiff joint or tissue, holding it at end-range position to improve passive motion.
May be articulated or not
Cannot be used on clients with abnormal tone
Adjustments can be made based on client’s pace and tolerance

41
Q

Dynamic orthotic

A

Encourage or promote joint movement
Often use rubber bands or other elastic components
Don joy allows, but limits movement (0-90º instead of 0-140º)

42
Q

How to prevent torque deformity?

A

Torque deformity occurs when fingers start to twist or cross over.
The lower the profile, the lower the chance of getting torque deformity.
There should be a 90º angle from the point of pull to joint it is closes to.

43
Q

Purpose of orthotics

A

Protect/prevent deformity
- supports an unstable joint
* arthritis
* post or pre surgery
* fracture management
* prevent contractures?
* CP
Improve ROM
- slow, continuous stretch
- block a joint
Improve function
- act as prosthetic
* nerve injury
* amputation
* CP

44
Q

A few musts when applying an orthotic

A

Understand the anatomy of the hand
- the orthotic must fit and support the arches
- failure to do so will result in flat hand
Understand the creases and their role in free movement
Dual obliquity
- the variance between the length and height of the metacarpals, with the radial side longer and higher than the ulnar side
Apply minimal stretch
Be comfortable and wearable
Must cover only the joints necessary
Must be secure
Must be easy to apply and take off
Must be free of pressure points

45
Q

What you need to start making orthotics

A

Thermoplastics
- 100s of types
- low melt: 100-140º
- high melt: 200º+
Splinting scissors
Heat source
- water
- guns
Straps
- velcro
- buckles, d-rings (transmit greater force)
Other stuf
- outriggers
- hooks, rubber bands, tubes

46
Q

Properties of orthotic materials

A

Conformability - getting into the cracks and crevices
Weight or thickness
Flexibility - ability to take repeated stress
Rigidity - does it bend? how resistant is it to stress?
Durability - ability to tolerate wear and tear, how long will it last?
Solid or perforated
Color
Heat to cool time
Heat temperature
Memory
Elasticity
Drapability
Bonding
Edges

47
Q

Resting hand/pan position

A

Wrist 10-20º extension
Slight flexion of digits

48
Q

Orthotic functional position

A

Wrist 20-35º extended
Arches apparent
MPs slightly flexed
IPs 45-60º flexion
Thumb abducted and opposed

49
Q

Intrinsic plus (antideformity) position

A

Wrist 10-20º extension
MPs 90º flexion
IPs 0º

50
Q

Trough

A

Part of the forearm, dorsal or volar
2/3 rule

51
Q

Hypothenar bar

A

area over small finger, dorsal or volar

52
Q

MP bar

A

sits at or below the MP joint, dorsal or volar

53
Q

Thumb hole/trough

A

Thumb area

54
Q

C-bar

A

found on resting hand or thumb splints, sometimes stands alone

55
Q

Pan

A

place the hand sits

56
Q

Thumb post

A

Keep in mind the part you want blocked

57
Q

Opponens bar

A

Area over thumb

58
Q

Outrigger

A

Anything that comes off the splint

59
Q

Orthotic straps

A

Hold the orthotic on
- usually velcro and foam
- can use D-rings, rivets, slits in splint for patients that need more than Velcro
Applying the straps
- usually has 3 points of pressure
* two in one direction and one in the other
- don’t block joints or pressure points
Round the edges

60
Q

Cock up splint

A

WHO
Prefabbed if it’s for a short time use
Custom is always better
Used with
- carpal tunnel
- wrist sprain
- carpal fx
- tendonitis
- ganglion cyst removal
- after an arthroplasty
- radial nerve palsy
- protect wounds
Support the wrist, cerebral palsy, stroke
Base of many dynamic splints

61
Q

Ulnar or radial gutter

A

WHO or WHFO
Looks like a cock up except it’s only hits one side of the forearm and hand
Same basic use as cock up
- especially carpal or metacarpal fx or thenar fx

62
Q

Hand immobilizers

A

Resting hand, resting pan, intrinsic plus, or antideformity
WHFO
Protection for wounds, tendons, arthritic, flaccid hands
Typical for burns
Crush or major trauma
- often applied in operating room

63
Q

Thumb spica or thumb immobilizers

A

WHFO
HFO
Used for
- DeQuervain’s
- athrtitis
- post CMC arthroplasty
- preventative for CMC arthritis
- scaphoid or thenar fx
- Gamekeeper’s thumb
- UCL tears

64
Q

Elbow and forearm orthotics

A

Forearm - usually dynamic to increase supination or pronation
Elbow - usually to protect a fx or epicondylitis or block or increase movement
- can be static, dynamic, or static articulated

65
Q

Elbow orthotics

A

Immobilizers following
- elbow fx
- arthroplasty
- instability
- biceps or triceps repair
- cubital tunnel
- burns
Static, dynamic, or hinged

66
Q

Kleinert, Duran, or Chow orthotics

A

90º rule
Used for flexor and extensor tendon repairs
Takes the place of the affected tendon during the healing process

67
Q

Functional orthotics

A

Tenodesis orthotic - used with C5-8 spinal cords to increase the strength of tenodesis action
Others for writing, creating a thumb or radial nerve

68
Q

Serial casting

A

Typically a last resort unless part of protocol
Leave on 24 hours - 3 days later, remove and do again

69
Q

Orthotic wear and care

A

Washing and cleaning orthotic straps
- remember melt temp
Send it home in writing
- what is it for
- wear time
- instructions in the use and to contact therapist
- do not attempt to adjust

70
Q

Mallet finger

A

Rupture or interruption of the terminal extensor tendon
It will not get better.

71
Q

What to do about mallet finger?

A

The only way it will heal without surgery is to leave it in place (extension) for 6-8 weeks and allow scar tissue to “glue” the tendon/rope back together. If you remove the splint and make ONE fist, prior to the 6-8 weeks, you will tear all the developing scar tissue and you have a cut tendon/ rope again! If you have to start over, it is less likely to heal!
Splint: the end joint (DIP) should be kept in an extension splint, it is best to tape it to the splint so that it will not move, the splint can be fabricated out of thermoplastics or you can use an aluminum splint, it can go on the top or bottom

72
Q

What to do if mallet finger doesn’t go back perfectly straight after 6 weeks in an orthotic?

A

You must put the splint back on and keep it on for 4 more weeks then try it again

73
Q

Dermatomes of the upper limb

A

Treatment (8 decks)

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