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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
Custom orthotic pros
Fit the client - Doesn’t immobilize all Requires skill Better compliance More expensive
26
FO
Finger orthotic
27
HFO
finger hand orthotic
28
HO
hand orthotic
29
WHO
wrist hand orthotic
30
WHFO
wrist hand finger orthotic
31
EWHFO
elbow wrist hand finger orthotic
32
EO
elbow orthotic
33
SEWHFO
shoulder elbow wrist hand finger orthotic
34
Resting hand orthotic
WHFO Resting pan Antideformity Antispasticity
35
Cock-up orthotic
Dorsal or volar based Wrist immobilizer WHO
36
Thumb spica
WHFO
37
CMC splint
HO
38
Static orthotic
Doesn't move Protect, rest, position
39
Static articulated orthotic
They can be hinged and locked (don joy) - If they hold the joint still, they are hinged static
40
Static progressive orthotic
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
Dynamic orthotic
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
How to prevent torque deformity?
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
Purpose of orthotics
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
A few musts when applying an orthotic
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
What you need to start making orthotics
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
Properties of orthotic materials
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
Resting hand/pan position
Wrist 10-20º extension Slight flexion of digits
48
Orthotic functional position
Wrist 20-35º extended Arches apparent MPs slightly flexed IPs 45-60º flexion Thumb abducted and opposed
49
Intrinsic plus (antideformity) position
Wrist 10-20º extension MPs 90º flexion IPs 0º
50
Trough
Part of the forearm, dorsal or volar 2/3 rule
51
Hypothenar bar
area over small finger, dorsal or volar
52
MP bar
sits at or below the MP joint, dorsal or volar
53
Thumb hole/trough
Thumb area
54
C-bar
found on resting hand or thumb splints, sometimes stands alone
55
Pan
place the hand sits
56
Thumb post
Keep in mind the part you want blocked
57
Opponens bar
Area over thumb
58
Outrigger
Anything that comes off the splint
59
Orthotic straps
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
Cock up splint
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
Ulnar or radial gutter
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
Hand immobilizers
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
Thumb spica or thumb immobilizers
WHFO HFO Used for - DeQuervain's - athrtitis - post CMC arthroplasty - preventative for CMC arthritis - scaphoid or thenar fx - Gamekeeper's thumb - UCL tears
64
Elbow and forearm orthotics
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
Elbow orthotics
Immobilizers following - elbow fx - arthroplasty - instability - biceps or triceps repair - cubital tunnel - burns Static, dynamic, or hinged
66
Kleinert, Duran, or Chow orthotics
90º rule Used for flexor and extensor tendon repairs Takes the place of the affected tendon during the healing process
67
Functional orthotics
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
Serial casting
Typically a last resort unless part of protocol Leave on 24 hours - 3 days later, remove and do again
69
Orthotic wear and care
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
Mallet finger
Rupture or interruption of the terminal extensor tendon It will not get better.
71
What to do about mallet finger?
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
What to do if mallet finger doesn't go back perfectly straight after 6 weeks in an orthotic?
You must put the splint back on and keep it on for 4 more weeks then try it again
73
Dermatomes of the upper limb

Treatment (8 decks)

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