Splints and Orthotics Flashcards
What are 5 goals for using UE splints?
Immobilization
Protection/support
Correction or prevention of deformities
Substitute for weak or absent UE function
Serve as base attachment for ADL equipment
What is a wrist cock up splint? What position is the wrist held in with this type of splint?
An anterior or palmar splint that contains the forearm and metacarpals. May include phalanges as well if needed for positioning
Wrist position: neutral or 10-20 degrees of extension
List 5 conditions where a wrist cock up splint might be used.
Rheumatoid arthritis Fractures of carpal bones Colle's fracture Carpal tunnel syndrome Stroke with paralysis
What is a thumb spica splint? What position is the thumb positioned in with this type of splint?
A hand-based splint designed to immobilize the first CMC joint
Thumb position: Partial opposition and abduction with thumb IP joint left free for maximum function
List 4 conditions where a thumb spica splint might be used.
CMC arthritis
Scaphoid fracture
Scaphoid lunate instability
de Quervain’s tenosynovitis
What is a dorsal wrist splint? What does it allow for? What condition is it used for?
Frees the palm for feeling and grasping through use of grips that curve around over the second and fifth metacarpal heads
Allows for attachment of dorsal devices to form a dynamic device
Used for flexor tendon repairs
What position is the arm placed in when in an airplane splint?
90 degrees of abduction with elbow flexed to 90 degrees
Weight of arm is borne on a padded lateral trunk bar and iliac crest band. A strap hold the device across the trunk.
What is the purpose of an airplane splint?
Used to immobilize the shoulder following fracture or burn injury to prevent contracture of the axillary region
What is the purpose of a tenodesis splint?
Assists patients in use of wrist extensors to approximate the thumb and forefingers (grip) in the absence of active finger flexion
Facilitates tenodesis grasp in patients with quadriplegia
What splints are used to treat Mallet finger, Boutonniere’s deformity and swan neck deformity?
Mallet Finger: palmar DIP gutter splint to support distal phalange
Boutonniere’s deformity: palmar PIP gutter splint to support middle phalange
Swan neck deformity: ring splints of PIP joints to prevent PIP hyperextension
List 4 purposes of an orthotic device.
- Used to reduce functional loss due to weak, painful, diseased or deformed joint
- Supports, accommodates, or protects a joint or body segment
- Restricts or facilitates motion
- Corrects alignment
What principle forms the mechanical basis for orthotic correction?
Three point pressure principle
A single force is placed at the area of deformity or angulation; two additional counterforces act in the opposing direction
List 6 types of foot orthoses.
Heel wedge Heel lift Heel cushion Heel cup Metatarsal pad/bar Rocker bar
What is the purpose of a heel wedge? What conditions is it typically used for?
Can be applied to medial heel to prevent excessive hindfoot eversion or to lateral heel to prevent excessive hindfoot inversion
Used to treat pes planus or pes cavus
What is the purpose of a heel lift? List 3 conditions for which it may help alleviate.
Rigid insert that ads extra height to the heel of a shoe
Accommodates for leg length discrepancy, limitations in ankle dorsiflexion and to take pressure of the Achilles tendon for patients with Achilles tendonitis
What is the difference between a heel cushion and a heel cup? What conditions does it assist in alleviating?
Heel cushion: Soft pad placed on the heel of the inner sole to help cushion the heel to decrease pain and pressure in that area.
Heel cup: rigid insert that covers the plantar surface of the calcaneus and extends upwards on all three sides. Works to stabilize the calcaneus in a neutral position and provide greater shock absorption
Used to help treat patients with heel spurs and plantar fasciitis
What is the purpose of a metatarsal bar/pad? What does it allow for?
Flat piece of padding that is placed just posterior to the metatarsal heads either on the outer sole or the inner sole of the shoe and shifts pressure from the met heads to the shafts.
Allows for more push off in weak or inflexible feet
What is the purpose of a rocker bar?
Located proximal to the metatarsal heads to improve weight shift onto the metatarsals (aids with push off during gait)
Describe a hinged/articulating AFO.
Single axis of rotation, allows motion in sagittal plane while controlling motion in other planes
Describe a free motion AFO.
Little or no resistance to PF or DF, helps maintain alignment and medial/lateral stability
What is the purpose of a dorsiflexion assist? Provide an example.
Assist toe clearance during swing phase and help control PF at intial contact. Prevent foot drop.
Example: Posterior leaf spring AFO
What is the difference between a plantarflexion stop versus a dorsiflexion stop?
PF stop = blocks PF at 90 degrees, allows for free DF, for weak DF or tight PF
DF stop = block DF, allows free PF, for individuals with weak plantar flexors
Describe the purpose of a static or solid AFO. Provide an example.
Provides maximum stability and control of the ankle, assists with swing clearance and prepositioning
Example: Leather lacer
What is the purpose of a ground reaction AFO? (4)
Controls forward progression of the tibia
Primarily for PF weakness
Assists with knee extension during stance
Resists DF at the ankle
What is the purpose of a patellar tendon bearing AFO (PBAFO)? (3)
Unloads the distal limb
Primarily for PF weakness
Shelf transfers force to the medial tibial flare
What is the purpose of a Charcot restraint orthotic walker (CROW) boot?
Immobilize and protect the foot and ankle
What is purpose of a hinge joint on a knee orthosis?
Provides mediolateral and hyperextension control while allowing for flexion and extension
What is the purpose of an articulated knee orthosis? Examples?
Controls knee motion and provides added stability
Lenox Hill, Don Joy
What is the purpose of a Swedish knee cage?
Provides mild control for excessive hyperextension of the knee
What is the purpose of a hip knee ankle foot orthosis (HKAFO)? List 2 cons of using this orthoses.
Provides control for LE joint at and above the ankle
Controls hip abduction, adduction, and rotation
Cons:
Restricts swing through and swing to gait pattern
Heavy and increases energy expenditure
What is a Craig Scott KAFO? What population of patients is this specifically designed for?
KAFO designed specifically for people with paraplegia. Allows a person to stand with a posterior trunk lean.
What type of orthosis is a reciprocating gait orthosis (RGO)? How does it work? What patients typically use this device?
An RGO is a type of trunk, hip knee, ankle foot orthosis (THKAFO).
Works using a cable system. When the patient shifts their weight onto the supporting hip, the cable forces the weightbearing LE into extension and the opposite leg into flexion to allow for the limb to advance.
Used for patients with paraplegia
List 3 types of pediatric LE devices, their function and what they treat.
Denis Browne splint = bar connecting two shoes that can swivel; used for correction of club foot or pes equinovarus in young children
Frejka pillow = keeps hips abducted; used for hip dysplasia or conditions with tight adductors in children
Toronto hip abduction orthosis = abducts the hip; used in treatment of Legg-Calve Perthes disease
What is a parapodium? What population is this typically used in?
Standing frame designed to allow a patient to sit when necessary. Ambulation achieved by shifting weight and rocking the base across the floor.
Used primarily by the pediatric population
What is the purpose of a flexible LSO corset? (2)
Used abdominal compression to increase intra-abdominal pressure
Provides tactile reminder for postural correction
List 5 indications for the use of a flexible LSO corset.
Low back pain Compression of abdominal incision Respiratory assist in SCI patients Sacroiliac support for pregnancy Post operative protection
What is the purpose of a rigid LSO corset? (2)
Uses a three point pressure system to control flexion, extension and lateral flexion of the lumbar and sacral segments
Provides tactile reminder for positioning
List 4 indications for the use of a rigid LSO corset.
Low back pain
Spondylolisthesis
Stenosis
Post-op precautions
What is the purpose of a thoracolumbosacral orthosis (TLSO)?
Limit flexion, extension, lateral flexion and rotation of the thoracic, lumbar and sacral spinal segments
What is the purpose of a soft cervical collar? List 3 indications for its use.
Provides minimal levels of control of cervical motion but serves as a tactile reminder for postural correction
Indications: cervical pain, whiplash, cervical weakness
What is the purpose of a semirigid cervical orthosis? List 2 examples and 3 indications for their use.
Uses a 3 point pressure system to control flexion, extension, lateral flexion and rotation at the cervical segments
Examples: Miami J and Philadelphia collar
Indications: post op precautions, stabile cervical vertebral injury, whiplash
What is the purpose of a rigid halo orthosis? List 2 indications for its use.
Provides maximal control of all cervical motion with halo attachment to the skull. Four uprights connect from the halo to a thoracic jacket.
Indications: unstable cervical vertebral fracture and SCI
Describe the purpose of a Minerva/cervical thoracic orthosis (CTO). List 2 indications for its use.
Semi-rigid cervical collar connected to a thoracic jacket via metal uprights. Provides good control of all cervical motions.
Indications: stable cervical and upper thoracic fractures and fusions.
