Upper Extremity Orthoses Flashcards
1
Q
Uses for upper extremity orthoses
A
- Stroke
- TBI
- SCI
- CP
- MS
- Peripheral nerve injury
- Trauma
- Sporting
- Arthritis
- Work related injury
2
Q
Why would you recommend on orthosis for a patient
A
- Immobilize an extremity to help promote tissue healing (IMMOBILIZATION)
- Increase range of motion (ROM) (MOBILIZATION)
- Block unwanted movement of a joint (RESTRICTION)
- Apply traction either to correct or prevent contractures
- Assist in providing enhanced function
- Help correct deformities
3
Q
Describe the purposes of an upper extremity orthosis
A
- Immobilization: most common and simple; resting position, restrains the joint the orthosis crosses
- Mobilization: move/stretch to facilitate change, facilitates tissue growth/”physiological creep”, serial, static progressive and dynamic orthoses
- Restriction: restrict/block an aspect of targeted motion & allow motion to other areas; static, dynamic, taping techniques
4
Q
What are the 4 types of UE orthotic designs
A
- Static
- Serial static
- Static progressive
- Dynamic
5
Q
Describe a static orthosis
A
- Most Common, rigid
- Provides stabilization, protection and support to a body segment
- Can be used as adjunctive treatment or exercise device by blocking a distal segment to increase glide of another joint or improve tendon excursion
6
Q
Describe serial static orthoses
A
- Applied to a lengthened tissue, typically at the end range of motion: Mechanical stretching principles
- Allows for stretching of the tissue into the desired direction of correction
- Can be removed during therapy session and adjusted daily, weekly or longer
- Systematically remolded based on gains made during the therapy session
- Non-removable versions are better choice for the young, cognitive or behavioral issue pts, or those who have variable tone and spasticity.
- Worn for extended periods of time
7
Q
Describe dynamic orthoses
A
- Use of an elastic type force to mobilize specific tissues to achieve increases in ROM
- Have a base with outriggers/components: Spring, rubber band, elastic cord loaded
- Creep principle through constant load applied to tissue
- The dynamic force applied is maintained as long as the elastic component can contract, even when the tissue reaches the end of its elastic boundary.
8
Q
Describe static progressive orthoses
A
- Used to mobilize tissue in one direction through the application of a low load long duration stretch for a long period of time
- GOAL: tissue will accommodate to this new positon
- Different than dynamic orthosis in that the force applied is static
- Mobilization force is applied through a static line, non elastic strapping materials, hinges, turnbuckles or inelastic tape
- When new joint position is achieved the device will not continue to stress the tissue
- Patients may tolerate this method better than dynamic orthoses
9
Q
What must a physical therapist consider when determining what type of orthosis is needed?
A
- Immobilization
- Mobilization
- Restriction
10
Q
What bony prominences are vulnerable to pressure
A
- Olecranon process at the elbow
- Lateral and medial epicondyles of the humerus
- Ulnar and radial styloid processes at the wrist
- Base of the first metacarpal
- Dorsal thumb and digit metacarpophalangeal and interphalangeal joints
- Pisiform bone
11
Q
Superficial nerves that are vulnerable to pressure
A
- Radial nerve at the radial groove of the humerus
- Ulnar nerve at the cubital tunnel
- Superficial branches of the ulnar and radial nerves at the distal forearm
- Median nerve at the carpal tunnel
- Digital nerves on the volar aspect of the digits
12
Q
What is the position of function for the hand
A
- Wrist 20-30 deg ext
- MP joints 35-45 deg flexion
- PIP joint 45 deg flexion and DIP relaxed flexed position
- Thumb in palmar abd
13
Q
What is the position of rest/anti-deformity/safe for the hand
A
- Wrist in 30-40 deg ext
- MP joints 60 to 90 deg flexion
- PIP and DIP in extension
- Thumb in palmar abd
14
Q
Describe UE orthoses levers
A
- Rigid structures which a force can be applied to produce rotational motion about a fixed axis
- Fulcrum corresponds with the anatomical axis of the target joint,
- Effort arm is the segment of the orthosis that applies the effort force
- Resistance arm is the segment of the limb that resists the effort force
15
Q
Define stress on an UE orthoses
A
- Concerns for compression, shear, bending and torsion (goal is to distribute)
16
Q
Define angle of force application on an UE orthoses
A
- In mobilization splints, angle should be 90º to the body segment being mobilized to maximize therapeutic effect
17
Q
What are some signs of too much stress
A
- Edema
- Skin blanching
- Vascular changes
- Pain
18
Q
What are the mechanical principles of UE orthoses
A
- Levers
- Stress
- Angle of force application
- Force application = tolerable
- Mobilization vs. stabilization
19
Q
What are the types of UE orthoses
A
- Shoulder-elbow-wrist orthoses (SEWO)
- Shoulder-elbow orthoses (SEO)
- Elbow orthoses (EO)
- Elbow-wrist-hand orthoses (EWHO)
- Wrist-hand orthoses (WHO)
- Hand orthoses (HdO)
20
Q
Indications for a SEWHO
A
- Distal humeral fractures
- Immobilization after surgery
- Unconscious movement during sleep
- Olecranon and Epicondyle fractures
- Ligament injuries in the elbow joint
- Instabilities or hyperextension
- Injuries requiring limited ROM at the elbow
- Elbow arthroplasty
- Post-op conditions
- Post-op cast
21
Q
Indications for an EO
A
- Distal humeral fractures
- Immobilization after surgery
- Unconscious movement during sleep
- Olecranon and Epicondyle fractures
- Ligament injuries in the elbow joint
- Instabilities or hyperextension
- Injuries requiring limited ROM at the elbow
- Elbow arthroplasty
- Post-op conditions
- Post-op cast
22
Q
Indications for a wrist-hand-thumb orthosis
A
- Post cast fracture immobilization
- Wrist fractures and sprains
- Cumulative Trauma Disorder
- Carpal Tunnel Syndrome
- Post tendon transfer support
- Postoperative support after removal of internal or external fixation devices
- Gamekeeper’s thumb
- DeQuervain’s Syndrome
23
Q
Indications for a thumb spica
A
- Sprains
- Fractures
- Strains
- Skier’s thumb
- Gamekeeper’s thumb
- Post-op rehab
24
Q
Describe a tenodesis orthosis
A
- Used in SCI patients
- Must have some wrist extension intact, specifically extensor carpi radialis
- Allows pt to produce prehension through reciprocal wrist extension and finger flexion motion
- Pt potentially can improve grasp, holding and releasing desired objects
25
Q
Describe a Bioness H200
A
- Wireless
- Low amplitude FES
- Allows for functional training of reach, grasp, opening and closing of the hand
- Can also be used as NMES unit
26
Q
Describe a Givmohr Sling
A
- Developed by an OT and PT (Givler and Mohr)
- Also available in bilateral sling form
- Proposed benefits include: Reduction in subluxation and pain, Improved UE positioning for ambulation, Creates compressive forces throughout the UE
27
Q
For a functional hand orthosis to be worn during activity you need to check out
A
- Distal trim lines do not interfere with metacarpophalangeal flexion
- Palmar splint permits thumb opposition to index and long fingers
- Thumb palmar abduction is maintained
28
Q
What should you check out for UE orthoses
A
- Comfort and circulation are intact
- Acceptable appearance
- No excessive pressure, “gapping,” or migration
- Splint base is properly contoured to provide total contact with the body
- Joint position is accurate to prescription
- Movement of the splinted joint is controlled as prescribed
- Splint does not impede movements of the neighboring joints
- Mechanical joints of aligned properly (example elbow joint and wrist joint)
- No sharp edges on trim lines
- Straps are snug and located properly to ensure total contact
- Outriggers and splint components are securely and safely fastened to the base
