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69 Cards in this Set

  • Front
  • Back
History of Orthotics and Prosthetics

Advances due to WWI, WWII, Vietnam, Iraq

Prior to WWI-craftsman were blacksmiths, armor makers & patients themselves

Post WWII-scientific research
-PTB prosthesis and quadrilateral socket for TF
-After Vietnam-myoelectric and modular prostheses
-Iraq—monies for research in prosthetics

Polio in 1950’s
-Most advances in orthotics
Lots of advancements due to war
Orthoses for orthopedic conditions
-hip, ankle and knee braces
-shoe inserts

Orthoses for neurological conditions
-shoes
-HKAFO, KAFO, AFO, FO, etc (for foot drop, spinal injury)

Spinal orthoses

UE orthoses (stroke, arthritis)
ok
team approach

Patient, MD, orthotist, nursing, OT, PT, social worker, psychologist, neurologist, nutritionist
ok
FUNCTIONS OF ORTHOSES

___ for weak/unstable part
Prevention of ___
___ proper gait/mechanics
Protection (fx)
Relieve ___– someone w/ arthritis, or sublux shoulder
Support for weak/unstable part

Prevention of contractures

Facilitate proper gait/mechanics

Relieve pain – someone w/ arthritis, or sublux shoulder
Orthopedic orthoses
Ankle:

Stirrup

lace-up – mixed evidence if can prevent injury, but can give support after injury

elastic support

prophylactic

active ankle brace

controlled ankle motion walker (CAM walker)
ok
Orthopedic orthoses: Ankle

Stirrup
-depend on strength of foot wear
-provide some M/L support

Lace-up
-functions similarly to ankle taping
-sized and sided
-contains rear foot
ok
Active ankle brace
-Allows PF and DF; discourages inversion
-Popular in ___ sports
-Popular in jumping sports
Orthopedic orthoses: Ankle

Elastic support
-elastic sleeve
-Used instead of taping
-main effect is ___
-Used for tendinitis, edema, etc
--One type is Achillotrain

Prophylactic
-longer effect than prophylactic taping
-usually combinations of elastic and lace-up
-main effect is compression
Orthopedic orthoses: Ankle

Controlled ankle motion (boot)

-adjustable ROM
-‘___ bottom’
-Fxs, post surgical,
-severe ankle sprains
-‘rocker bottom’
Orthopedic orthoses
Knee:

___ most common anatomic assistive device after spinal orthoses

Prophylactic (to prevent med/lat injury to lig – no conclusion if make a difference)

postoperative/rehabilitation

functional

patellar

valgus control

unloading
Second most common anatomic assistive device after spinal orthoses
Prophylactic (what the football players wear)

designed to decrease ___ damage to the knee

conflicting evidence regarding efficacy

___ in knee injury rate

increased foot/ankle injuries
designed to decrease M/L damage to the knee

no change in knee injury rate
Orthopedic orthoses: Knee

Postoperative bracing (looks like goniometer on side of knee)
-protected and controlled motion
-___ how much is allowed, or
-Gradually increase it to get more ROM
-Dial how much is allowed, or
Orthopedic orthoses: Knee

Functional orthoses
-attempt to control ML stability, anterior tibial translation and recurvatum
-used for return to activity
--___ (original name of brace) – b/c of muscle bulk, need cast, hard to take off shelf and fit a patient/client

prefab or custom
-degree of instability
-level of sports competition
-size and shape of the leg
--Joe Namath (original name of brace) – b/c of muscle bulk, need cast, hard to take off shelf and fit a patient/client
Orthopedic orthoses: Knee

Prefab
-come in multiple sizes
-different measuring systems for each company

Custom - best
-take cast of the limb
-choose the type of hinges
ok
Orthopedic orthoses: Knee

Research summary

controversial
Difficult to control rotational forces since the orthoses fit around the thigh and calf (soft tissues that are not rigid)
subjective reports of improvement by wearers
Wearing them does not actually prevent injury

psychological dependence?
ok
Orthopedic orthoses: Knee

Patellofemoral orthoses
-attempt to correct patellar position
-mixed results from research studies
-Control pain
-Prevent ___

Valgus control
-usually made of neoprene or drytex with heavy duty hinges, flexion and extension stops
-Prevent dislocation
Orthopedic orthoses: Knee

Unloading orthoses
-decrease stress in ___ knees
-Designed to ___ joint surfaces of either med or lat compartments of knee-(create varus or valgus correction to unload joint)
-Medial compartment relief braces
-Might postpone TKA

more effective than neoprene sleeves

condylar separation under fluroscopy
-decrease stress in OA knees

-Designed to distract joint surfaces of either med or lat compartments of knee-(create varus or valgus correction to unload joint)
Orthopedic orthoses

Hip

Hip compression (looks like compression shorts)
-___ injury such as hip pointers, groin, or hamstring pulls
-compression shorts
-Orthosis any sort of outside thing -girdle
-soft-tissue injury such as hip pointers, groin, or hamstring pulls
Orthopedic orthoses

Posterior Dislocation

1. Congenital
-___ Harness – keeps hips ER, and keeps head of femur in acetabulum

2. Adults
Hip-Abd Orthosis – keeps hip abducted and ER to keep femur in acetabulum
-Pavlik Harness – keeps hips ER, and keeps head of femur in acetabulum
Orthopedic orthoses: Hip

Legg-Calve-___ Disease:

1. Scottish-Rite – keeps hips abducted and rotated – walk on inside of shoe (you will look like a slut if you wear this)

2. Newington – really wide (black and white pic - looks like a split)
Legg-Calve-Perthes Disease:
Orthoses for Neurological Conditions
ok
FO

Shoe modifications:

Lifts

Metatarsal bar
-shift pressure behind MT heads

last modifications

wedges

depth changes
-accommodate orthotics

rocker bottom
ok
FO

Plastic foot-orthoses and supramalleolar (SMO)

shoes
-diabetes
-arthritis

modify weight transfer

accommodate deformities

Shoe insert – below the ankle
___ to break up clawing of toes of kids w/ lots of tone
Ridges to break up clawing of toes of kids w/ lots of tone
AFO

General indications:
-___ deformity – if its fixed, not much you can do about it
-weakness of foot and ankle
-need for stability

General ___:
-fixed deformity
-open wound
-flexible deformity – if its fixed, not much you can do about it

General contraindication:
-fixed deformity
AFO

Metal and leather:
conventional
relies on well constructed shoe
Good if you have ___, b/c fluctuating size will not fit in plastic

Used if:
plastic can NOT support the deformity
___edema
Good if you have edema, b/c fluctuating size will not fit in plastic

fluctuating edema
AFO
Plastic

May have contoured foot plate:
Dynamic AFO (DAFO) many variations
support of arch and toes with custom, contoured footplate
tone reduction
There is some ___ to the plastic, not completely rigid

___ AFO:
no support of arch or toes-no contoured footplate
There is some give to the plastic, not completely rigid

Molded AFO:
no support of arch or toes-no contoured footplate
AFO
Plastic

Solid AFO:
no ankle motion

Indications:
no control of DF
excessive knee extension
in weight bearing

Contraindications:
knee flexion contracture
need for ankle motion in development (baby – creeping, interferes w/ development)

If you lock an ankle in DF, can’t move knee– gonna get knee flexion
If you lock in PF , then you hyperextend knee – got that. If people have weakness – can accommodate for that w/ a little bit of PF.

Try the keeping your foot flat on ground, then df and pf, see what your knees do

DF assist = can be solid AFO that prevents PF, or posterior leaf spring(?)
ok
Solid Ankle AFO

Impacts the 3 rockers of gait:

1. Impaired loading response-no pf to reach foot flat-lose normal shock absorption-may get postural instability

2. Prevents forward progression of tibia over foot in midstance-terminal stance—hampers forward progression of COM-reduces step length of opposite swinging limb

3. If stiff toe plate, the extension of toes necessary for forward progression at heel rise is blocked
ok
Plastic

Hinged AFO:
allows ankle motion
amount of motion limited by a ‘stop’
usually limit ___ (does not allow foot drop, allows DF – so you can use what they have)

Indications:
___ DF
limited control DF and PF
usually limit PF (does not allow foot drop, allows DF – so you can use what they have)

Indications:
voluntary DF
Plastic AFO

Dorsiflexion assist AFO
can be a spring
conventional

elasticity of plastic

Indications:
adequate passive ROM
weakness in DF

Malleolus are free – assist w/ foot drop
If a lot of spasticity, this type will not overcome that.
Mostly taken of shelf
None of them designed to be worn without shoes
ok
Conventional
Klenzac and Double-Adjustable

(metal attached to leather shoe)

2 channels – you can adjust better, you can put a spring to help w/ DF, post to stop PF = double-adjustable
ok
Floor-___ or Ground ___ - plastic AFO

Promote knee extension
Limit dorsiflexion

Contraindications:
Fixed knee or ankle contracture

Notice anterior part is solid – for kids w/ CP who walk w/ crouched gait – helps straighten their knees by controlling DF – would not work w/ fixed contracture

If fixed contracture, serial cast to neutral, then AFO
Floor-Reaction or Ground Reaction - plastic AFO
pt. problem movies

see slide 38
ok
KAFO

Controls and aligns knee and ankle

Indications:
___ hip and trunk
when excessive movement at knee at stance that can’t be controlled by an AFO – complete spinal cord injury patients

Contraindications:
unable to meet ___ demands
lack of strength
open wounds in area of orthosis

Must have good hip control
Both legs – craigs-scott braces
Ankles set in DF, hips forward – can stand that way
Swing thru gait w/ lofstrand crutches
Able to lock and unlock the knee
Can be metal or plastic
Indications:
voluntary hip and trunk

Contraindications:
unable to meet energy demands
KAFO

Components:

An ___

uprights
-plastic or metal

hinged knee

patella pad and/or thigh band

Lock
An AFO
Craig-___ KAFO

(Dr. bishop's metal leg attached to leather shoe)

Used with SCI ___:
Swing to or thru
Designed for balance in stance
___ lock
Craig-Scott KAFO

Used with SCI bilaterally:
Bail lock
___ Control KAFOs (SCKAFOs)

Prescribed for ___ weakness
Knee is locked in extension during stance
Free knee flexion and extension in swing
Some allow resisted flexion during initial contact

Locks in extension during heel strike, and bends during swing. Looks like iron man

Rule – brace as minimally as possible
Stance Control KAFOs (SCKAFOs)

Prescribed for quad weakness
HKAFO

Indications:
___ loss of voluntary control of the trunk and lower extremities
need to stabilize the ___

Contraindications:
unable to meet energy demands – bc its heavy
Inadequate thoracic, cervical and upper extremity function
hip flexion contracture – needs full knee ext to stand

Loss of some trunk control
Indications:
full or partial loss of voluntary control of the trunk and lower extremities

need to stabilize the trunk

Contraindications:
hip flexion contracture – needs full knee ext to stand
Standing HKAFO

Spina bifida
CP
developmental delay

parapodiums
standing shells

Parapodium – standing frame to get them ready for HKAFO, or long leg brace – walked, lofstrand, then walk like penguin
ok
Walking HKAFO

Patient needs:
upper extremity and trunk strength to lift and position orthosis
ability to don and doff
ok
RGO (___-Gait Orthosis)

Uses a dual cable system
AFOS and Knee joints offset posteriorly with lateral ring locks
Rigid pelvic band
May have plastic molded TLSO attached

Anyone who has no control of legs (complete SCI – can choose this instead of craig scott.) – cables = shifts weight, step w/ other leg. Has bail lock
RGO (Reciprocal-Gait Orthosis)
HGO-___ Guidance Orthosis

Close fitting rigid body orthosis
Low friction hip joint
Fixed ankle shoe plate with 6 degrees of df
Rocker sole
Designed to reduce energy in walking & some think has better ground clearance and smoother gait than RGO

Similar to reciprocating orthosis
HGO-Hip Guidance Orthosis
Generalities:
wearing schedules
skin care – not bare skin, wear with sock
orthosis care
clean with soap and water

problems:
skin or orthosis breakdown
pain
swelling discoloration – will be red, but skin redness should go away in 15 min. If not, adjust
ok
Going to the literature

SCI:
orthoses aid standing and walking
mobility will likely be at house mobility level
-different story for incomplete SCI

profound psychological and physiological effects of weight bearing
ok
Spinal Orthoses

Effects:
trunk support
motion restriction
modification of skeletal ___

Negatives:
atrophy, weakness, dependence
discomfort
respiratory ___
Effects:
modification of skeletal alignment

Negatives:
respiratory difficulty
Common Thoracic Pathologies - Scoliosis

Etiology:
Idiopathic in 65% of cases
-infantile, juvenile or adolescent

Congenital- with vertebral and/or rib abnormalities

Neuromuscular- 10% of all cases, (CP, myelomeningocele, spinal muscular atrophy)

Myopathic (MD, arthrogryposis)

Incidence: 2% of population have > 10 degree, 0.2-0.3% have > 20 degree, 0.1% >40 degree,

50% of curves <15 degrees do not progress

Once discovered, will continue to get worse until done growing
ok
Common Thoracic Pathologies
Scoliosis

Anatomical Abnormalities:
Scoliosis is usually defined as structural or functional.
Structural does not change in postures (sit-stand)
functional one will change depending on cause.


Clinical Findings:
Frontal plane curvature noted observation
rib hump
Subjective complaints of soft tissue and/or joint pain
SOB if severe.
ok
Common Thoracic Pathologies
Scoliosis

Differential Diagnosis:
determine the scoliosis
determine whether progression will be an issue


Diagnostic Tests: x-rays with measurement of curvature.
ok
Common Thoracic Pathologies
Scoliosis

Treatment:
Medical intervention of NSAID for pain

< 20 degrees, no medical intervention only monitoring, or bracing if curve increases 5 degrees or more over 6 months

___-___ degrees bracing

>50 degrees, surgery

Controlling the scoliosis:
Exercise- no proven benefit
E-Stimulation- questionable results with curves > 30 degrees (did not work well)
Bracing - 23/24 hours of the day (1 hr for bathing and exercising)
Fusion
30-45 degrees bracing
Common Thoracic Pathologies
Scoliosis

Treating associated pain and dysfunction:
Pain controlling modalities
Mobilization of appropriate segments as needed, stability of other segments.
Restoration of ROM as tolerated
Restoration of muscle flexibility
Restoration of muscle strength of periscapular and trunk/hip stabilizers
Patient education posture, body mechanics, and fitness
ok
Scoliosis

Indications:
10-20° observe
20-30° observe, brace if progresses
___-40° orthosis
40-50° surgery—try to delay spinal fusion until child has as much trunk height as possible

Milwaukee brace -CTLSO

TLSO
result in curve stabilization
Wear 23/24 hrs/day

Milwaukee – go down to pelvis, can go to lumbar and thoracic curve. Comes up under chin, uncomfortable, pull away from brace, and straighten the spine
30-40° orthosis
Boston Brace is type of TLSO

For scoliosis. Lumbar or low thoracic curves. Must come all the way down to pelvis. Cast of patient – cannot be taken off shelf. Must readjust as child grows.
ok
TLSO

Scoliosis
post surgical fusion
post fracture

Wear t-shirt under plastic
ok
___ Hyperextension or CASH TLSO

Used for patients with ___ fxs of low thoracic and lumbar spine
Limits trunk flexion

Come off the shelf. For fractures. All back braces go down to sacrum, over the pelvis.
Jewett Hyperextension or CASH TLSO

Used for patients with compression fxs of low thoracic and lumbar spine

Limits trunk flexion
Taylor or Knight-Taylor TLSO

Taylor--limits flex/ext of thoracic and lumbar spine

Knight-Taylor –same, but also limits lateral flexion
ok
LSO – lumbo-sacral orthoses

Rigid:
post fracture
post surgery - fusion

Flexible
ok
Cervical orthoses

___ collar-does not restrict motion in any plane – rests your muscles. No fx, for comfort only

molded soft collar

poster appliances

custom molded:
halo
CTO
Soft collar-does not restrict motion in any plane – rests your muscles. No fx, for comfort only
Poster appliance - see slide 70

Halo

Halo – broken neck. Screwed into your head. Most restrictive type of cervical orthoses.
ok
Philadelphia:
CO

Aspen 4-Post:
CTO
Aspen – restricts enough motion for healing.
ok
Upper Extremity Orthoses

Purpose: Prevent/correct ___

support, protect or ___ the joint
provide ___ to a joint by relieving stress of maintaining muscle contraction
Assist weak movement
Substitute for absent movement
Transfer movement from one joint to another (e.g. tenodesis)
Assist in muscle re-education and exercise
Purpose: Prevent/correct deformity

support, protect or immobilize the joint

provide rest to a joint by relieving stress of maintaining muscle contraction
Splint design

After assessment of the patient's function or dysfunction, give careful consideration to the following:
The needs and expectations of the patient
Position
Areas to be supported
Distribution of support
Total contact?
Small area of support?
ok
Areas to be exposed
Exposure of sufficient tactile surface for sensory input
Points and directions of forces
Movements which may be restricted by the splint
Ease of application and removal of splint

An effective method of determining the above factors is as follows:
use your own hands to simulate the support, position and forces to be exerted by the splint
ask patient to perform desired movements
if a particular splint may meet some needs and not others, consider providing more than one splint for differing purposes
ok
Principles of wrist/hand splinting

Mechanical considerations:

apply force ___ to the segment

use leverage

disseminate the applied force

minimize friction
apply force perpendicular to the segment
Principles

Anatomic considerations:
accommodate bony ___
use skin creases
maintain ___ – keep hand in functional position

Kinesiological considerations:
allow full motion at non affected joints
ie MCPs when immobilizing the wrist
accommodate bony prominences
maintain arches – keep hand in functional position
Wrist/hand splints:

post-fracture

tendonopathies
-tennis elbow

carpal tunnel

instability of wrist

arthritis:
OA
RhA – rheumatoid arthritis
ok
Static:
immobilize and protect
allow tissues to rest

Dynamic:
control motion
allow motion
substitute for muscle
ok
Elbow

Splints designed to dial in motion
ok
Shoulder

Post-injury
Post-surgical
ok
Shoulder

Post-injury:
Fracture
Return to play
Post dislocation
ok