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75 Cards in this Set

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What are two main purposes of orthotics?
1. Stability
2. Support
What are two purposes of orthotics as they relate to ROM?
To either restrict or improve ROM
Who is involved with deciding what type of orthotic a patient gets? and why?
-Patient/family, need committment from them
-MD or Orthosurgen
-PT/OT, category of orthotic, to address the needs of strength, ROM and why we want an orthotic
-Orthotist to see what kind of support they want, type of material, casts patient
What are some indications as to why someone would need an orthotic? Also list specific diagnosis
-Paresis or weakness
-Spasticity
-Paralysis, no active control
-Stabilize frxs
-CVA, MD, CP, SB, SCI
What is important when fitting someone for spinal orthoses?
Important to capture the iliac crests, position them so there is no rotation
Name three types of Cervical Orthoses.
1. Halo
2. Philadelphia collar
3. Soft collar
When would a halo be used?
To get maximum stability and minimum mobility
What is a Philadelphia collar?
A rigid collar to decrease flex/ext. Makes rotation difficult. Can be cut out for a trake.
When would a soft collar be used?
For muscle spasms, soreness or for comfort. No used to restrict movement.
What are three types of thoracic orthoses?
1. Thoracic Lumbar Sacral Orthoses
2. Boston Orthosis
3. Milwaukee
Describe a TLSO
Neopriene that captures the iliac crests and allows for hip flexion. Must wear a tshirt under it.
What is a Boston Orthosis used for? Specific conditions.
-Scoliosis
-OA of the spine
-Spinal Frx
What is a Milwaukee orthosis used for, specific conditions? And what does it look like?
-Idiopathic scoliosis
Has a pad for mandible, and occiput for maximal Cspine extension.
What is a turtle shell? What condition is it used for?
Attaches on patients side. Must do a log roll. Used for adults with a thoracic frx or a spinal cord injury.
Name a type of Lumbar orthosis. Type of support provided?
Corset used as a reminder not to bed at back. Provides little to no support.
In determining what type of LE orthosis is necessary, what should a PT be looking at? Specific areas?
Strength/ROM/weakness/tone and how these affect gait.

Look specifically at hip, knee and ankle. Look at each joint and what mvmt. is available.
What is a type of Hip orthoses and what does it look like?
Hip, knee, ankle, foot orthosis. HKAFO

Controls motion at hip, knee and ankle. Has a pelvic/hip band, not used for functional mobility. Has locks that patient controls or are controlled by weight shifting.
Who would be prescribed a HKAFO? And why?
Adult with a spinal cord injury, children w/ midthoracic spinal cord injury or CP. Used in the home, provides lots of support and stability. Used to increase ROM, strength and bone integrity.
What is a KAFO, why is it used and what is it good for?
Controls motion at the knee and ankle. Must have active hip control.

Used in adults with paraplegia, knee joint instability, children with MM.
What is a special feature that a KAFO could have?
Knee control method with a drop ring lock. But with patients with hypotonia, no locks.
What do you have to have control over if you have an AFO?
Hip and knee motion
What types of movements can an AFO prevent?
Limits PF/DF as well as prevent genu recurvatum at the knee via preventing PF
Aside from preventing motion, what motion can an AFO assist with?
Dorsiflexion
How does an AFO prevent genu recurvatum of the knee?
Prevents PF by making the orthoses in 2-3 degrees of DF
Where does an AFO extend to? (anatomically)
Extends from the shoe to below the knee
When is an AFO contraindicated?
If the ankle cannot be brought into the neutral position passively in a non wt. bearing position. This means there is a PF contracture and an AFO is contraindicated. Must be able to obtain neutral position passively prior to AFO.
What types of diagnoses would you expect to wear an AFO?
CVA, TBI, Peripheral Neuropathy, CP
What is a posterior leaf spring AFO helpful for? Describe it in general.
Assists with DF in swing phase of gait.

It's plastic and springy. Not much stability. Keeps ankle in neutral position. Typically can get it off the shelf.
Who would a posterior leaf spring AFO be good for?
CVA patients w/ DF weakness and little to no extensor spasticity.
What does a hinged AFO assist with?
Assists/restricts sagital plane movements of DF and PF.
What is a modification that a hinged AFO could have? How does it work? Prevents what?
Posterior stop to limit PF, but allows free DF. Imposes a flexion force at knee during early stance and prevents genu recurvatum.
What are some indications for using a hinged ankle AFO?
To allow for DF strengthening during ambulation while preventing PF spasticity.
Who would benefit from a hinged AFO?
Anyone that has some ankle strength, but not enough. CVA and CP
What does a solid AFO do?
Provides medial/lateral and sagital plane stability. There is NO MVMT AT ANKLE!!
Why would someone need a solid AFO?
If they have wekness at the knee. To control PF spasticity. If they have a severely unstable foot/ankle.
What types of diagnosis would you expect to see a solid AFO?
Spinal bifida to control the foot.
When would you NOT want to use a solid AFO?
If they have some strength, a solid AFO doesn't allow them to use the muscle and it will atrophy.
What is a double upright AFO?
It has a shoe attached with 2 metal braces along side of the joint.
Why would you use a double upright AFO?
Less contact with the skin, good for patients that have EDEMA or POOR SENSATION.
What types of diagnosis would you expect to see a double upright AFO used?
Diabetes, peripheral neuropathy and fluctuating edema.
What is a DAFO? What mvmts does a DAFO allow?
Pediatric AFO that is dynamic, more flexible material. Allows some DF, and some rotation, no PF.
Name three additions to a DAFO and what they are used for.
-Elastic strap to help w/ weak quads.
-Leaf Spring to assist DF
-Foam inside to help avoid pinching
What are some reasons you would prescribe a DAFO?
-Stretch PF
-Work on sit to stand
What are three ways you check alignment of an AFO?
1. Scope down the toe
2. Scope down the shaft of leg to heel
3. Look at arches
What does SMO stand for? What mvmts does it control?
Supramalleolar orthotic. Controls medial/lateral (pron/supin) stability, NOT sagital DF/PF. Free PF/DF
What is the theory behind a SMO?
Control the joint by stabilizing the joint above it.
What diagnosis would you use a SMO?
Down's syndrome, hypotonia.
What is posting and why is it used?
Padding on the outside of the brace. Used to keep the splint verticle and control valgus and varus.
Why are night splints or resting splints used?
For a prolonged stretch to the gastroc/soleus. Can have straps to create a PF stop.
How long can a child wear night splints and what is occuring physiologically?
Can wear up to 6 hours. Makes changes to the sarcomeres.
What are Floor Rxn Orthosis and are they specific to adults or pediatrics?
Pediatric specific. They control CROUCH walking by having a DF stop and not allowing much PF.
Shoe inserts are used for what diagnosis? Describe the support.
Used for spina bifida, no PF and weak quads. Support is rigid, comes in from behind the foot and has no calcaneous control.
What are hot dogs? Who are they used on?
Components of arches, an insole. 2-3 or younger children who pronate. Can be plastic with lips.
What type of orthosis is used for JRA?
CUSHIONING insoles w/ arches. Controls pronation.
What are twister cables and why are they used?
Pelvic band with cables that attach to AFO's. Prevent intoeing and promote ER.
Why would total contact orthosis be used?
Someone with osteogenesis imperfecta, frequent frx.
What is a Pavlik harness and why is it used? What ages?
Used for developmental dysplasia of the hip. Strap around shoulders, around hip and around foot. Puts child in ER, hip flex and abd to get femur into acetabulum.

Birth to 8/9 months.
What type of wearing schedule would you suggest after prescribing orthosis?
Have time on and time off. Start slow with 1-2 hours for a couple of days and slowly increasing. Also can start just at night for positioning or just during ambulation. Don't start w/ all day wear. Progress over 2 weeks.
What precautions do you have to consider with orthosis?
Skin breakdown, especially over bony prominences like the calcaneous, malleoli and navicular. Look for redness lasting more than 5 minutes.

Ensure proper fit.
What types of things should a PT assess when deciding to prescribe orthodics?
-Gait, deviations
-Strength
-AROM/PROM of knee or ankle
If a patient doesn't have active hip control, what type of orthotic will you prescribe?
HKAFO w/ no community ambulation
If patient has active hip control, but no active knee control, what type of orthotic?
KAFO
If patient has active ankle control, what type of orthotic?
Foot orthotic
If patient has active knee control, what type of orthotic?
AFO
If patient does not have active ankle control, what type of orthotic?
Either an AFO or SMO
If a patient needs sagital and medial/lateral support, what type of orthotic?
solid AFO or hinged with a stop
If a patient only needs medial/lateral support, what type of orthotic?
SMO
If a patient has a foot slap or ft. clearance problem, what type of orthotic?
Indicates either DF weakness or PF spasticity.

Posterior Leaf Spring
If a patient is toe walking, what type or orthotic?
May have pes equinus, extensor spasticity or a short leg.

AFO either solid or hinge with posterior PF block
If a patient has trouble with pronation and supination instability, what type of orthotic?
SMO
If a patient is hyperextending their knee, what type of orthotic?
Indicates knee muscle imbalance, ligament laxity, extension synergy pattern and possibly pes equinus.

Prescribe a AFO with a PF block or a KAFO.
If a patient has lateral trunk bending or a Trendelenburg gait, what type of orthotic?
Possible contralateral hip ABD weakness. HKAFO.
55 y.o. CVA patient has R DF weakness and genu recurvatum. No LE spasticity or extensor pattern is noted. What type of orthotic?
Hinge AFO that utilizes the patients DF, but limits PF, which will limit knee hyperextension.
2 y.o. w/ toe walking and bilateral PF spasticity during gait. Assume some DF strength. What type of orthotic?
Don't use a solid AFO because the child will not be able to use her DF strength. Also it's heavy and bulky.

Hinge w/ PF stop, allows use of DF and is rigid.

DAFO is flexible in all ranges except PF. Allows DF and some rotation, but no PF.

Don't use Posterior leaf spring because it allows for some PF and not rigid enough.
Why would you use a AFO w/ a posterior stop vs a solid AFO?
A Hinge AFO w/ posterior stop will utilize DF if they have it, a solid will not. Solid is heavy and bulky.