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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
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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) |
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team approach
Patient, MD, orthotist, nursing, OT, PT, social worker, psychologist, neurologist, nutritionist |
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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 |
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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) |
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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 |
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Active ankle brace
-Allows PF and DF; discourages inversion -Popular in ___ sports |
-Popular in jumping sports
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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
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Orthopedic orthoses: Ankle
Controlled ankle motion (boot) -adjustable ROM -‘___ bottom’ -Fxs, post surgical, -severe ankle sprains |
-‘rocker bottom’
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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
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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 |
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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
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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
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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 |
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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? |
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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
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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) |
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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
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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
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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:
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Orthoses for Neurological Conditions
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FO
Shoe modifications: Lifts Metatarsal bar -shift pressure behind MT heads last modifications wedges depth changes -accommodate orthotics rocker bottom |
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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
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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 |
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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 |
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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 |
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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(?) |
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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 |
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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 |
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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 |
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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 |
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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
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pt. problem movies
see slide 38 |
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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 |
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KAFO
Components: An ___ uprights -plastic or metal hinged knee patella pad and/or thigh band Lock |
An AFO
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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 |
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___ 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 |
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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 |
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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 |
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Walking HKAFO
Patient needs: upper extremity and trunk strength to lift and position orthosis ability to don and doff |
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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)
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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
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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 |
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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 |
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Spinal Orthoses
Effects: trunk support motion restriction modification of skeletal ___ Negatives: atrophy, weakness, dependence discomfort respiratory ___ |
Effects:
modification of skeletal alignment Negatives: respiratory difficulty |
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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 |
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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. |
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Common Thoracic Pathologies
Scoliosis Differential Diagnosis: determine the scoliosis determine whether progression will be an issue Diagnostic Tests: x-rays with measurement of curvature. |
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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
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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 |
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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
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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. |
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TLSO
Scoliosis post surgical fusion post fracture Wear t-shirt under plastic |
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___ 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 |
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Taylor or Knight-Taylor TLSO
Taylor--limits flex/ext of thoracic and lumbar spine Knight-Taylor –same, but also limits lateral flexion |
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LSO – lumbo-sacral orthoses
Rigid: post fracture post surgery - fusion Flexible |
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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
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Poster appliance - see slide 70
Halo Halo – broken neck. Screwed into your head. Most restrictive type of cervical orthoses. |
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Philadelphia:
CO Aspen 4-Post: CTO Aspen – restricts enough motion for healing. |
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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 |
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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? |
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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 |
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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
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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 |
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Wrist/hand splints:
post-fracture tendonopathies -tennis elbow carpal tunnel instability of wrist arthritis: OA RhA – rheumatoid arthritis |
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Static:
immobilize and protect allow tissues to rest Dynamic: control motion allow motion substitute for muscle |
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Elbow
Splints designed to dial in motion |
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Shoulder
Post-injury Post-surgical |
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Shoulder
Post-injury: Fracture Return to play Post dislocation |
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