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MVMT SCI II > LE and spinal orthoses > Flashcards

LE and spinal orthoses Flashcards

1
Q

Why is an orthotic used?

A

-to address pathological symptoms

-control motion, pain, or deformity

MOTION
-by stopping, limiting, or assisting at a specific joint or position

PAIN
-by limiting or stopping motion, or by reducing stress to a joint through support or through shock-reducing cushion

DEFORMITY
-by supporting an existing deformity and preventing it from progressing
-by altering the position of the deformity to what is considered natural

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2
Q

Goals of an orthotic

A

meets the individual mobility needs and goals

maximizes stance phase stability

minimizes abnormal alignment

minimally compromises the swing phase

pre-positions the limb for initial contact

ensuring the device will work with patient’s preferred assistive device

-can be worn for long periods without damaging the skin or causing pain
-can be easily donned and doffed

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3
Q

Basic principles of orthoses

A

-balanced parallel force system used to control joint motion

-one corrective force and two stabilizing forces (three points of force application)

-the larger the corrective force, the larger SA required for force application

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4
Q

Classification of orthoses:

A

They are named for the joints that they cross

FO
AFO
KAFO
HKAFO
KO
HO

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5
Q

Foot orthoses facts

A

-rigid, semi-rigid, or flexible
-custom fabrication and off-the-shelf

-subtalar joint support (frontal plane)

-fits into shoes/low profile

INDICATIONS
-pes planus (pronation)
-pes cavus (supination)
-plantar fasciitis
-heel spurs
-metatarsalgia
-mild-moderate calcaneal varus/valgus
-mild-moderate midfoot deformity
-laxity
-diabetic neuropathy

OPTIONS
-full length/partial length (consider discrepancy in leg length)
-material: soft vs firm
-reinforcement
-off-loading

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6
Q

What is a UCBL orthotic?

A

TYPE: FO

-thermoplastic
-custom

-controls calcaneus and midfoot
–transverse plane
–frontal plane

**MOST CORRECTIVE FO

INDICATIONS:
-flexible moderate pronation/calcaneal deformity
-moderate deformity
-plastic materials (range of rigid support)
-require larger/wider shoe size

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7
Q

SMO facts

A

Type: FO

-plastic
-custom

-controls calcaneus, midfoot
–transverse plane
–frontal plane

-ankle support
–frontal plane

-allows free DF and PF

-rigid outer surface and a more flexible material inside

INDICATIONS:
-ankle instability (frontal plane)
-flexible calcaneal and midfoot deformity (frontal, transverse)
-moderate-severe deformity
-visible above shoe line

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8
Q

Types of AFOs

A

solid AFO

semi rigid

articulated (joint)

GRAFO - ground reaction

PLS AFO - posterior leaf spring AFO

Arizona

CROW

Richie Brace

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9
Q

Universal AFO fitting goals

A

-increase ankle stability
-improve cadence
-increase balance/step length
-limit foot drop
-increase knee stability
-limit genu recurvatum (hyperextension)
-create heel to toe gat pattern
-guided control in 3 planes

-increase PT confidence and increase endurance and decrease fatigue

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10
Q

Metal AFO facts and indications

A

-aluminum sidebars attached to a standard shoe
-leather or metal calf band

-custom

-articulation at ankle (hinge)
–> free motion
–> limited motion
–> assisted DF and PF

controls ankle motion in sagittal plane

INDICATIONS
-ankle motion management (sagittal plane)
-edema (if there is constant fluctuating volume) –> need to avoid thermoplastic device

CONS
-increased weight
-more time for fabrication
-increased maintenance

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11
Q

PLS-AFO facts and indications

A

posterior leaf spring orthosis

-thermoplastic material
-custom and off the shelf

-posterior plastic strut has material flexibility
–> sagittal plane

-footplate suport
–> transverse plane: midfoot
–> promotes weight acceptance at initial heel contact
–> keeps angle of ankle at 90 degrees

INDICATIONS
-**drop foot
-tib ant. weakness
-DF paralysis
-lightweight
-low profile
-off the shelf options
-minimal foot deformity

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12
Q

Dynamic carbon fiber AFO facts and indications

A

-carbon fiber material

-off the shelf, some custom

-energy storing in sagittal plane

POSTERIOR PANEL VS ANTERIOR PANEL
-anterior for PF weakness
-posterior panel for DF weakness

INDICATIONS
-thin, lightweight
-low profile
-can be used for dropfoot
-DF or PF weakness
–CVA
–MS
–neuropathy

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13
Q

SA- AFO facts and indications

A

“solid ankle foot orthosis”

-thermoplastic or carbon materials

-custom

-trimelines are anterior to malleoli

-fixed ankle for all phases of gait

3 planes of control
-sagittal –> stability
-frontal –> support
-transverse –> support

INDICATIONS
-low tone
-potential or complete paralysis of gastroc or soleus
-mild instability of knee
-deformities of the ankle (varus, valgus)
-contracture/spasticity management
-traumatic LL injury with pain

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14
Q

Ground reaction AFO facts and indications

A

-thermoplastic materials

-custom

-padded anterior tib section

-knee extension moment in stance (pushes tibia back)
–sagittal plane

-ankle support
–frontal plane
–transverse plane

INDICATIONS
-crouch gait
-quad weakness 3-/5
-knee instability
-weak PFs

CONTRAINIDCATIONS
-genu recurvatum
>20 degrees knee flexion contracture

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15
Q

Articulated AFO facts and indications

A

-thermoplastic or carbon

-custom fabrication

-ankle articulation

OPTIONS
-dorsiflexion assist
-PF/DF stop

Three planes of control
-sagittal plane controlled motion
-frontal plane support
-transverse plane support

INDICATED
-drop foot
-need for natural ankle motion
-medial/lateral ankle instability
-varus/valgus deformity
-plantarflexion contracture

CONS:
-allowing motion reduces control;
-ankle joints add bulk and weight
-poor cosmesis

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16
Q

AFOs with inner booties facts and indications

A
  • 2 different thermoplastic materials

-custom fabrication

-inner molded soft bootie

-rigid AFO outer plastic

INDICATIONS
-severe ankle deformity
-bony prominences
-sensitive skin, sensory issues
-need for rearfoot or frontal plane control
-pressure distribution of dorsal strap

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17
Q

Arizona AFO: leather ankle Gauntlet facts and indications

A

-leather gauntlet reinforced with plastic, lace up

-custom molded

**designed to immobilize

-frontal plane support
-adjustability for edema management
-low profile increased comfort solid ankle and articulating styles

INDICATIONS
-posterior tibia tendon dysfunction
-tendonitis
-ankle arthritis
-DJD
-chronic sports injuries

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18
Q

CROW - charcot restrain orthotic walker

A

Type: AFO

-thermoplastic with custom soft foam liner and insert
-rocker bottom
-requires shoe lift for CL side

PLANES OF SUPPORT
-sagittal
-frontal
-transverse

** common for diabetic patients

INDICATIONS
-charcot joint - is a syndrome in patients who have peripheral neuropathy, or loss of sensation, in the foot and ankle–> leads to greater risk of fracture
-chronic diabetic ulcers
-ischemic necrosis
-fracture management

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19
Q

Richie brace facts and indications

A

TYPE: AFO

INDICATIONS:
-PTTD (mild to moderate)
-lateral ankle instability
-peroneal tendinopathy
-cavo-varus deformity

FEATURES:
-semi-rigid support
-control of 1st ray, midtarsal, and subtalar joint
-control of ankle inversion/eversion
-unrestricted sagittal ankle motion

20
Q

PRAFO: pressure relief ankle foot orthosis facts and indications

A

-soft padded fabric/lambswool, plastic reinforcement PLS

-off-the-shelf

SUPPORT:
-sagittal plane support of ankle position
-transverse plane support of the hip position

-no posterior heel contact

-adjustable

INDICATIONS
-supine bedrest
-prevent PF contractures
-maintain neutral hip rotation while supine–>plastic stoppers that prevent internal rotation
**not intended for ambulation

21
Q

KO - knee orthosis, ACL, or unloader facts and indications

A

MATERIAL: composite, metal, carbon graphite, titanium knee hinges

-can be custom or off-the-shelf

SUPPORT:
-sagittal (flexion/extension stops)
-frontal
-transverse (limited)

-lightweight

INDICATIONS:
-ACL, PCL, MCL, LCL instabilities
-high-intensity athletic activities
-OA, offloading support

22
Q

Post-op knee braces

A

-fabric reinforced with metal uprights in specific ROM position

-off-the-shelf

SUPPORT –> Limited ROM allowed
-sagittal
-frontal

-immobilizer
-Short-term use

23
Q

KAFO facts and indications

A

MATERIAL
-thermoplastic with metal, carbon fiber, metal, and leather

SUPPORT:
-sagittal
-frontal
-transverse

Variety of joint types and function
-torsion/contracture management
-stance control
-C-brace (microprocessor)

INDICATIONS
-when stability during stance cannot be provided by AFO
-when hyperextension of the knee impacts joint integrity
-varus/valgum is present
-genu recurvatum
-hamstring/quad weakness or paralysis
-spastic/flaccid paralysis of the lower limb
–> ex: post-polio syndrome

PART TIME USE
-stance/ambulation therapy
-contracture management

CONS
-increased weight and bulk

24
Q

Hip orthoses facts and indications

A

MATERIAL
-thermoplastic pelvis and thigh cuff with metal hip joints, fabric/foam lined

-custom or off-the-shelf
-unilateral or bilateral

SUPPORT PLANES
-frontal plane (abduction/adduction control)
-sagittal plane (hip stops)

INDICATIONS
-Legg-Calve Perthes, developmental dysplasia of the hip, post-surgical, hip dislocation

25
Q

SWASH facts and indications

A

“sitting, walking, and standing hip orthosis”

TYPE: HO

Material: Thermoplastic hip and thigh cuffs, metal uprights that allow motion through a specific range

-off-the-shelf

-pediatric

SUPPORT:
-maintains hip abduction (frontal plane)
-limits adduction while sitting, standing, walking
-free flexion-extension ROM of the hip (sagittal plane)

INDICATIONS
-spastic hemi/di/quadriplegia
-hip adduction tone
-post botox
-risk of hip displacement
-gait scissoring
-allows motion and ambulation

26
Q

HKAFO/RGO:

A

RGO: reciprocating gait orthosis

MATERIAL
-thermoplastic with metal joints nd metal uprights

-custom

PLANES OF CONTROL (hip knee ankle)
-sagittal
-frontal
-transverse

RGO:
-reciprocating pelvic attachment allows reciprocal gait pattern
–> Need trunk rotation/strength

INDICATIONS
-part-time use for stance and ambulation (therapy)
-myelomeningocele
-spina bifida
-paraplegia
-spinal cord injury (C8-T12)

CONS
-increased bulk and weight
-expensive

27
Q

Cranial remolding orthoses facts and indications

A

MATERIAL: thermoplastic with foam liner

-custom

-cranial growth-dependent remodeling

INDICATIONS
-plagiocephaly
- brachycephaly
-scaphocephaly
-cranial deformation secondary to torticollis
-post op craniosynostosis
-ages 4-12 months

** good outcomes but poor insurance coverage

28
Q

Fitting goals for spinal orthoses

A

-substitute/assist axial muscle actions
-function as a kinesthetic reminder
-protect anatomical structures
-prevent/reduce pain
-prevent progression of condition
-reduce severity of deformity

29
Q

Soft cervical collar facts and indications

A

-soft foam
-off shelf

SUPPORT:
-sagittal
-frontal

-easy don/doff, velcro

-inexpensive

INDICATIONS
Soft tissue injuries
Hyperextension/flexion injuries
Post-surgical Fusion
Mild cervical arthritis/nerve pain

30
Q

Philadelphia cervical collar facts and indications

A

-lightweight foam
-off-the-shelf

SUPPORT:
-moderate C2-C5
-thoracic extension: C6-T2
–> sagittal plane
–> frontal plane
–> transverse plane

*tracheotomy access

INDICATIONS
-post-surgical application
-trauma, fractures
-immobilization for cervical metastasis
-cervical arthritis
-degenerative diseases

31
Q

Miami J cervical collar facts and indications

A

MATERIAL: plastic, fabric-padded removable liners, two pieces, velcro closure

-off shelf

SUPPORT:
-moderate C2-C5
-thoracic ADDITION: C6-T2 (upper thoracic)
–> sagittal plane
–> frontal plane
–> transverse plane

MRI compatible

INDICATIONS
Post surgical application
Stable cervical spine injuries
Degenerative diseases
Cervical arthritis

32
Q

CTO/Minerva

A

CTO- cervical thoracic orthoses

“Minerva”

MATERIAL: Thermoplastic, fabric pad lining, metal uprights

-off shelf
-can be applied while the patient is in supine in the hospital

RIGID IMMOBILIZAITON C3-T2
-sagittal (flexion and extension)
-frontal

INDICATIONS
Stable cervical fractures
Post-surgical application
Immobilization for cervical metastasis

33
Q

SOMI: sternal occipital mandibular immobiler

A

MATERIAL: Metal uprights with foam lining, straps

-off shelf

Rigid immobilization C2-C7
-sagittal (mostly flexion)
-frontal plane (mild)
-transverse plane

INDICATIONS
-stable displaced fractures
-cervical disc immobilization
-post-surgical immobilization

34
Q

HALO

A

MATERIAL: Thermoplastic vest with fabric liner, metal uprights, titanium skull pins

MAX immobilization of C1-C3
-sagittal
-frontal
-transverse

-pinless option available (less infection)

INDICATIONS
**UNSTABLE C spine fractures
-dens type I, II, III of C2
-C1 with rupture of transverse lig
-SCI
-post-surgical management

CONS
-risk of infection at pin sites, scarring

35
Q

LSO

A

MATERIAL: Thermoplastic shell, soft foam liner

Custom fabrication or off-the-shelf

THREE PLANES OF CONTROL:
-L1-L5
-sagittal, frontal, transverse

-bivalve (two pieces, front and back)

Trimlines:
* sub scapula
* xyphoid process
* Sacrum
* Contain ASIS for pelvic control

INDICATIONS:
Post-surgical immobilization
Low back pain management
Compression fractures
Non-surgical disc treatment
Obese patients
Laborious work

-IMMOBILIZATION OF:
-flexion/extension
-some rotation and side bending

36
Q

BOB- Boston overlap brace anterior overlap LSO

A

MATERIAL: Thermoplastic, variable flexibility/rigidity, lined or unlined

custom fabrication

SUPPORT:
-sagittal
-frontal
-transverse

-overlap closure anteriorly

IMMOBILIZATION: L3-L5 (lower lumbar) through abdominal compression (hydrostatic loading) (hydrostatic load on soft tissue/organs helps to reduce load through axial skeleton

Trimlines:
* Posterior sub scapula
* Xyphoid process
* Distal sacrum
* Contain ASIS for pelvic stabilization

INDICATIONS:
Post surgical immobilization
Low back pain management
Compression fractures L3-L5
Non-surgical disc treatment
Disc disease
Spondylosis, Spondylolysis, Spondylolisthesis
Anti-lordotic posturing

37
Q

CASH- cruciform anterior spinal hyperextension

A

MATERIAL :
-aluminum uprights with foam pads, straps
-off shelf
-lightweight, anterior design

SUPPORT
-flexion limited T6-L1 (maintain extension)
–> sagittal plane

INDICATIONS
-anterior compression fractures (anterior column burst fracture)
-mild kyphosis
-frail patients in need of minimal support
-reduction of kyphosis in OA

38
Q

Jewett Hyperextension Brace

A

MATERIAL
-Aluminum uprights with foam pads, straps
-off-the-shelf
-Lightweight, anterior design, easy donning

SUPPORT
-flexion limited T6-L1

INDICATIONS
Anterior compression fractures T6-L1 Burst fractures
Post Surgical Immobilization
Mild kyphosis
Frail patients in need of minimal support
Reduction of kyphosis in osteoporosis

39
Q

Soft TLSO hyperextension corset

A

-Fabric/elastic with rigid thermoform reinforcement, more comfortable
-off the shelf

POSTURAL REMINDER- limits thoracic flexion in the sagittal plane

-good cosmesis, lightweight

INDICATIONS:
-Geriatric kyphosis
-Stable anterior thoracic compression fractures
-Accommodates frail individuals
-More comfortable for the elderly

40
Q

Lumbar-sacral corset

A

-Elastic or neoprene, plastic or metal reinforcement, moldable stays, off-the-shelf

-mild-mod support:
– > sagittal (flexion and extension)
–> abdominal compression (hydrostatic loading)

INDICATIONS:
-LBP

41
Q

SI belt

A

-1.5-2” wide elastic webbing and posterior pad
-off the shelf
-low profile
-pressure on SI joint

INDICATIONS
-SIJ pain
-SIJ subluxations
-pregnancy SI support

42
Q

TLSO

A

MATERIAL: Thermoplastic, many design variations
-bivalved (straps on both sides)
-lateral opening
-anterior/posterior opening
-lined/unlined
-may have struts
-flexible/rigid plastic
-intimate, total contact
-can have openings for feeding tubes, etc

-custom

SUPPORT:
-sagittal plane
-frontal plane
-transverse

Trimlines:
-sternal notch, the spine of the scapula

INDICATIONS
Post-surgical immobilization Unstable/Stable fracture management T3- L3
Pain management
**Can include hip joint & thigh cuff for lower lumbar stabilization
** can also include cervical attachment (CTLSO)
Neurologic injuries
Custom for atypical shapes

*TYPICALLY NEED ASSISTANCE FOR DONNING

43
Q

TLSO for scoliosise

A

-Thermoplastic with padding, additional padding for corrective forces

-custom

-design depends on the curve

SUPPORT
-sagittal
-frontal
-transverse

DOSE: hours per day

INDICATIONS:
-curves with apex T8 and below
-curves > 25 degrees
—> consider age of patient and growth
–> consider skeletal immaturity
- non-surgical intervention

GOALS:
-50% correction
-prevent progression of curve

44
Q

CTLSO: Milwaukee scoliosis brace

A

-thermoplastic pelvic section
-Anterior & posterior uprights (aluminum) -Neck ring
-padding at apex/strapping

-custom, time-consuming to produce

PLANES:
-sagittal, frontal, transverse

INDICATIONS:
-treatment of curves with apex above T8

CONS:
-outdated
-low compliance

45
Q

Night-time bending brace for scoliosis

A

-Thermoplastic, foam lining

-Anterior opening

-Custom fabrication

SUPPORT:
-sagittal (curve)
-frontal plane (lordosis, kyphosis, rotation)
-transverse plane

-only worn at night

TYPES: Charleston Bending brace, providence brace

INDICATIONS
-Idiopathic Scoliosis, Single Curves,
-Curvature of 25-40 degrees

CONS
-low compliance

MVMT SCI II (9 decks)

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