-O08 Emily Station 6

Question 0

Dynamic wilmer elbow orthosis

Answer 0

Spring mechanism counteracts gravity and enables flexing of elbow
Limited movement is sufficient to initiate flexion
No locking mechanism incorporated

Question 1

Erbs palsy

Answer 1

Mainly occurs during birth whilst moving through birth canal
Neck and shoulders stretched too far apart
Forced delivery
Large birth weight
Excessive weight gain in pregnancy

Question 2

Steeper stanmore orthosis

Answer 2

Weight of arm taken onto shoulder yoke via universal type shoulder joint
Locking elbow joint
Possibility of using prosthetic td
Can have custom made forearm and shoulder section

Question 3

New design for brachial plexus

Answer 3

Silicone humeral cuff with leather shoulder yoke
Custom made elbow orthosis
-made with grp and carbon fibre
-seaflex liner
-ottobock locking joints

Cast over silicone sleeve
Cast at 90degrees elbow flexion
Force system to resist elbow extension
Severe modification 
No additional supporting straps

Question 4

Advantages if new design for brachial plexus

Answer 4

Lightweight
Improved cosmesis
Allows free movement at glenohumeral joint
Increased comfort
Less material in contact with skin
-reduces sweat

Question 5

Disadvantages of new design for brachial plexus

Answer 5

More time consuming to donn/doff silicone sleeve
Difficulty adjusting strap tension with one hand
Reduced support/control at shoulder

Question 6

Further treatment of brachial plexus

Answer 6

Glenohumeral arthrodesis
Trans humeral arthrodesis

Amputation

• bpi patients with fused shoulders make poor users of functional prosthesis
• cosmetic benefit of own arm

Question 7

Erbs palsy incidence

Answer 7

1/1000 births-downs syndrome
2-3/1000 births- cp
1/3500boys - muscular dystrophy 
1/1000 births -spina bifida
3/1000 births -erbs palsy

Question 8

Realistic goals for erbs palsy

Answer 8

Bringing affected hand to mouth for feeding

-use affected arm for opposition

Question 9

Erbs palsy presentation

Answer 9

Waiters tip
Arm
-internally rotated
-adducted
Wrist 
-flexed
Depends on level of lesion

Question 10

Erbs injuries

Answer 10

In many cases are self resolving with full recovery
-80-90% spontaneously recover

No significant recovery in 3 months-surgery

Question 11

Orthotic aims of erbs palsy

Answer 11

Prevent and reduce deformity

Improve functional position of hand

Question 12

Orthoses used for erbs palsy

Answer 12

Dynamic elbow joint
Rachet elbow joint
Custom made sleeping orthoses to stretch out

Question 13

Sling for bpi

Answer 13

Can lead to elbow flexion deformity
Prevents shoulder subluxation therefore decreases pain
May cause neck problem
Cheap and easy to apply

Question 14

Cuff (shoulder) for bpi

Answer 14

Good for c5/c6 injury who still have hand and elbow function
Many off the shelf designs
Prevents shoulder subluxation and pain
Does not control elbow or hand

Question 15

Wilmer shoulder orthosis for bpi

Answer 15

Downwards strap acts as a fulcrum(where rotation occurs)
-weight of forearm pushes humerus upwards and into shoulder joint
Quick and easy to fit
Not possible for patient to move elbow joint
Orthoses actively forces humeral into glenohumeral

Question 16

Wilmer elbow orthosis for bpi

Answer 16

Simple elbow joint placed medially
Apply forces to resist elbow extension
Elbow can be placed in different degrees of flexion
No shoulder support
May need glenohumeral arthrodesis as shoulder not supported
Automatic locking mechanism