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PTRS 746 > LE, UE, Spinal Orthotics > Flashcards

LE, UE, Spinal Orthotics Flashcards

1
Q

What is a PRAFO stand for?

A

Pressure Relieving Ankle Foot Orthosis

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2
Q

What is a PRAFO indicated for?

A

Contracture prevention and pressure prevention caused by:
Neuro involvement (CVA, SCI, TBI)
Orthopedic (hip fracture, amputation)
Long term immobility (ICU)

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3
Q

What is the main orthotic principle?

A

3 point pressure system

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4
Q

What are design considerations for orthotics?

A

diagnosis, prognosis, comorbidities, height, weight, cost, cosmesis, degree of deformity, degree of correction, musculoskeletal factors, mobility requirements, stability requirements, anticipated functional level

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5
Q

What are the 5 trim lines?

A 
Proximal (focuses on knee)
Anterior (determines motion at ankle)
Ankle
Foot (medial and lateral stability)
Metatarsal (effects push off, if behind MT heads you'll have more rocker but less push off, if past toes it extends push off)
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6
Q

What do you evaluate as a PT for orthotics?

A

Functional ROM: midtarsal, subtalar, talocrural, knee, and hip joints
Functional Muscle Strength: focus on general LE muscle groups

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7
Q

What do you look at for foot alignment?

A

Supination, pronation, skeletal deviations

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8
Q

What do you look at for ankle alignment?

A

foot drop, medial/lateral instability, plantarflexion contracture

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9
Q

What do you look at for knee alignment?

A

Flexion, genu recurvatum, genu varum, genu valgum

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10
Q

What is the foundation of any orthotic?

A

SHOES

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11
Q

What are characteristics of prefabricated AFOs?

A 
"off the shelf"
limited fit and function
mild involvement
temporary use
diagnostic procedures
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12
Q

What are custom fit orthotics?

A

prefabricated device modified to fit a specific patient

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13
Q

What support does custom fit orthotics provide?

A

Provide limited fit and function
mild to moderate involvement
temporary use
diagnostic procedures

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14
Q

What is the process for getting a custom fabricated orthotic?

A

casting, measurement, negative mold, positive mold, fabrication, modification

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15
Q

What is the most common orthotic in kids?

A

Supramalleolar (SMO/DAFO)

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16
Q

What support does a DAFO provide?

A

allows DF and PF
provides forefoot, midfoot, and subtalar stability
tone management
has no force or stability around ankle

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17
Q

What does ground reaction orthotic facilitate?

A

pre-tibial cuff facilitates knee extension
rigid foot plate facilitates push-off
capable of tri-planar motion control

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18
Q

What is purpose of patellar tendon bearing orthotic?

A

reduces force on mid-foot and heel

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19
Q

What does a solid ankle orthotic do?

A

trim lines encompass malleoli to immobilize ankle and provide medial and lateral stability.
Maximum motion control in all planes
Disrupts normal gait because it doesn’t allow PF or rocker.

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20
Q

What is purpose of semi solid orthotics?

A

Trim lines bisect malleoli which takes away some restriction of solid AFO.
Allows some DF in late stance.
Provides some M-L stabilization

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21
Q

What is posterior leaf spring?

A

Stores energy during loading.
Releases energy to facilitate swing.
Provides little M-L stability

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22
Q

What does a articulated AFO do?

A

various materials can be used
can address multiple biomechanical functions (DF stop, PF stop, DF assist)
varying levels of adjustability
Size/weight and cosmesis may be problematic

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23
Q

What are types of articulated AFOs?

A

Oklahoma ankle joint with PF stop
Gillete ankle with DF assist
Chamber axis hinge

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24
Q

What is metal upright orthosis?

A

Easily adjustable
maximal stabilization
may be indicated for patients with high risk feet or fluctuating edema.
weight and cosmesis are major concerns

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25
Q

How are dorsiflexors affected in pathologic gait?

A

DF peak during swing and heel strike in normal gait, prevents foot slap.
Compensatory gait patterns: steppage gait, hip hike, circumduct
orthotic considerations: DF assist

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26
Q

How are plantarflexors affected in pathlogic gait?

A

Peak activity during push off in normal gait
Compensatory patterns: lurching gait because they can’t propel forward
Orthotic considerations: move MT trim lines to make foot plate rigid, DF stop will create rigid lever for push off

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27
Q

What do quadriceps do in pathologic gait?

A

Peak activity during heel strike of gait.
Compensatory gait patterns: hyperextension of knee, may flex trunk so their knee can be locked out, may have hand in pocket to push knee back and lock it
Orthotic considerations: posteriorly offset knee joint so it’s easier to lock it out.

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28
Q

What does a KAFO do?

A

provides maximal stability
creates functional leg length discrepancy
increases energy expenditure

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29
Q

What do stance control KAFOs do?

A

stability during stance
knee flexion during swing
larger and more expensive
locking mechanisms vary

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30
Q

What are requirements for KAFOs

A

adequate cognitive function

hip flexion and extension strength >3/5

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31
Q

What are contraindications for KAFOs?

A 
knee flexion contracture >10
spasticity
uncorrectable valgus/varus >15
poor balance or ataxia
hip flexion strength
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32
Q

What are neuromuscular electrical stimulation devices?

A

electrically stimulates tibialis anterior

some units can stimulate quads and hamstrings

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33
Q

What is an IDEO?

A

Intrepid Dynamic Exoskeletal Orthosis
rigid foot plate and ankle enlage limit ankle motion and facilitate push off
3-4 inch cushion blunts heel strike and allows transition from heel to forefoot
PF position facilitates deflection of strut and energy storage through terminal stance

34
Q

What are purposes of orthotics?

A 
support and align
immobilize, restrict, or mobilize
prevent or correct deformity
substitute or enhance motion
reduce pain and discomfort
35
Q

What are indications for spinal orthotics?

A 
Correct of prevent deformity
Relieve pain
Support fracture healing
Post-op protection
Prevent further injury
Support and align
36
Q

What are the 3 spinal orthotics principles?

A

3 point pressure system

Increase hydrostatic pressure, provide kinesthetic reminder, modify support systems

37
Q

What are parts of the extrinsic stability of the spine?

A

Flexors: psoas, abdominals
Extensors: erector spinae, paraspinals

38
Q

What intrinsic components of the spine?

A

Ligaments: linkage, transfer loads, smooth motion
Discs: shock absorption

39
Q

What are design considerations of spinal orthotics?

A

Necessity, cosmesis, weight, available ROM, cost, adjustability, effectiveness, functionality

40
Q

What is purpose of soft collars?

A

Facilitate spinal alignment, limit some ROM, provide kinesthetic reminder

41
Q

What are the types of collars?

A

Soft collar

Semi-rigid collars- Miami J, aspen, philidelphia

42
Q

What is a SOMI or Lerman-Minerva?

A

cervical orthoses with thoracic extension

often indicated with bed ridden patients

43
Q

What is a halo?

A

Tri-planar motion control of cervical spine
Maximum immobilization
Restricts 90-95% of normal motion
poor patient acceptance with high complication ratew

44
Q

What is an over the counter LSO?

A

Flexible LSO (lumbosacral corset)

45
Q

What does a chairback LSO do?

A

restricts sagittal plane motion

tightening of abdominal support reduces lumbar lordosis

46
Q

What does a Knight LSO do?

A

Restricts sagittal and coronal plane motion

tightening abdominal support reduces lumbar lordosis

47
Q

What do TLSOs do?

A

restricts sagittal and coronal plane motion
tightening abdominal support reduces lumbar lordosis
Tightening axillary straps facilitates thoracic extension

48
Q

What is a Jewett hyperextension TLSO indicated for?

A

Compression fracture
kyphosis
arthritis

49
Q

What TLSO is more common in geriatric patients?

A

CASH hyper extension TLSO

restricts flexion

50
Q

What is a turtle shell brace?

A 
rigid TLSO (body jacket)
restricts sagittal, coronal, and transverse plane movement
51
Q

What is a CTLSO?

A

TLSO with cervical extension

52
Q

What are orthotic indications for scoliosis?

A 
skeletal immaturity (premenarche)
curves between 20 and 40 degrees
documented progression
single or double curves
53
Q

What is a accommodative TLSO?

A

addressed fixed deformity
aligns head and trunk over pelvis: reduces shear forces, facilitates UE use, enhances mobility base, facilitates respiratory function

54
Q

What is a corrective TLSO?

A

progressive correction of idiopathic spinal curvature
stabilization of congenital spinal curvatures
prevent and or correct deformity

55
Q

What are the types of corrective TLSOs?

A

Boston brace: gold standard, worn full time 18-23 hours/day
Milwaukee brace: upper thoracic and cervical curves, worn full time
Charleston bending brace: for smaller, flexible lumbar curvature, worn only at night

56
Q

What is physical therapy for corrective TLSO?

A 
skin care
trunk mobility and strengthening
aerobic training
postural feedback and training
functional training with brace
57
Q

What are indications for UE orthotics?

A

Trauma: vocational, burns, MVAs
Congenital deformity
Disease: RA, SLE, neurological impairments, especially those associated with abnormal tone

58
Q

What is purpose of UE orthotics?

A

symptom relief, immobilization, protection, scar management, provide resistance, compensate, prevent deformity, stabilization, correct deformity, aid function, influence spastic muscle

59
Q

What are designs of UE orthotics?

A

Static
Serial static: modify brace weekly
Static progressive: use static components to apply force
Dynamic: uses elastic components to apply force

60
Q

What is the anatomy of the extensor mechanism?

A

Mechanism relies on excursion of extensor tendons
extensor excursion is less than that of flexors
So extensor mechanism is more likely to shorten and it is more difficult to compensate for loss of extensor excursion

61
Q

What is functional anatomy of MCP and PIP?

A

Ligament length dependent on joint position

62
Q

What is prone to shortening in MCP and PIP?

A

MCP extension: collateral ligaments are slack and prone to shortening
PIP flexion: volar plate is slack and prone to shortening

63
Q

What is the anti-deformity position of the hand?

A

MCP flexion with PIP and DIP extension (intrinsic plus)

64
Q

What is intrinsic plus position?

A

MCP flexion with PIP/DIP extension
Positioning MCP in flexion protects IP extension
Commonly used after trauma, burn, or tendon repair

65
Q

What is intrinsic minus position?

A

MCP extension wit PIP/DIP flexion
Often results from intrinsic denervation of ulnar nerve
Unopposed extension cause MCP hyper extension and IP flexion

66
Q

What happens to pressure to an area?

A

It is never eliminated it is only distributed

must accommodate for bony prominences

67
Q

What are common prominences under pressure?

A 
olecranon
humeral epicondyles
styloid processes
base of 1st MC joint
dorsal thumb, MP, and IP joints
pisiform
68
Q

What are common nerves under pressure?

A 
Radial groove of humerus (radial)
Cubital tunnel (ulnar)
Distal forearm (ulnar)
Carpal tunnel (median)
Volar digital nerves
69
Q

What is position of hand in a functional hand splint?

A

Wrist in 20-30 of extension
thumb in palmar abduction
MCPs in 15-20 of flexion
IPs in slight flexion

70
Q

What is intrinsic plus wrist and MCP position in splints of palmar burns?

A

30-40 degrees extension of wrist

70-90 flexion of MCP

71
Q

What is intrinsic plus position of wrist in dorsal burns?

A

neutral to slight extension

72
Q

What is intrinsic plus position of wrist and MCPs in crush injuries?

A

0-30 degrees wrist extension

60-80 degrees of MCP flexion

73
Q

What is IP and thumb position in intrinsic plus splint?

A

extension of IP joint

palmar abduction of thumb

74
Q

What is position of wrist splint for carpal tunnel syndrome?

A

0 degrees

75
Q

In radial nerve palsy what is position of wrist splint?

A

30 degrees

76
Q

What is position of wrist splint in wrist extensor tendonitis?

A

20-30 degrees

77
Q

With a colles’ fracture how is wrist positioned?

A

up to 30 degrees

78
Q

What is position of wrist in RA?

A

comfort level up to 30 degrees

79
Q

With RSD/CRPS what is splint position?

A

as tolerated

80
Q

Splint position with wrist joint synovitis?

A

0-15 degrees

81
Q

What are syndromes that may cause the thumb to be immobilized?

A

DeQuervain’s: inflammation of APL and EPB synovial sheaths
RA
Gamekeepers thumb: ulnar collateral ligament injury

82
Q

What is position of thumb if it needs to be splinted?

A

25-30 degrees of abduction with MP joint in neutral

PTRS 746 (15 decks)

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