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FINAL Flashcards

1
Q

High level amputations

name 2

A

Hip disarticulation / Hemipelvectomy: they need to use more pelvic and trunk movements to advance prosthetic device, obvious gait deviations. High energy expenditure.

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2
Q

Hip disarticulation :

Where will WB be?

(2)

A
  1. WB will be on the IT and the overlying gluteal tissue

2. Some WB anteriorly on abdominal musculature

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3
Q

Hemipelvectomy

Where will WB be?

(2)

A

soft tissue in gluteal and lower abdominal area because disarticulation on the SI joint and smyphesis pubisi

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4
Q

What is energy expenditure with prosthesis in gait for high level amputation?

hemipelvectomy
disarticulation

A

200% of normal walking energy

*also ambulation is slow

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5
Q

Canadian socket

what is it

A

pelvic jacket

socket typically used: plastic molded jacket encompassing the residual limb: molded cast of the residual limb.

If there is a hip disarticulation still have IT on the side for WB, but if not it will be on the soft tissue

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6
Q

Why do we need mechanical joint alignment

A

to increase stability: biomechanical stability by aligning the joints in a certain way

  1. Hip joint: is moved slightly anteriorly to put the weight line posteriorly to create an extension moment
  2. Knee joint: put slightly posteriorly to put the weight line anteriorly to create an extension moment at the knee
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7
Q

Hip: mechanical joint alignment

A
  1. Hip joint: is moved slightly anteriorly to put the weight line posteriorly to create an extension moment
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8
Q

Knee: mechanical joint alignment

A
  1. Knee joint: put slightly posteriorly to put the weight line anteriorly to create an extension moment at the knee
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9
Q

WHy is a larger foot put on a higher level amputation prosthesis

A

Larger foot to increase BOS: on the prosthesis the foot is larger for more base of support A/P and M/L stability

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10
Q

what does the extension aide on the high level amputation do

A

extension aides and step control length straps so when go into swing, a posterior strap limits hip flexion to reduce the hip flexion moment

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11
Q

in the high level amputation how do you get knee flexion

A

knee flexion with a posterior pelvic tilt–sit back hard in posterior tilt in the back of the socket to collpase the hip and knee

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12
Q

why a soft cushion heel in the high level ampuation

A

to help PF

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13
Q

why is the high level amputation slightly shorter:

A

to clear the prosthetic leg

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14
Q

does the high level prosthesis need a torque absorber?

A

it is above the ankle foot assmebly because lose the tibial and femoral rotationin the transverse plane for absorption o f movements in the transverse plane

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15
Q

What is included on a high level prostheses

10

A
  1. WB: IT and abdominal in hip disarticulation
    WB on abdominal in hemipelvectomy
  2. canadian socket
  3. mechanical jt alignment of hip and knee
  4. larger foot to increase BOS
  5. strong hip extension aide and step length control
  6. soft cushion heel to promote PF
  7. prosthesis slightly shorter
  8. torque absorber above the ankle foot assembly
  9. may use shoulder strap for added suspension
  10. posterior pelvicc tilting for knee flexion
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16
Q

Bilateral LE amputation:

Prevelance

A

severe diabetes

PAOD: one in every 4 bilateral in3-5 yrs

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17
Q

Bilateral LE amputation:

E expended–implication

A

use wc for function

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18
Q

Bilateral LE amputation:

pressure distribution in socket–why need it

A

since they dont have a good lef to shift weight onto

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19
Q

Bilateral LE amputation:

lightweight material–why

A

to help go into swing phase in gait

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20
Q

Bilateral LE amputation:

increase foot length–why

A

increase BOS

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21
Q

Bilateral LE amputation:

reduce overall height–why

A

lower COG

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22
Q

Bilateral LE amputation:

torque absorber?

A

to absorb force in the transverse plane

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23
Q

Bilateral LE amputation:

Increase UE dependence

A

with AD because otherwise energy stored in prosthesis and wont have enough pushoff in gait –rely on UE for BALANCE and for PROPULSION

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24
Q

Things need in Bilateral LE amputation: 7

A
  1. WC
  2. comfortable pressure distribution in socket
  3. lightweight material
  4. long foot length
  5. reduce overall height
  6. torque absorbers
  7. increased UE dependence
    * *WORK ON OVERALL BALANCE AND UE STRENGTH –ie triceps, shoulder depressors, latisimus
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25
Q

Bllateral Transfemoral Amputation

what type of knee unit? 
overall height?
socks?
WC?
ambulation goal
A

1) what type of knee unit: one locked knee and one free knee with weight activated brake
2) overall height: reduce 2-3 INCHES
3) socks soft socks to have comfortable WB
4) need WC
5) ambulation goal: 100-200ft

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26
Q

What are stubbies

A

short profile prosthesis used in bilateral AK (can do 4pt gait)

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27
Q

Bilateral Transtibial Amputation

overall height?
ambulation goal:
AD?

A

1) Overall height: reduce height by 1 inch
2) Ambulation Goal: 1/3 of a mile
3) AD for balance and pushoff

lightweight material, comfortable socket

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28
Q

UE amputations:

cause

A

trauma/cancer/congenital: farming, factories,

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29
Q

Hand function if amputate thumb

A

lose 50% of hand function

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30
Q

Transmetacarpal amputation

what is it

A

proximal to MCP

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31
Q

Digital amputation

what is it

A

amputate MCP

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32
Q

Partial hand amputation

what is it

A

disarticulation at the CMCs: keep all the carpal bones but remove everything distally

(metacarpals, phalanges)

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33
Q

Wrist disarticulation

what is it

A

take all carpal bones, keep styloid processes of radius and ulna

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34
Q

Below Elbow amputation

what is it

A

keep as long as possible: at least 4cm as lever arm

25% from medial epicondyle to ulnar styloid process of good hand

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35
Q

Elbow amputation

what is it

A

take radius and ulna, keep humerus

Muscles: need strong scapula stabilizers for above elbow amputee

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36
Q

Shoulder amputation

what is it

A

take humeral head from glenoid fossa

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37
Q

Forequarter amputation

what is it

A

ie cancer patient

take scapula and clavicle and everything distal

requires a lot of surgical reattachment for scapular muscles –myoplasty and myodesis

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38
Q

What to consider about giving UE prosthesis

8

A
  1. skin inspection
  2. girth
  3. sensation
  4. ROM
  5. MMT: need power in body powered prosthetic device
  6. posture : dont want muscle imbalances
  7. function
  8. length

Muscles: need strong scapula stabilizers for above elbow amputee

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39
Q

Phantom pain phenomenon

who/when

A

more common in UE than in LE amputee,

more seen acutely closer to the surgery as time goes on it gets better:

mirror therapy

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40
Q

Goal for post op UE amputation

6

A
  1. promote healing
  2. decrease pain: desensitize/massage/TENS
  3. maintain residual limb ROM and prevent contracture
  4. maintain residual limb strength : body powered prosthesis
  5. independent in ADL
  6. residual limb shaping : want oval
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41
Q

Important motions: what to work on

partial hand and wrist amputation:

A

supination and pronation to orient distal segment

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42
Q

Important motions: what to work on

below elbow amputation:

A

elbow/shoulder/scapular motions

*ROM: will go into flexion at elbow bc lost weight

(lost pronation and supination)

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43
Q

Important motions: what to work on

above elbow amputation:

A

work on shoulder and scapular ROM

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44
Q

Voluntary opening device for UE

what it does

A

opens when move it to flexion –better option

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45
Q

voluntary closing device for UE

what it does

A

closes with shoulder flexion–not as good option for funciton

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46
Q

4 types of UE devices for amputation

  1. passive
  2. body powered
  3. external powered
  4. myoelectic
A
  1. passive–cosmetic not functional
  2. body powered: proximal movements control distal parts
  3. external powered: switch to flip to make it move hand
  4. myoelectic: combo of body power and external power
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47
Q

Myoelectic prosthesis

how it works

A

combo of body power and external power – there is a prosthetic device with EMG electrodes that recruit wen muscle activated

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48
Q

Passive prosthesis

how it works

A

cosmetic, not functional

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49
Q

Role of orthotics (6)

A
  1. support or brace for extremities and spine
  2. support due to weakness or paralysis
  3. protect injured / unstable joint
  4. produce assisted motion
  5. accomodate for deformity
  6. correct deformity
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50
Q

how AFO helps support

A

prevent footdrop in swing–ie after stroke or peroneal nerve injury

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51
Q

KO help protect unstable joint

A

if tear ACL/MCL

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52
Q

RGO provide assisted motion

A

reciprocal gait assist: one leg forward and other leg back

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53
Q

FO accomodate deformity

pes equinus

A

pes equinus deformity fixed PF: cannot change it and dont want to walk on metatarsal heads so use wedge to accomodate for WB distribution

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54
Q

FO accomodate deformity

pes cavus

A

since high medial arch, use wedge to accomodate for equal WB distribution

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55
Q

FO

what is it

A

built into shoe:

ie heel lift, medial longitudinal arch etc anything not crossing the ankle joint

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56
Q

AFO

what is it

A

short leg brace

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57
Q

KAFO

waht is it

A

long leg brace: pass the knee joint

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58
Q

HKAFO

A

high profile brace used with SCI: pelvic band, hip joint in addition to long leg brace

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59
Q

KO/HO

A

KO: just for the knee
–ie chopart strap on infrapatellar tendon to reduce pain from lateral patella tracking

HO: just for the hip
–ie afte fail total hip and have revision and put it on and lock the hip joint so not flex beyond 90 or go into adduction

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60
Q

CO

A

cervical orthosis: ie soft collar

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61
Q

CTO

A

cervical thoracic orthosis

extend down to thoracic spine

ie SOMY –sternal mandibular immobilizer

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62
Q

TLSO

A

thoracolumbosacral orthosis

ie Jewitt Brace: to put into more extended position

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63
Q

LSO

A

lumbosacral orthosis for the low back or below the thoracic spine (abdominal binder)

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64
Q

Reason to get a traditional vs contemporary orthosis

A

Traditional: metal and leather:

1) fragile skin
2) fluctuating edema

Contemporary: contemporary plastic

1) Lighter
2) custom fit
3) more cosemetic

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65
Q

Shoe function:

4

A

shoes are the base of the orthotic

  1. stabilize
  2. protect
  3. shock absorption
  4. pressure distribution
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66
Q

Shoe anatomy:

Sole (inner vs outer)

Heel

Upper part of the shoe

Opening

Shoe reinforcements

A

Sole:
inner = soft
outer = hard plastic

Heel:
spring heel =

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67
Q

Sole: of shoe

2

A 
inner = soft
outer = hard plastic
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68
Q

Heel of shoe

2

A

Heel:
spring heel = less than 3/4 inch

oxford heel: 3/4 to 1 inch

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69
Q

Upper part of shoe

3

A

Toe Cap = over the toes in the front of the shoes

Vamp = the rest of the front of the shoe from where maleoli are

Quarter: goes around the anatomical heel

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70
Q

Opening of shoe to don and doff

2

A

Tongue/opening:

balmoral: narrow opening
blucher: wider opening

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71
Q

Shoe reinforcements

2

A

Shoe reinforcements
toe box: more reinforced to protect the toes

counter: reinforce around the heel (good for excess hindfoot pronation/supination)

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72
Q

Shoe size considerations: how much space between longest toe and front?

A

Length: want 1/2 inch between longest toes

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73
Q

What width of shoe do we want?

A

the widest at the widest of foot at MTP

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74
Q

Purpose of shoe/foot orthotics

5

A
  1. shock absorption : cushioned heel
  2. reduce friction/ shearing/ compression on pressure sensitive areas
  3. modify WB pattern
  4. accomodate for or correct deformities
  5. limit motion of unstable and painful joints
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75
Q

What can be in shoe to reduce shock absorpbtion?

A

cushion heel

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76
Q

what can be in shoe to reduce friciton / shearing /compression on pressure sensitive areas?

A

GEL HEEL RELIEF PAD

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77
Q

What can be used to modify WB pattern in shoe

A

metatarsal pad

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78
Q

what can accomodate or correct for deformities in shoe

A

wedge

fixed: bring it to ground
flexible: move it to the other direction

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79
Q

how can shoe limit motion of unstable and painful joints

A

sole rocker

rocker bottom shoe to get heel to toe without moving the MTP

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80
Q

Types of wedge in shoe:

4

A
  1. heel wedge: hindfoot
  2. sole wedge: whole foot
  3. lateral wedge: lateral side higher
  4. medial wedge : medial side higher
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81
Q

Why use a lateral wedge?

A

Fixed pronation/eversion deformity = valgus deformity

Flexible supination/inversion = varus deformity

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82
Q

Why use medial wedge?

A

Fixed varus deformity: supination and inversion

Flexible Valgus deformity: pronation and eversion

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83
Q

What are flares?

A

increase the surface area and flare out the heel or sole of foot

ie for ankle sprains: if strong tendency to have inversion sprain put flares on lateral side as counterforce to prevent inversion

84
Q

Lateral Flare

what it does

A

prevent inversion sprain / varus (most sprains are inversion)

85
Q

Medial Flare

what it does

A

prevent pronation / valgus

86
Q

Thomas heel

what is it

why

A

project on the MEDIAL side forward 1/4 inch (and elevate a bit like a wedge)

for pes PLANUS (flat) and pronation

87
Q

Reverse Thomas heel

what is it

A

project on LATERAL side

88
Q

Lifts

what are they and why used?

A

built into shoes

must be sole lift and not a heel lift if more than 1/2 inch because too much PF

LLD: of more than 1/4 inch approaching 1/2 inch is significnt

89
Q

When must a heel lift be made into a sole lift?

A

if it is more than 1/2 inch

90
Q

what is sig for LLD?

A

LLD: of more than 1/4 inch approaching 1/2 inch is significant

91
Q

What foot insert orthotics are there?

6

A
  1. heel cushion relief
  2. metatarsal pad
  3. toe crest
  4. medial arch support
  5. custom midfoot insert (UBCL)
  6. heel/sole lift and wedges
92
Q

where would a Thomas heel be more common?

A

medial side to prevent inversion

93
Q

who would need a reverse thomas heel?

A

supinators

94
Q

Who needs lifts? what type?

A

LLD:

if less than 1/2 inch can do heel lift

if more than 1/2 inch can do a sole lift

95
Q

who does a contralateral lift?

A

ortho: cannot clear leg in gait
neuro: stroke has issue initiating flexion on paretic side so lift the good side to decrease friction on the floor

96
Q

Rockers:

what they do

A

allow a nice heel to toe gait WITHOUT STRESS on the CALCANEOUS or METATARSAL HEADS

Rocker sole: rockers can be built into the sole of the shoe

Toe Rocker: angle out proximal to MTP heads

Heel Rocker: weight more forward on calcaneus

97
Q

Rocker Sole

purpose

A

complete rocker bottom

98
Q

Toe Rocker

purpsose

A

angle out PROXIMAL to the MTP heads:

–if painful at metatarsal heads to put weight on metatarsal shalves instead

–can be used if wounds or skin breakdown near metatarsal heads or back of calcaneus

99
Q

Heel Rocker

A

instead of force coming in on back of heel, it is more forward on the calcaneus: roll into toe off instead of all pressure at MTP jioint it is on metatarsal shalves

100
Q

6 foot insert orthotics

A
  1. heel cushion relief
  2. metatarsal pad
  3. toe crest
  4. medial arch support
  5. custom midfoot insert (UBCL)
  6. heel/sole lift and wedges
101
Q

Heel cushion relief

what is it

A

gel pad:

can excavate a portion of pad to relieve pressure
create a concavity to accomodate and reduce pressures

102
Q

Metatarsal Pad

what is it

A

ring for forefoot
–pressure on shalves and not on metatarsal heads

cookie

103
Q

Toe Crest

what is it

who uses it

A

on plantar sulcus of toes to bring down the phalanges on the inner sole of the shoe to make contact with plantar toes TAKES AWAY PRESSURE FROM THE METATARSAL HEADS

increases area because P= F/A

for hammer toe or claw toe deformity

104
Q

Medial Arch Support

when to be rigid vs when to be soft?

A

Rigid: for flexible deformities

Soft: for rigid deformity

105
Q

Custom hind and midfoot insertion UCBL

A

University of california biomechanics lab:

can use in severe pes planus (first choice would be a medial wedge before a UCBL)
(can use in plantar fascitis, frontal plane abnormalities, stabilize the midfoot)

–rigid walls: high posterior, medial, lateral (control hindfoot )

–medial longitudinal arch suppport

–pes planus use a shoe with a good counter to control the hindfoot

106
Q

Heel/sole Lift and wedge

Lift when? Wedge when?

A

lift: LLD
wedge: pronation or supination issue, equinus deformity

  • -medial wedge decreases pronation for flexible deformity
  • -medial wedge for fixed supination deformity

–fixed equinus deformity use heel lift

107
Q

how can a wedge be used in tarsal tunnel syndrome?

A

when posterior tibialis comes around the medial malleoli and soem entrapment: shorten the tendon with medial wedge –more inversion and supination to shorten tibialis posterior tendon

108
Q

what wedge for equinus deformity fixed?

A

posterior wedge

109
Q

SMO: Supramalleolar Orthosis

3 reasons to use it

A

Low proflle AFO

–stabilize foot in frontal plane an some saggittal plane
(if want for footdrop, can only use for mild footdrop otherwise need longer profile)

–can control hindfoot pronation: need to stabilize medial arch with hindfoot pronation

–use in peds for CP: lock subtalar neutral to reduce tone in full LE

(ankle stirrup brace can be considered and SMO)

110
Q

SMO:

4 things it does

A
  1. medial to lateral ankle/foot control
  2. mild footdrop
  3. severe drop of medial arch with hindfoot pronation
  4. tone reduction
111
Q

Stirrup ankle air splint

A

stabilize

elastic band on bottom and two shells and goes over malleoli and inflate with air

112
Q

Pediatric tone inhibiting air splint

A

CP: use DAFO

Hypertonicity

TBI: subtalar neutral to reduce tone in LE

113
Q

Arizona Brace

A

corset for ankle foot complex: rigid material around malleoli (its the one with the shoelace in front)

  1. severe pronation / pes planus
  2. DJD of ankle
  3. posterior tibial tendonitis
  4. chronic achilles tendonitis
  5. mild foot drop
  6. tarsal joint instability
  7. chronic ankle sprains
  8. charcot foot –mishapen foot with flat collapsed arch –used in mild case but real boot if severe
114
Q

Traditional AFO

stirrup to shank
ankle joint alignment
locked
metal uprights
calf band
spring assist 
correction straps
adjustments fitting
A

stirrup to shank: connect to JOINT and UPRIGHT

ankle joint alignment: level of the medial malleoli (posterior on lateral side for fibula and toe out)

locked: anterior stop prevent DF, posterior stop prevent PF

metal uprights: 1 CM SPACE BETWEEN UPRIGHT AND SKIN

calf band: end BELOW fibula head : 1-1.5 inches below fibula head to clear the common fibular nerve

spring assist : DF / PF spring assist

correction straps: valgus correction strap (medial side), varus correction strap (lateral side)

adjustments fitting:
–Calf band: 1 1/2 inch below the fibular head (1.5 inch) and do –calf band snug test

–1 cm space between upright and skin

–mechanical ankle joint level of medial malleoli: and toe out should be incorporated into the brace –lateral uprights should be more posteriorly situated relative to the medial upright

115
Q

what is the stirrup to shank atachment?

A

bottom of shoe has metal shank connected to sole of shoe
metal peice connect to shank

stirrups connect to JOINT and UPRIGHT

116
Q

Ankle joint alignment in traditional AFO?

A

level of the medial malleoli (distally down) :

posterior on the lateral side where fibula comes down further, allows for toe out

117
Q

In traditional AFO:

posterior stop

what it prevents

A

prevent PF

118
Q

In traditional AF:

anterior stop

what it prevents

A

prevent DF

119
Q

In traditional AFO:

rules about metal uprights

A

never touch skin

1 CM SPACE BETWEEN UPRIGHT AND SKIN

120
Q

In traditional AFO:
Calf band

where

A

terminal proximal bracne is calf band

end BELOW fibula head : 1-1.5 inches BELOW FIBULA HEAD to clear the common fibular nerve

121
Q

In traditional AFO:

DF spring assist:

A

more common

as go into HS spring is lengthened bot controlled lengthening –it wants to pull you up into DF

as you go to DF it recoils

Control FF and assist toe clearance

122
Q

In traditional AFO:

PF spring assist:

A

resist DF as advance to midstance and tibia comes over the foot

recoils to allow for pushoff (PF)

123
Q

In traditional AFO:

Klenzac ankle

A

both DF and PF spring assist

124
Q

In traditional AFO:

Correction strap: T strap on medial or lateral side

A

MEDIAL SIDE: prevent pronation
vertical strap is like a collateral ligament : if it is on the medial side like the deltoid ligament it prevents eversion

LATERAL side to prevent inversion like a lateral collateral ligament of the ankle
(used for MS and Stroke which do PF and inversion)

125
Q

In traditional AFO:

Valgus correction strap

what side

A

MEDIAL SIDE: prevent pronation

vertical strap is like a collateral ligament : if it is on the medial side like the deltoid ligament it prevents eversion

126
Q

In traditional AFO:

Varus correction strap

what side

A

more common

LATERAL side to prevent inversion like a lateral collateral ligament of the ankle

(used for MS and Stroke which do PF and inversion)

127
Q

Fitting Considerations for traditional AFO:

A

–Calf band: 1 1/2 inch below the fibular head (1.5 inch) and do –calf band snug test

–1 cm space between upright and skin

–mechanical ankle joint level of medial malleoli: and toe out should be incorporated into the brace –lateral uprights should be more posteriorly situated relative to the medial upright

128
Q

Plastic AFO:

A
  1. articulated vs non-articulated
  2. shoe insert, calf shell, calf band
  3. posterior leaf spring
  4. variable trim line
129
Q

Plastic AFO

articulated vs non-articulated

A

usually articulated

130
Q

Shoe insert, calf shell, calf band

Plastic AFO

A
  1. shoe insert: plastic part in shoe-shoe insert
  2. calf shell: in addition to calf band for more surface area to distribute forces
  3. calf band: fixate and stabilize to limb
131
Q

Plastic AFO

PLS

A

posterior leaf spring

for FLACCID FOOT DROP (ie after stroke)

132
Q

Plastic AFO

variable trim line

A

can be recessed back behind the malleoli

more recessed back in PLS: more flexibility –for flaccid dropfoot

but comes around further in solid plastic AFO–for severe frontal and saggital plane tone and severe equino varus

133
Q

Toe off brace

A

provide DF resistance until midstance and heelrise and provide PF energy return at toe off

(a blue rocker is a more rigid toe off brace)

134
Q

Hemispiral Brace

A

**good brace for equino varus ** (PF and inversion)

because it is like the lateral collateral:
comes over lateral malleoli and spirals around posteriorly and wraps around medially

135
Q

AFO consideration

Stairs
Ramps
Sit to stand
posture adjsutments
cycling/nustep
DF ace wrap
A

Stairs: may do step two pattern (ie liek in ski boot)

Ramps: smaller steps because DF/PF limited

Sit to stand: hard to get foot under with limited DF

posture adjustments: may take away ankle strategy and use hip strategy

cycling/nustep: take off brace first

DF ace wrap: anchor in DF

136
Q

AFO Checkout

PLASTIC

(6)

A
  1. no excess pain from trim lines and bony prominence: if red do capillary refill test (need shoe fit well)
  2. wearing schedule: build up tolerance
  3. relief of pressure sensitive areas
  4. ambulating: no gapping or pistoning between brace and limb
  5. good fit inside supportive shoe
  6. no skin irritation when removed
137
Q

AFO Chechout

TRADITIONAL

A
  1. uprights 1cm from skin
  2. good alignment of mechanical and anatomical joint (allow for toe out)
  3. clear fibula head
  4. no calf band irritation
    Calf band: 1 1/2 inch below the fibular head (1.5 inch) and do –calf band snug test
  5. shoe that is attached fits properly
  6. closures secure and easy to operate
138
Q

KO

reasons to use one

A

after surgery
brace in functional activity
brace for arthritis
patellofemoral issues

139
Q

KO: 4 things that it can be in options

length
material
axis
motion

A
  1. short or long prodile
  2. soft or rigid material
  3. single axis or polycentric (match anatomical joint after ACL)
  4. restrict saggital/frontal/and transverse plane motion–prevent terminal extension to prevent rotation
140
Q

Type of Postop KO

what do they have

3 types

A

Longer profile

dial locks–can lock in a range

expandable–velcro in case edema

  1. zimmer splint: no joint, velcro–good for edema (ie after quadriceps tendon tear)
  2. genutec: hinged brace with joint (bledso)
  3. ottobok knee immobilizer –cannot bend knee
141
Q

Functional KO

when are they worn

why

4 type

A
  1. ADL, recreational activity
  2. to prevent excess motion / stabilize joint (ie post ACL repair)

GLADIATOR BRACE: medial and lateral uprights and a hinge joint for more medial and lateral stability of the knee

POST OP ACL BRACE: may allow some flexion but limit terminal extension so not get the rotation

FUSION BRACE: post ACL repair –able to move around and walk but not stress ACL

SWEDISH KNEE CAGE: prevent genu recurvatum –can sit, bend knee, prevent hyperextension (anterior force in popliteal and posterior force above and below)

142
Q

gladiator brace

what is it

A

GLADIATOR BRACE: KO with medial and lateral uprights and a hinge joint for more medial and lateral stability of the knee

143
Q

fusion brace

what is it

A

post op ACL repair –able to move around and walk but not stress ACL

144
Q

swedish knee cage

what is it

A

prevent genu recurvatum –can sit, bend knee, prevent hyperextension (anterior force in popliteal and posterior force above and below)

145
Q

Unloading Knee Orthosis

A
  1. braces designed for unloading at the knee joint ie valgus and varus correction braces: reduce medial/lateral compression by applying varus/valgus force
  2. lateral uprights on both sides for ligamentus instability for frontal plane stability without a corrective force
  3. OA: if pain in lateral joint: want a valgus correction brace to apply force laterally
    if medial joint pain want varus correction brace
146
Q

Varus Correction brace

A

lateral upright has a compression pad that applies pressure medially to decrease compression on medial side of joint

and reduce ligament strain on lateral side of joint

147
Q

Valgus Correction brace

A

medial upright has a compression pad that applies pressure laterally to decrease compression on lateral side of joint

and reduce ligament strain on medial side of joint

148
Q

Patellofemoral Orthosis

A

anterior knee pain (crepitus, pain behind knee cap) and control lateral tracking

  1. Chopart Strap: around infrapatella tendon to prevent kneecap tracking SUPERIOR
  2. Taping: control patella
  3. Lateral Restraining Bar: prevent knee cap ,oving too far laterally
  4. Palumbo: straps pull medially to prevent lateral patella tracking
149
Q

Polumbo:

A

for excess lateral patella tracking:

straps pull medially to prevent lateral patella tracking

150
Q

Chopart Strap:

A

around infrapatella tendon to prevent kneecap tracking SUPERIOR

151
Q

KAFO

why it is used

what material

3 components

A

knee ankle foot orthosis

  1. for knee and ankle control
  2. traditional (leather and metal) vs plastic (thigh shell and calf shell, custom made)

3 components: AFO / knee joint with pad / thigh component

152
Q

KAFO:

types of knee joints

A

uniaxial:
polycentric:

posterior offset knee joint: take mechanical knee joint and move it back: to increase extension moment by putting weight line in front
-can have a drop ring lock

153
Q

KAFO

Drop ring lock–

A

normally it is up: stand and extend the knee to drop it down to lock the knee

154
Q

Types of knee locks

A

drop ring lock: normally it is up: stand and extend the knee to drop it down to lock the knee

cam lock (with bail release = pawl lock): wire in popliteal area and pull to release knee –always locked and then release it to sit

Fan lock: lock in one degree setting ie always 20 degrees

Dial lock : allows for a range ie a desginated amount of flexion extension

155
Q

Types of knee locks
for KAFO

4

A

drop ring lock: normally it is up: stand and extend the knee to drop it down to lock the knee

cam lock (with bail release = pawl lock): wire in popliteal area and pull to release knee –always locked and then release it to sit

Fan lock: lock in one degree setting ie always 20 degrees

Dial lock : allows for a range ie a desginated amount of flexion extension

156
Q

cam lock

A

cam lock (with bail release = pawl lock): wire in popliteal area and pull to release knee –always locked and then release it to sit

157
Q

fan lock

A

Fan lock: lock in one degree setting ie always 20 degrees

158
Q

dial lock

A

Dial lock : allows for a range ie a desginated amount of flexion extension

159
Q

Stance control KAFO

A

knee always locked in stance but when DF it pulls cable to DISENGAGE THE KNEE JOINT AND IT WILL COLLAPSE THE KNEE TO PREPARE FOR SWING

160
Q

indication for stance control KAFO (4)

A

knee always locked in stance but when DF it pulls cable to DISENGAGE THE KNEE JOINT AND IT WILL COLLAPSE THE KNEE TO PREPARE FOR SWING

  1. good for quad paralysis
  2. quad weakness due to polio
  3. incomplete SCI
  4. femoral nerve neuropathy
161
Q

role of AFO to control Knee motion

A

into HS: posterior shell anterior directed force : for knee flexion

into MIDSTANCE to HEELRISE: anterior calfband posterior directed force to knee extension

162
Q

What happens when SET THE AFO in more DF?

A

if have recurvatum push tibia and fibula forward so not snap into extension —– posterior shell anterior directed force : for knee flexion

163
Q

What happens when SET THE AFO in more PF?

A

if have buckling knee holds tibia and ibula back to not allow it to advance: create more extension at the knee

164
Q

For RECURVATOM how should we set the AFO? DF or PF?

A

DF to move it slightly behind the knee joint (against extension)

165
Q

Ground reaction orthosis

what it is

A

has a anterior shell on anterior of the proximal tibia

increase knee stability

AFO set in slight PF to increase extension moment for knee stability without needing a KAFO

indications:

  1. increase knee stability
  2. pediatrics (SP, spina bifida, TBI, SCI)
166
Q

knee air splint

when it is used

A

training KAFO

fro buckling knee , used with a DF wrap (thighband of brace is 1.5 inch below the IT)

167
Q

KAFO Checkout

A
  1. no proximal compression on IT, groin, or greater trochanter in sit or stand (ends 1.5 inch below IT)
  2. good anatomical and mechanical joint alignment–ankle level of medial malleoli and knee at level of DISTAL femoral condyles
  3. no skin pinching with movement
  4. relief for pressure sensitive areas
  5. secure and easy to operate straps and locks
  6. no pain or skin irritation: if redness do capillary refill test
168
Q

Craig Scott Orthosis

A

it is a KAFO: (use in low thoracic SCI)

  1. stirrup shoe attachement, pre tibial and proximal femoral band **KNEE LOCK with CAM lock ***
  2. set ankle in DEGREES of DF
  3. stand with LORDOSIS and increased posterior pelvic tilt
  4. swing to /through gait /standing
169
Q

HO

components 5

where do you put the hip joint align

A

after hip dislocate/THR

ALIGN MECHANICAL HIP 1/4 inch SUPERIOR AND 1/4 inch ANTERIOR OF GREATER TROCHANTER in order to put extension moment with weight line behind the joint

  1. pelvic band or jcaket
  2. lateral upright
  3. mechanical hip joint
  4. DIAL LOCK–can set range
  5. thigh shell –can prevent adduction
170
Q

HKFO

what is it

A

lock hip jont to not have to stand in hyperextension

1, conventional vs okastc

  1. pelvic band or jacker
  2. lateral uprights
  3. mechanical joint 1/4 inch superior and 1/4 inch anterior to anatomical joint
  4. thigh bands
  5. stirrups
  6. stops/locks–usually DROP RING LOCK
171
Q

RGO

what is it

A

reciprocal gait orthosis

HKFO with thoracolumbar extension to stabilize the spine (use with high SCI)

2-4 point gait for T4-L4 paraplegia (and swing to), it doesnt allow bilateral flexion

offset drop ring knee locks

molded thigh shell and solid AFO

can do with FES

REDUCED ENERGY EXPENDITURE

172
Q

Exoskeletal orthosis

what is it

A

backpack power device so he can walk

173
Q

Parapodium

what is it

A

pediatric HKFO to allow child to stand

–ROM, flexibility, WB through joints bone health…

hip and knee joints allow to sit , can use with swing to/through gait

NOT FOR RECIPROCAL GAIT

174
Q

Indications for HKFO

A
  1. promote WB and standing in peds
  2. poor hip and trunk control
  3. control or prevent hip motions
  4. integrated with spinal orthotics
175
Q

Specialized orthotics

A

fracture orthosis

peds braces: dennis brown splint, palvik harness, scottish rite

176
Q

AFO Fracture Orthosis

where is the WB

is it eliminated

type of fracture and where

A

reduce WB through fracture site:

patella tendon bearing shelf to take weight off the shaft of the lower leg and take more weight proximally,

compression and total contact

reduce but not eliminate WB for mid/distal tiba fracture

comminuted fractuere

can have a patten bottom but then need a contralateral leg lift
. (note: it does not cross the knee joint)

177
Q

KFAFO and HKFO fracture orthosis

where is WB

type of fx and where

where cannot it be used

A

1 Ischial shelf component—more pressure on the ischial tuberosity. Build an ishcial shelf into the brace to take the WB through the IT and take it away from distal femur. Use for a tibial plateau fracture. Redistribute weight away from the fracture site.

  1. Tibial plateau fractures* (used for these )
  2. Mid to distal femur fractures (cannot use with a proximal femoral fracture because too close with WB near fx site)
178
Q

Dennis brown splint

A

i. Club foot / correct forefoot add & equinovarus (CTEV)—congenital talipes equinovarus
1. equinovarus : plantarflexion and inversion
ii. Abduction bar -on the brace to keep the feet separated
iii. Hinged shoes -can be rotated out to restore the normal tibial torsion

iv. Integrated with serial casting
1. Can be integrated with serial casting
2. But dennis brown splint allows you to rotate the feet out to try to restore the normal position—this is a brace that is correcting because of malleability in pediatric population

v. Tibial torsion abnormalities

179
Q

Palvik Harness

A

i. For congenital hip dysplasia

ii. Poor hip joint congruency / stability
- For poor congruency between the femoral head and acetabulum

iii. Hold hips in abduction and flexion to maximize contact: femoral head in acetabulum
iv. Anterior straps to produce about 100 DEGREE FLEXION and posterior straps for ABDUCTION– To stabilize the femoral head in the acetabulum

Canvas straps between chest and feet

Children under 6 months of age –Used before the child is ambulatory

Rhino cruiser for ambulation if needed

180
Q

Rhino cruiser

A

used for hip dysplasia when stand and ambulate

181
Q

Scottish Rite Brace

A

i. For Legg Clave Perthes disease—AVN of the femoral head

ii. Loss of normal blood supply in young child
- Bone does not form correctly
- Misshapen femoral head

iii. Avascular necrosis of femoral head/ misshaped femoral head

iv. Pelvic band / movable hip joints / abducted thigh cuffs
- -It is like an HO with pelvic bands
- - Movable hip joints
- -ABDUCTED with thigh cuffs

v. Allows RECIPROCAL WB GAIT

vi. Integrated with surgical interventions
- -Usually multiple surgeries, not using the brace alone (ie brace after surgeries)

182
Q

Orthotic donning:

which is in
supine ___

sitting __

A

SUPINE: HKFO, LSO, TLSO

SITTING: CO, CTO

183
Q

why sit to don CO and CTO

A

CO & CTO don in sitting

Cervical orthosis, cervical thoracic orthoses put on usually in sitting

184
Q

why supine to don HKFO, LSO, TLSO

A

HKAFO—usually don in supine (ie roll on side, brace put under them, then roll back onto brace)

LSO & TLSO in supine

Lumbar spine orthoses, thoracolumbar spine orthoses

In supine for good adjustment of the abdominal binder or the straps coming around the lower abdomen

185
Q

Orthotic don considerations

A

a. Consider the need to remove the insole—for space inside the shoe
b. Can don shoe and brace together—the AFO can already be inside the shoe so can put them both on at once
c. Use a shoe horn with brace then shoe donning—can use the shoe horn to get on the shoe if put on the brace first
d. Secure closure of the shoe after maximal opening—putting on the sneaker widen it on all the way, the blucker opening, don’t want to crush the counter
e. For KAFO knee pad may need to be tightened in standing / and make sure the drop ring lock is engaged

186
Q

Orthotic Checkout

A

—- Before application is it as prescribed: correct joints and suspensions

—- Check structural integrity and joint motion
Lock works
No broken pparts
Flex knee at least to 110 degrees – especially for sitting on lower surfaces

—- Can individual sit comfortably with feet flat on the floor

—- Check clearance for pressure sensitive areas

—- Check for good mechanical / anatomical joint congruency

—- Check for equal weight-bearing in standing
Can do the paper test

—- Check for balance in standing

—- Does brace stabilize or assist as indicated

—- Check for clearance of upright (about 1 cm)—make sure uprights don’t touch skin and that they wear long socks to protect their skin

—- Check for strap tightness—if put on straps do the finger test, if cannot get finger in the calf-band or thigh-band it is too tight, if slides in too easy it is too loose

—- Check skin integrity along with wearing schedule

187
Q

Orthotic Considerations

A

—- Keep away from heat
especially for low temperature plastics, more so in hand and wrist splints

—- Keep away from sand / liquids
Interfere with joints and movement of the joints

—- inspect brace before donning
Make sure nothing sharp exposed
Make sure nothing in the shoe that shouldn’t be in there

—- Provide necessary cleaning and maintenance

—- Consider changes in girth
Issue with weight gain and loss
Keep away from heat
especially for low temperature plastics, more so in hand and wrist splints

—- Keep away from sand / liquids
interfere with joints and movement of the joints

—- Inspect brace before donning
Make sure nothing sharp exposed
Make sure nothing in the shoe that shouldn’t be in there

—- Provide necessary cleaning and maintenance

—- Consider changes in girth
Issue with weight gain and loss

188
Q

Indication for Spinal Orthosis

A

—- Pain relief

—- Mechanical unloading
ie brace in extension to decrease loading on the anterior of the vertebrae

—- Spinal immobilization (post trauma / surgery)
Provide the R: rest

—- Management of compression fractures
especially in geriatric population (ie if anteriorly situated fracture can hold them in extension)
Scoliosis management

—- Kinesthetic reminder to avoid certain motions (ie soft collar)

189
Q

Spinal Orthotic Considerations

A
  • –Need good fit
  • –Easy to don / doff
  • –Provision for lines / tubes -If patient has a feeding tube or picc line there should be access to that
  • –Access for wound care (surgical incision) -Be able to look at the suture line
  • –Allow dissipation of heat / comfortable
190
Q

Spinal orthotic drawbacks and precautions

A

—Atrophy with prolonged use (not using abs or back extensors as much

Hypermobility above and below
-See this with spinal fusions
Above and below the area stabilized get more mobility to compensate

—Osteopenia:Not allowing normal loading through the spine, loss of minerals in the bone

—Skin irritation / breakdown
especially if not fitted well
Do skin inspections

—Pulmonary compromise
TLSO restrict movement in lungs
Affect vital capacity, give deep breathing exercises, not too restrictive for normal expansion

—Cosmesis / compliance Not so pretty, very obvious

—Energy expenditure
Affect trunk movement/rotation this will affect overall gait and more energy expended

—ADL performance, Bending over and putting on shoes Gets in the way

191
Q

Cervical Collar

how much reduce ROM

waht is it for

A

CO

Soft tissue trauma “whiplash”
CO is not used in fracture

Reminder

soft collar vs. rigid collar (does not really control AO joint at all, this is more for rest so healing can occur)

slight reduction in cervical movement by 10% in saggital plane

Rigid collar reduce cervical movement by 25% in saggital plane

Promote “R”: Rest for healing to occur

Warning to others

192
Q

Higher profile HCO:

how much ROM reduced

when used

A

HCO:
philedelphia
miami J

65-70& ROM reduced!

use for
CERVICAL FUSION
DISECTOMY

193
Q

Philadelphia

A

HCO: —foam material with a rigid exoskeleton (under chin and back portion up to occiput): it velcros

Higher profile HCO:

  • –Reduce ROM 65%-70% (especially in sagittal plane)
  • –Easy to put on – 2 components connected by Velcro on both sides
  • – When it is used:
    i. Following ant. Cervical fusions
    ii. Discectomies
194
Q

b. Miami J:

A

HCO: (“Aspen” Cervical Collar) higher profile—after cervical discetomy (remove disc) or fusion

Higher profile HCO:

  • –Reduce ROM 65%-70% (especially in sagittal plane)
  • –Easy to put on – 2 components connected by Velcro on both sides
  • – When it is used:
    i. Following ant. Cervical fusions
    ii. Discectomies
195
Q

SOMI

what is it

parts

indications (7)

A

HCTO: Sternal Occiputal Mandibular Immobilizer

HCTO: head cervical thoracic orthosis

Parts:
3 uprights: one anterior post & two posterior posts
Mandibular and occiput plates

Indications:

1) Mid cervical fractures
2) Step down from halo vest device
3) RA : in cervical area
4) DJD : in cervical area
5) Dens instability—odontoid process (if very severe would use a HALO)
6) Nerve impingement

196
Q

Minerva Brace

A

HCTO: like SOMI but a little more controlling than the SOMI—provides more stabilization

HCTO: head cervical thoracic orthosis

Custom mold bi-valved with ant/ post plates
Anterior and inerscapular portion in back
Higher post profile for cervical extension control

Indications
1. Step down or alternative to halo vest device
2. Mid-cervical fractures
3. STABLE C1-C2 fractures
Don’t use for unstable C1/C2, it is ONLY FOR STABLE

197
Q

HALO Vest

A

For maximum immobilization in cervical spine (mid high fractures)
—– Stabilization, so don’t get pressure in spinal cord

Good restriction in all planes

Parts
Cranial ring with skeletal attachment (4-6 pins)—put into the bone of the cranium
Attach to vest by 4 rods
Non-metal material ( For medical imagery testing)

Changes center of gravity—more of a challenge to work on sitting balance

Need to clean and adjust at pin sites
Also need to adjust if loosen
Need to do wound care around pin sites (benedine, tighten it, adjust it)

198
Q

CASH: Cruciform Anterior Spinal Hyperextension

type of brace

purpose

indication

A

TLSO: thoracic lumbar sacral orthosis

PROMOTE EXTENSION : the brace is on the anterior of the body

  • -Vertical bar and horizontal bar
  • -Lightweight

Indication:
1) Low thoracic and high lumbar anterior COMPRESSION FRACTURES (T6-L1):
want to be in extension to take away compression on anterior portion of the vertebrae
—Take away anterior compression so want to be in extension

2) Osteoporosis: people with OA who are getting anterior compression fractures

199
Q

Jewitt

what it does

indications

where it has pressure

A

TLSO: PROMOTE EXTENSION: Main force (T7/T8) on the posterior at the intrascapular pad: anteriorly directed force for extension

1) Thoracic and lumbar ANTERIOR COMPRESSION FRACTURE: T10-L3
2) Post-op STABILIZATION to keep in extension after surgery to prevent flexion: promotes extension

Promotes extension : pressure at the back mostly around T7/T8 in the intrascapular pad, then there is a counterforce anterior above and below)

Lateral uprights, 3 point pressure system: counter-forces above and below on the anterior : upper sternal pad and super pubic pad posteriorly directed force

200
Q

ATLANTIC BODY JACKET

A

TLSO: common in the clinic

TLSO: thoracic lumbar sacral orthosis —–Molded plastic bi-valved

Indications:

1) *Post-op spinal fusions (anywhere between T7 to L4)
2) Muscle injuries
3) DJD
4) RA
5) Nerve Impingement

In documentations: write that it was intact and precautions were observed and maintained—we do not do a lot of ther-ex with these patients

201
Q

Chairback:

type of brace

what motions it controls

A

LSO (lumbo sacral orthosis): primarily designed to stabilize in the lumbosacral spine, posterior uprights to control in saggital plane (uprights in back)

—flexion / extension

202
Q

Knight

type of brace

what motions it controls

A

LSO: lateral uprights that gives control in sagittal plane and frontal plane control:

flexion / extension + lateral flexion + some rotation

  • Post-operative and trauma bracing for thoracic, lumbosacral spine: these braces have abdominal binders that can be velcroed in front part
203
Q

Taylor

type of brace

what motions it controls

A

TLSO brace extends up further to support thoracic spine: similar to atlantic and cash and Jewitt: if doesn’t give a lot of lateral support it is just a knight : control in saggital plane:

flexion/ extension

  • Post-operative and trauma bracing for thoracic, lumbosacral spine: these braces have abdominal binders that can be velcroed in front part
204
Q

Knight Taylor:

type of brace

what motions it controls

A

TLSO: frontal and saggital plane:

flexion/extension + lateral flexion + rotation

  • Post-operative and trauma bracing for thoracic, lumbosacral spine: these braces have abdominal binders that can be velcroed in front part
205
Q

Scoliosis Orthotics

A

— Prevent further progression
— Hold the curve and support the body
— Most commonly used for AIS (adolescence idiopathic scoliosis) during adolescence
Don’t always know the origin of it
Use in adolescence during growth spurts maybe age 12-18 years
— Worn 16 - 23 hours / day
– Some braces designed to be worn only at night: 8 hours / day (nocturnal

–Include correction pads—put pressure on ribs or spinous processes -

-Can be a
higher profile: CTLSO (Milwaukee):
or
shorter profile: TLSO (Boston brace)

206
Q

Milwaki Brace

A

CTLSO for scoliosis: high profile
—–Apex of curve is above T6: this is a high profile brace
(If a low apex below T6 then you can use a lower profile scoliosis brace)

hold in posterior pelvic tilt creating a longitudinal force, there is some distraction longitudinal, it is not only a horizontal correction

Parts:
3 point pressure—pads on the uprights : 3 Uprights: 1 anterior upright 2 posterior uprights

Correction pads to control the scoliosis

Longitudinal distraction also!

207
Q

. Lower profile scoliosis braces:

ie Boston Brace

A

TLSO: apex of the curve is below T6 a

TLSO

Spinecor dynamic brace—series of straps tighten for transverse and rotary forces

—Boston brace—lower profile scoliosis brace

Providence brace

—Wilmington brace

—Charleston brace

פרםתיסיס (7 decks)

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