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Rehab Tech Final > Bracing > Flashcards

Bracing Flashcards

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1
Q

orthosis =

A

is a device worn to restrict or assist motion or to transfer stress from one area of the body to another

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2
Q

Foot slap

A

Orthotic: Inadequate DF assist

Anatomical: Weak dorsiflexors

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3
Q

Toes-first contact

A

Orthotic: Inadequate heel lift or PF stop

Anatomical: Short leg, heel pain, spasticity

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4
Q

Flat foot contact

A

Orthotic: Inadequate DF assist

Anatomical: Poor balance

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5
Q

Medial/lateral foot contact

A

Orthotic: Transverse plane malalignment

Anatomical: Weak inverters/everters

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6
Q

Excessive knee flexion

A

Orthotic: Inadequate knee lock

Anatomical: Knee pain, hamstring tightness

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7
Q

Hyperextended knee

A

Orthotic: PF stop issue

Anatomical: Weak quads, PF contracture

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8
Q

Anterior trunk bending

A

Orthotic: Inadequate knee lock

Anatomical: Weak quads, hip/knee flexion contracture

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9
Q

Posterior trunk bending

A

Orthotic: Inadequate hip lock

Anatomical: Weak glute max

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10
Q

Lateral trunk bending

A

Orthotic: Excessive height of KAFO

Anatomical: Weak glute med, leg length difference

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11
Q

Wide walking base

A

Orthotic: KAFO misalignment

Anatomical: Abduction contracture, poor balance

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12
Q

Internal/External LE rotation

A

Orthotic: Malaligned uprights

Anatomical: Hip rotator spasticity, femoral torsions

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13
Q

Late stance delayed transition

A

Orthotic: Inadequate PF stop

Anatomical: Weak PFs, pain

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14
Q

Toe drag

A

Orthotic: Inadequate DF assist

Anatomical: Weak DF, spasticity

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15
Q

Circumduction

A

Orthotic: Knee lock

Anatomical: Weak hip/knee flexors

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16
Q

Hip hiking

A

Orthotic: Knee lock

Anatomical: Contralateral short leg, hip flexion contracture

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17
Q

Vaulting

A

Orthotic: Knee lock

Anatomical: Weak hip/knee flexors, long contralateral limb

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18
Q

Test dorsiflexion with:

A

the knee extended and subtalar neutral

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19
Q

🧠 CPG Highlights – Stroke, AFOs, and FES (2021)

A

Focus: Studies involving stroke + either Ankle-Foot Orthoses (AFO) or Functional Electrical Stimulation (FES).

Both AFO and FES lead to functional improvements post-stroke.

CPG cannot recommend a specific device type due to wide variability in included studies.

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20
Q

Action Statements: When AFO or FES Should Be Considered

A

Quality of Life

Gait Speed

Other Mobility

Balance

Walking Endurance

Spasticity/Tone

Strength/Muscle Activation

Kinematics

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21
Q

“Should provide AFO or FES” for

A

most functional domains (gait speed, endurance, mobility, etc.).

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22
Q

“May provide” in

Study These Flashcards
A

domains like spasticity/tone and strength when benefits are expected.

23
Q

“Should NOT provide” if

Study These Flashcards
A

there’s no functional goal (e.g., static sitting balance alone).

24
Q

Acute vs. Chronic:

Study These Flashcards
A

Applies to both unless otherwise noted

25
What are the main goals for an AFO (Ankle Foot Orthosis)?
1. Improve swing phase limb clearance 2. Improve stance phase stability
26
1. Improve swing phase limb clearance
→ Helps prevent toe drag and facilitates safer foot progression.
27
2. Improve stance phase stability
→ Enhances ankle and foot support during weight acceptance to reduce risk of falls or compensatory gait strategies.
28
AFO Composition Breakdown:
foundation foot control ankle control superstructure
29
Foundation =
The part that interfaces with the shoe (e.g., footplate or shoe insert). Provides base support for the rest of the orthosis.
30
Foot Control =
Stabilizes the foot and manages foot alignment (e.g., prevents pronation/supination). May include straps or molded footbeds. Portion of the brace that makes contact with the plantar aspect of the foot Medial/lateral support Stance control Often required with excessive pronation/supination pattern Partial or full foot plate
31
Ankle Control =
Controls dorsiflexion and plantarflexion. Can include hinges, stops, or assistive springs.
32
Main Types
Pre-fabricated: Plastic Carbon-fiber fabric Custom: Custom-molded plastic Metal Carbon-fiber
32
Superstructure =
Portion of the brace proximal to the ankle. Provides leverage
33
Pre-fabricated =
Generally more flexible but available in semi-rigid (plastic) Carbon-Fiber May allow for small modifications (trimming of foot plate) Minimal medial/lateral stability or knee control
34
Custom =
Higher cost Better management of complex needs Triplanar foot deformities Can be with or with an ankle joint
34
Anterior Shell
-Limits forward progression of the tibia -Limits dorsi flexion in stance -Increased dynamic balance -May cause knee hyperextension
35
Posterior Shell
-More complex abnormalities impacting knee flexion and hyperextension -May allow greater dorsi flexion depending on rigidity
36
Anterior Trimline
increased control Allows less motion
37
Posterior Trimline
Less contact Decreased control Allows more motion
38
Feature: Joints
Allow ankle motion Changes can be made as needs change Vary in material: Metal: heavy but most rigid Flexible (tamarac): may allow unwanted eversion/inversio
39
Plastic =
Strong Less expensive Easy to custom and mold to deformities Sensitive to extreme temperatures May not accommodate edema
40
Carbon Fiber =
Light weight Low profile Accommodates edema (stable) Store and releases energy
41
Metal =
Heavy Accommodates fluctuating edema and skin issues Least amount of skin contact
42
Functional E-Stim
Stimulation of the common peroneal nerve to activate anterior tibialis Goal to dorsi flexion with some eversion. Two brands on the market: Bioness L300 = Geoscope Walk-aide (Outcomes Accelerated) = Inclinometer and accelerometer
43
Functional E-Stim For Who?
Stroke, Multiple Sclerosis, Cerebral Palsy, Spinal Cord Injury, Traumatic Brain Injury
44
APTA Clinical Practice Guideline (2021): use of FES
can be effective to correct foot drop No recommendations on whether FES is more beneficial than an ankle foot orthosis
45
Functional E-Stim Coverage: Limited.
Cost: consumer $5000. Clinical: Bioness: $20-50,000 Medicare: only for incomplete SCI after 30+ consecutive PT appointments using device Veteran’s Administration: Covers rental/purchase Private Insurance variable. More coverage for ortho dx verse neuro???
46
Sukanta et al 2010- Restoration of gait and motor function in persons with stroke.
Compared use of FES for foot drop and conventional therapy (CT) 60 minutes 5 days per week for 12 weeks FES Group: Conventional therapy + 30 minutes of FES to tibialis anterior Conventional Therapy: PT- neurodevelopmental facilitation approach and OT focus on ADLs. No additional specifics given. Concluded that use of an FES device for foot drop resulted in faster walking speeds. Limitations: small sample size, lack of specifics of therapy interventions.
47
Functional E-Stim Considerations:
Only addresses foot drop: Minimal stance support and stability with someone with weak plantar flexors Limited knee control Stimulation may not be tolerable Need adequate ankle range of motion Would allow for assistance without shoes Weather??? Dependent on batteries. Effectiveness varies on patient presentation and response
48
Knee Ankle Foot Orthosis
Individuals who require more extensive knee control Knee joints can be locking or allow knee flexion Heavy Generally not found to be functional High energy cost
49
Knee Ankle Foot Orthosis - types
(A) Conventional KAFO (B) Plastic KAFO (C) Allows conversation to an AFO
50
Reciprocating Gait Orthosis (RGO)
Hips: unlocked with posterior cables or bars Knees/ankles locked 4 step gait pattern: Weight shift Extend trunk Unweight Swing
51
Orthotic Fitting
Performed by the orthotist PT can assist with monitoring skin, function, damage
52
Roles of the Physical Therapist
Functional Movement Examination to determine benefit to improve function Participate in a multi-disciplinary brace clinic (Physiatrist, DPT, Orthotist) Assist a physician who DOES NOT specialize in bracing (Type, required documentation) Monitor for functional changes, brace damage, need for re-assessment

Rehab Tech Final (8 decks)

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