L9 Orthotics

Question 1

four considerations when prescribing orthotics

Answer 1

advantages: how orthotic will improve mobility and gait/protect/influence tone
disadvantages: complications in ADLs, mobility, energy cost, expense
indications of usefulness to individual patient
contraindications due to pt circumstances

Question 2

ideal orthotic should function to:

Answer 2

maximize stance stability
minimize abnormal alignment
minimally compromise swing clearance
reduce joint contractures
preposition limb for initial contact
energy efficiency

Question 3

AFO for joint integrity assists with:

Answer 3

ligament support to prevent unwanted motion and prevent joint damage

Question 4

AFO for limb length assists with:

Answer 4

unequal leg length by adding a heel lift

Question 5

AFO for motor control assists with:

Answer 5

preventing unwanted motion

Question 6

AFO for muscle performance assists with:

Answer 6

endurance and weakness from weak muscle

Question 7

AFO for muscle spasticity/posture assists with:

Answer 7

reduces equinus gait and PF

Question 8

AFO for sensory loss assists with:

Answer 8

returning stability lost due to a lack of sensation/proprioception

Question 9

Assessment areas for orthotics

Answer 9

ROM
synergistic movement
sensation

Question 10

skin protection with an orthotic

Answer 10

socks: should cover entire area of orthotic, keep skin dry, and have no wrinkles
on first wear: check brace 20 min into wearing at edges and bony prominences, assess for redness

Question 11

how long should it take for an orthotic to affect gait?

Answer 11

IMMEDIATE

Question 12

drop foot: orthotic

Answer 12

AFO: leaf spring or DF assist

Question 13

ankel instability orthotic

Answer 13

solid AFO, hinged AFO

Question 14

ankle PF weakness orthotic

Answer 14

solid AFO w support strap
hinged

Question 15

knee hyperextension orthotic

Answer 15

sets ankle at neutral w minor DF

Question 16

orthotic with integumentary protection

Answer 16

provide joint protection from instability along with padding and cut outs to relieve pressure on wound

Question 17

common reasons for orthotic prescription

Answer 17

weakness
stroke
CP
TBI
peripheral neuropathy
alignment
SCI
progressive disease

Question 18

3 points of force at AFO

Answer 18

under met heads, anterior ankle, posterior calf

Question 19

3 points of force in KAFO

Answer 19

posterior ankle, distal knee, mid thigh

Question 20

carbon fiber orthotic advantage

Answer 20

lightweight and durable

Question 21

which patients are commonly described KAFOs

Answer 21

SCI
muscular dystrophy
spina bifida
polio
used for muscle weakness

Question 22

priority in AFO targeting gait

Answer 22

adequate fit and improvement in mechanics on variable surfaces

Question 23

priority in AFO targeting STS

Answer 23

increase GRF through limb while managing decreased DF by modifying chair height

Question 24

priority in AFO targeting floor to stand

Answer 24

manage decreased DF and difficulty manuevering, providing tall object to assist

Question 25

priority in AFO targeting balance

Answer 25

reduce joint mobility and make sure orthotic doesn't increase falls

Question 26

priority in AFO targeting stairs

Answer 26

prioritize safety

Question 27

essential features of orthotic

Answer 27

address impairment protects skin must be worn 6-8 hours a day without pain easy to put on/take off cosmetic appearance job and recreation considerations

Question 28

gait phases most important in orthotics

Answer 28

mid stance: hyperextension mid swing terminal swing

Question 29

solid AFO

Answer 29

large trim lines more support anterior strap covering foot and keeping in brace

Question 30

dynamic AFO/flexible

Answer 30

used in children to allow tibial advancement in stance

Question 31

hinged AFO

Answer 31

requires ROM peds or adults who need stability specifically in STS allows tibial advancement

Question 32

ground force AFO

Answer 32

people with crouched gait, flexed at hip and knee stability and prevents forward collapse at knee with anterior support below knee

Question 33

leaf spring AFO

Answer 33

flexible best used if pt only has foot drop

Question 34

when should a patient get a custom molded orthosis

Answer 34

for patients with impaired sensation significant hypertonicity risk of progressive deformity associated with this condition

Question 35

orthotic material types

Answer 35

thermoplastic: off the shelf, rigid but not durable carbon fiber: light weight, durable, factory made, no med/lat support

Question 36

leaf spring AFO for drop foot

Answer 36

mass produced with dynamic thermoplastic support weight of foot in swing phase to enhance limb clearance controlled lowering of the foot in the loading response

Question 37

DF assist orthotic

Answer 37

preposition foot for heel stroke at IC limited med/lat stabiltiy in stance contributes to push off for limb clearance not good for neuro/spasticity

Question 38

solid AFO

Answer 38

resist PF in swing for limb clearance by applying fulcrum of force at the anterior ankle w straping larger trim lines for tibial control calcaneal support interferes with all three ankle rockers or tibial advancement

Question 39

hinged AFO

Answer 39

thermoplastic allow sagittal plane motion allows more mobility w m/l stability less negative impact on functional mobility and dynamic postural control allows tibial advancement

Question 40

elastic vs pin HAFO

Answer 40

pin PF stop to stop PF elastic DF check strap to limit DF

Question 41

anterior floor reaction orthosis

Answer 41

anterior support for impaired motor control of knee and quad weakness restricts tibial advancement and prevents knee flexion in stance phase

Question 42

assessment for an orthotic should look at what parts of the LE?

Answer 42

alignment not standing in shoes, rear and sagittal calcaneal flexibilty/rigidity prone flexibility: gastro/soleus length, midfoot range, first ray range subtalar joint neutral