what factors influence the prescription of an orthosis (4)
- motor function
- goals
- impairments
- prognosis
two types of custom fabrication of an orthosis
- negative mold
2. positive mold
difference between negative and positive mold
negative - the shell of the limb
positive - when it is the shape of the limb
three parts of final orthotic check-out
- fit
- function
- patient education
regarding patient education when prescribing an orthosis, what is considered a red flag
redness from the orthosis lasting more than 15-20 minutes
True/False: the PT should watch the patient put on and take off the orthosis before they go
true
wearing schedule days 1-2
30 minutes, 2x/day
wearing schedule days 3-6
60 minutes, 2x/day
wearing schedule days 7-10
2 hours, 2x/day
wearing schedule days 10-14
4 hours, 2x/day
wearing schedule past day 14
all day use
with an orthosis, what else generally needs to be worn
a sock
when cleaning an orthosis, what should be avoided
submersion in water
should the patient place their foot into the orthosis then shoe, or straight orthosis into shoe then place their foot in
always foot –> orthosis –> shoe
three potential indications for knee orthoses
- surgery
- DJD
- recurvottum
what does KO stand for
Knee Orthosis
three types of KOs
- rehabilitative orthoses
- functional orthoses
- prophylactic orthoses
what is a prophylactic orthosis
an orthosis that prevents injury
why are there suspension considerations with KOs
as you move distally, the leg gets thinner, so the orthosis may slide down the leg
three GENERAL types of KOs
- flexible
- semirigid
- rigid
potential motions controlled with KOs
hyperextension, flexion, varus, valgus, translation
benefits of a polycentric KO
it changes the instantaneous axis of rotation
two types of joint KOs
- single axis
2. polycentric
what does KAFO stand for
Knee Ankle Foot Orthoses
difference with offset knee joint
it is more posterior to knee
three types of knee joint KAFO
- single axis
- post/offset
- adjustable
what is a Pawl-lock Bale release
it sits posterior to the lock, when it hits the front of a chair, it unlocks the knee
what type of knee joint is present with Pawl-Lock Bale releases
single axis knee joint
overall, what does the Pawl-Lock Bale Release allow
knee flexion for sitting
what does a Floor Reaction Orthosis do (KAFO)
positions the foot into plantar flexion
where is the COG for the Floor Reaction Orthosis
anterior to knee
the Floor Reaction Orthosis places the knee into…
extension
what does the Craig-Scott KAFO place the ankle into
dorsiflexion
because the Craig-Scott KAFO places the ankle into dorsiflexion, what happens to the knee
extension
who generally uses the Craig-Scott KAFO
patients with SCIs
what does the Craig-Scott KAFO allow people with SCIs to do
stand
what else needs to be used with Craig-Scott KAFOs
some sort of an assistive device
what does HKAFO stand for
Hip Knee Ankle Foot Orthosis
what needs to be used with HKAFOs
assistive device
indications for HKAFOs
significant weakness throughout the trunk and LEs
for HKAFOs, the body needs to be stabilized in what position to allow for engagement in other activities involving UE function
body needs to be in upright standing posture
three disadvantages/contraindications of HKAFOs
- high energy expenditure
- lack of necessary neck and UE strength and coordination
- hip flexion contraction greater than 30 degrees
two types of hip joints on HKAFOs
- single axis
2. dual axis
what motions are allowed by dual axis HKAFOs
- flexion/extension
- abduction/adduction
two general indications for hip orthoses for adults
- proximal femur fracture
2. total hip arthroplasty
for developmental hip dysplasia, what hip orthosis may be indicated for babies
Pavlik Harness
age appropriate for Pavlik harness
birth-6 months
what position is the child held in with the Pavlik Harness
Abduction and ER
does the Pavlik Harness control adduction?
no
