Orthothis Flashcards
(32 cards)
what is orthosis?
An orthosis is a mechanical device fitted to the body to maintain it in an anatomical or functional position.
what are the general principles of orthosis?
- Utilizes force to limit or assist movements
- A flexible deformity may be corrected by an orthosis, like one in mobile scoliosis
- If a fixed deformity is accommodated by an orthosis, it will prevents the progression of the deformity
- Orthosis adjustability is indicated foe children to accommodate their growth and for patients with progressive or resolving disorders
- The orthosis must be simple to maintain and clean
- The design should be simple for easy donning and doffing
- Orthosis can limit motion to reduce pain
- The orthosis must be comfortable to use
- orthosis has to be used only as indicated and as long as necessary
- It should allow movements wherever appropriate.
Explain Three Point Principle of Jordan
- This system applies corrective and assistive forces, which are implemented at the surface of orthosis through skin and are transmitted to the underlying soft tissue and bones.
- To remain stable, the body has to have one point of pressure opposed by two equal points of counter pressure in such a way F1=F2+F3
Biomechanics of orthosis
- Control of rotational moments across a joint
- Control of translational forces around a joint
- Control of axial forces around a joint
- Control of line of action of ground reaction force.
Factors effecting tissue response to the orthosis
Extrinsic factors: Pressure, shear and interface with the microenvironment
Intrinsic factors: Tissue mechanics
Give classification of orthosis according to function.
- Supportive: it stabilizes the joints and supports the body in its anatomical position. eg: calipers
- Functional: It stabilizes the joint and also make up for the lost function, eg: Foot drop splint in common peroneal nerve palsy
- Corrective: to correct deformities. eg: club foot
- Protective: To protect a part of body during healing. Rigid four collar for fracture cervical vertebrae
- Relief of pain: Lumbosacral corset supports the lower back preventing painful movements.
Give classification of orthosis according to function.
- cervical orthosis
- Head-cervical Orthosis
-Head-cervical-thoracic Orthosis - Sacral Orthosis
- Lumbosacral orthosis
- Thoraco Lumbo-sacral orthosis
What is Swedish knee cage
It is a knee orthosis that is used to control minor or moderate genu recurvatum
what is parapodium
It is used for leg length discrepancy and has a wide
abdominal support pad to assist in upright posture.
What is twister?
It is prescribed for lack of control of internal or external rotation or torsion of lower limb
Orthosis used for nerve injury:
- Radial nerve injury—a radial nerve glove is given with the wrist held in extended position or a wrist drop splint is given.
- Ulnar nerve injury—Splints that maintain the flexion of metacarpophalangeal
joints and extension at interphalangeal joint with a lumbrical bar, e.g. knuckle
duster splint.
Median nerve injury—Splint is applied to the thumb in an abducted, opposed
position. (Opponens splint).
Orthosis used for inflammation of joints and tendons:
Static thumb spica orthosis with the proximal interphalangeal joint kept free.
Orthosis used for burns:
Splinting done to hold the part in neutral position and
this prevents stiffening of the metacarpophalangeal joints
Orthosis used in rheumatoid arthritis:
Static three point proximal interphalangeal orthosis for Boutonniere deformity
Orthosis used for stroke and brain injury:
In stroke, large arm slings are used to prevent subluxation of the shoulder
Contraindications to Orthosis
- Severe deformity which cannot be accommodated in the orthosis
- skin infections
- If it limits movements in other joints
- Lack of motivation or other psychological problems
- when muscle power is inadequate to perform its function because of weight of the orthosis
Disadvantages of Orthosis
- Muscles supporting the spine can become weak
- Reduction in bone density
-skin ulcerations or calluses at the patient orthosis interface - The person becomes psychologically dependent on it
Physical Assessment
Type of paralysis and prognosis.
Posture static and dynamic
Range of movement of joints.
Muscle power; also of the hand grip especially when crutches are needed.
Coordination.
Deformity.
Sensations touch and proprioception.
Skin condition—ulceration, abrasions, dermatitis.
Alignment of limbs
Gait.
Need for assistive devices
Duration of gait
Deviation of gait
Ability to rise from various types of chairs
Ability to climb stairs and ramps.
Dexterity—ability to manage buckles and other fasteners.
Vision—walking safely indoors and outdoors needs good vision, especially
in dim light.
Spasticity.
Limb length discrepancy
Subjective Assessment
Goals—what the patient hopes to achieve with his calliper
Complaints from the patient about the orthosis on its performance and appearance, and whether there is pain.
Whether the patient has used an orthosis previously.
Comprehension—Understanding of oral and written instructions on how to use the orthosis.
Economic considerations like the funding of the treatment and the patient’s social environment
MATERIAL AND FABRICATION FOR LOWER LIMB ORTHOSES
Strength
Durability
Flexibility
Weight
Should accommodate a simple and inconspicuous design
Comfort
Inertness
What are callipers
Callipers are orthosis fitted to the lower limb. They may be
Foot orthosis (FO)
Ankle Foot orthosis (AFO)
Knee Ankle Foot orthosis (KAFO)
Hip Knee Ankle Foot orthosis (HKAFO).
Considerations While Prescribing Callipers:
- Specifications would include the nature and number of joints, the positioning of
straps and suspensions and accessory attachments to shoe or boot - Reason for prescribing must be explained to the patient, else there will be rejection.
- Stability of the hip and knee will decide the height of the calliper. Can be done after doing a muscle grading, paying special attention to the hip abductors extensors and knee extensors.
- Alignmen tis checked whether the ankle joint is over the medial malleoli, the knee
joint over the prominence of medial femoral condyle and the hip joint permits a patient to sit upright at 90°. - The calliper should be functional throughout all phases of gait and the static and dynamic alignment.
FOOT ORTHOSES (FO)
The foot orthoses is a boot that has components like supports and wedges to
manage different foot symptoms and deformities.
The FO can be divided into:
lower part and an upper part.
Components of the Lower Part:
1. sole, 2. ball, 3. shank, 4. toe spring, 5. heel
Components of upper part:
1. quarter, 2. heel counter, 3. vamp, 4.throat, 5.toe box, 6.tongue, 7. stirrup
