Orthotics

Question 1

Purpose of orthoses

Answer 1

1. Restrict abnormal or excessive motion
2. Support surrounding structures to prevent deformity or compensate for deformity
3. Transfer load from one region to another bypassing compromised tissue and joints
4. Assist in preserving and augmenting motion

Question 2

Pathomechanics

Answer 2

1. Abnormal mechanics that occur when body cannot tolerate outside applied forces or cannot internally generate enough force to perform functional activities (weakness, motor control)
2. Malalignment (structural) or inability to adequately resist outside applied forces from GRF

Question 3

How most orthotics work (accept those whose goal is to vertically offload)

Answer 3

3 point force/counterforce system

Question 4

Goals of orthoses

Answer 4

1. Maintain or correct body segment alignment
2. Assist or resist joint motion
3. Relief of distal WB force via axial loading
4. Protection against physical insult

Question 5

Pre-orthotic prescription

Answer 5

1. Assess A/PROM
2. Presence of contractures that prevent normal movement
3. Accommodative vs corrective orthotic
4. What joints need to be accommodated, which need to be corrected
   Fixed deformity: accommodative
   Unfixed deformity: corrective

Question 6

Foot orthosis

Answer 6

• used when foot cannot attain neutral, may shim gap to that fixed position (accommodative)
• or used to help foot attain neutral position (corrective)
• may unload compromised tissue or provide total contract
• may be full custom or off the shelf
• full, 3/4 or heel orthoses

Question 7

Supra maleolar orthosis

Answer 7

• low profile design that crosses the ankle joint
• less invasive trim lines than standard AFO
  Ie. Swede-O used to stop ankle from twisting (ankle sprains)

Question 8

Metal bar AFO

Answer 8

• commonly used in specific scenarios
• post-polio, neuropathic feet

Question 9

Total contact AFOs

Answer 9

• provide sleek, intimate fit w/ total contact to provide better control
• subtype are thermoplastic and thermosetting
• light weight and easily concealed

Question 10

Floor reaction AFO

Answer 10

• uses floor reaction force through toe aspect of foot plate to prevent forward tibial progression and subsequent knee collapse
• cannot be articulated
  Controls knee by what’s happening at the ankle

Question 11

Unweighting AFO

Answer 11

• may be patellar tendon bearing, specific weight bearing or total surface bearing to unweight the ankle and foot using prosthetic principles
• used to accommodate abnormalities
• socket-like

Question 12

Immobilizing AFO

Answer 12

• commonly used with LE deficiency where ankle immobilization desired
  Ie. Distal tibia/fibular fx, foot bone fx, tendocalcaneous rupture, diabetic foot (Charcot)
• normalizes gait cycle, controls foot drop, pushes knee back into extension for stability, has slight rocker bottom

Question 13

Non-articulating (solid ankle) AFO

Answer 13

• more accommodative
• does not allow DF at push-off
• knee forced into extension

Question 14

Articulating AFO

Answer 14

• more corrective
• can help w/ PF spasticity
• push knee into slight flexion to decrease genu recurvatum
• articulation at ankle allows for normal gait mechanics

Question 15

Allard - toeoff/BlueRocker AFO q

Answer 15

• prefabricated carbon fiber
• designed to absorb energy at heel strike and return at push-off
• controls for foot drop in neuromuscular patients ie. MS, stroke (very light control of foot drop at heel strike)

Question 16

Knee orthoses

Answer 16

Useful for:
- genu varum, valgum, recurvatum
- protect knee structures from undue loading/stress
- may be preventative or corrective
- may be permanent tx for repaired/compromised knee structures

Question 17

Athletic KO

Answer 17

• preventative
• after injury or ligament repair
• used to stabilize knee into valgus and varum, may not be enough to prevent abnormal movement
• Proprioception thought to play a role

Question 18

Non-articulated KO

Answer 18

• usually for short term use
• difficult to transfer
  Ie. Knee immobilizer (injuries) Swedish knee cage for neurologic pts

Question 19

Off the shelf KO

Answer 19

• offers limited control of the knee
• restricts gross motion

Question 20

Knee ankle foot orthosis

Answer 20

• indicated when lesser devices are biomechanically insufficient
• combines KO and AFO

Question 21

Single/double bar KAFO

Answer 21

• accommodates volume fluctuations
• for inadequate knee flex/ext strength
• several lock options; lock for ambulation, unlock for sitting
• may incorporate hyperextension stops
  Bail lock; back up until chair touches -> unlocks to permit sitting

Question 22

Total contact KAFO

Answer 22

• more customizable
• better load distribution

Question 23

Ischial weight bearing (unweighting) KAFO

Answer 23

• ischial containment or quadrilateral style brims with high trim lines
• generally used with paralytic limbs
• not as effective with larger or obese pts
• could use for non-union fx of femur or tibia or taking out knee replacement after infection

Question 24

Hip knee ankle foot orthosis

Answer 24

• very restrictive and laborious to swing to or through in gait
• causing high rejection rates
• included reciprocating gait orthoses, total contact, leather and metal upright, postural etc.
• could see in pediatric population but are rare

Question 25

Reciprocating gait orthosis

Answer 25

- commonly used in cases of spina bifida and spinal cord injury - combines flexion of one hip with extension of the opposition - flexion power of one hip utilized to extend the opposite hip allowing for reciprocal gait

Question 26

SWASH orthosis

Answer 26

- standing walking and sitting hip orthosis - maintains femoral abduction in standing, walking and sitting hip - may see with hip replacement pts that are non-cooperative w/ posterior precautions

Question 27

Hip abduction orthosis

Answer 27

- commonly used post-operative to position the femoral head optimally within the acetabulum

Question 28

Scoliosis

Answer 28

Lateral curvature of the spine

Question 29

Torticollis

Answer 29

Cervical spine scoliosis

Question 30

Functional scoliosis

Answer 30

Non-structural; d/t postural problems, nerve root irritation, inflammation, contractures, or leg length discrepancy * In forward flexion the curvature straightens and limitations in SB are symmetrical *

Question 32

Structural/fixed scoliosis

Answer 32

- permanent loss of normal ROM in SB/rotation in an asymmetrical pattern - does not disappear with trunk flexion - usually progressive - curve is named by convection (C or S)

Question 33

Etiology of structural scoliosis

Answer 33

- 80% idiopathic - Bony deformity: wedge vertebrae, hemivertibra, or failure of segmentation - Neuromuscular: upper or lower motor neuron lesion (MS, CP, polio) - Myopathic: muscular dystrophy - Persistent flexion contractures

Question 34

Convexity of structural scoliosis

Answer 34

- disc spaces are wide on the convex side and narrow on the concave side with vertebral body deformity Convex side: rib pushed posteriorly and thoracic cage narrowed (why we see the rib hump) vertebral body deviation Concave side: rib pushed laterally and anteriorly, spinous process deviation

Question 35

When assessing scoliosis must also…

Answer 35

Look at length length**

Question 36

Vital capacity in scoliosis

Answer 36

Limited if the lateral curve exceeds 60 deg with compression and malposition of the internal organs

Question 37

Double major or S curve

Answer 37

- both curves are fixed and will not correct

Question 38

Hip more prominent

Answer 38

On concave side or opposite convexity

Question 39

Shoulder blade more prominent

Answer 39

On side of convexity

Question 40

0-30 deg scoliosis

Answer 40

Treated with signs of progression

Question 41

30-45 degree scoliosis

Answer 41

Treated with orthotic intervention

Question 42

45 degree or greater scoliosis

Answer 42

Treated with surgical intervention

Question 43

CTLSO

Answer 43

- traditional method of scoliosis tx, don’t see much anymore - rigid frame design - uses three point pressure and kinesthetic reminder - worn 23 hours/day

Question 44

Thoracic-lumbar-sacral orthotic

Answer 44

- low profile orthotic for scoliosis - worn 23 hours/day or just for sleeping (depending on type) - made of semi-rigid plastic and foam s

Question 45

Semi-rigid design TLSO

Answer 45

- increases intra-abdominal pressure - limits ROM - commonly used for herniated disc, and moderate soft tissue strains and sprains, anterior compression fx of vertebral body, osteoporosis - commonly referred to as a body jacket

Question 46

Hyperextension TLSO

Answer 46

- pt unable to flex - used for osteoporotic patients

Question 47

Lumbosacral orthosis

Answer 47

- soft design - increase intra-abdominal pressure - commonly used for herniated disc and other mild to moderate soft tissue strains and sprains - can be used preventatively

Question 48

Boston overlap orthosis

Answer 48

- semi-rigid design - increases intra-abdominal pressure - limits ROM - commonly used for herniated disc and moderate soft tissue strains and sprains