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Musculoskeletal > Orthotics > Flashcards

Orthotics Flashcards

1
Q

What is an orthosis?

A
  • Used interchangeably with splints and braces
  • A device that is applied to part of the body for the purpose of protecting that part or assisting in the restoration or improvement of function
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2
Q

What are low-heat thermoplastic materials?

A
  • A combination of elastic, plastics, and rubberlike components
  • Used for splinting
  • Softens in temperatures between 135-180
  • Need to choose material based on purpose of splint and desired properties of material
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3
Q

What is memory when referring to orthotic material?

A
  • The degree to which the material is able to return to its original shape once molded and then reheated
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4
Q

What does drapability/conformability mean when referring to orthotic material?

A
  • The way the material conforms to the shape of the hand
  • Materials with high drapability work best with gentle handling since they conform easily to the arches or bony prominences by just placing the material on the patient
  • Requires light touch since it works well with gravity
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5
Q

What is elastic or flexible orthosis material like?

A
  • It has a springy feel
  • The material stretches but springs back
  • Can be more heavy handed when working with this material
  • Less conformable but has memory
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6
Q

What is bonding when referring to orthotic materials?

A
  • Materials can coated or uncoated
  • Coated materials will not stick to one another unless the coating is removed by scraping it off or using a bonding removal agent such as acetone
  • Bonded materials are needed in order to make dynamic outriggers
  • Uncoated materials will stick to itself. This can be good because it can save time but is a difficult material to work with when a new splinter
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7
Q

What are performance characteristics of orthosis materials?

A
  • Conformability
  • Flexibility
  • Durability
  • Rigidity
  • Perforations
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8
Q

What can be made with minimum resistance orthosis material?

A
  • Hand splints for tendon injuries
  • Injury/area that requires low resistance to stretch
  • However, small splints may require material with a higher resistance to stretch when splinting against gravity or for spasticity
  • Polyform
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9
Q

What can be made with moderate resistance orthosis material?

A
  • Medium-sized splints and orthotics
  • Hand splints, elbow splints, neck collar, knee splints
  • Polyflex
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10
Q

What can be made with maximum resistance orthosis material?

A
  • Back braces, foot drop splints, leg braces, and spasticity splints
  • Helps reduce tone
  • Ezeform
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11
Q

What are common tools needed when creating an orthosis?

A
  • Super shears
  • Nylon spatula: better than tongs
  • Heat gun: good for bonding and fine tuning
  • Curved scissors
  • Strapping material: foam has some give/stretch
  • Strap pads
  • Hook material: with and without adhesive. Does not stretch
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12
Q

What are static splints and what are they used for?

A
  • A splint that is molded to the hand to maintain the tissue in one position
  • No moveable parts
  • Ex: resting hand splint, CMC static splint, ulnar gutter splint, anti-spasticity ball splint, thumb hole wrist cock-up splint (wrist neutral splint)
  • Help relieve pain: helps drain edema and keeps extremity safe in anatomical position
  • Helps maintain joint alignment
  • Prevents adaptive shortening of soft tissue
  • Corrects soft tissue contracture
  • Immobilizes a joint or limb following trauma
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13
Q

What is a resting hand splint?

A
  • A static splint
  • Used to treat RA, carpal tunnel syndrome, fractures, hand burns (modified into intrinsic plus position), tendonitis, hemiplegia
  • MCP joints and skin are in a lengthened and stretched position
  • 70-90 degrees of MCP flesion and IPs straight
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14
Q

What are buddy straps?

A
  • Used to protect injured finger by keeping affected and neighboring finger together
  • Helps with mobility
  • Can be used with finger dislocation and fracture
  • Encourages flexion
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15
Q

What are common liners that are used with orthotics?

A
  • Fleecy Web/foam lining, Stockinette (helps absorb heat and can be washed), and Terry Foam
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16
Q

What is a dynamic splint?

A
  • Splint applies force and movement to joint(s)
  • Must have three parts: a splint base, an outrigger, and a dynamic traction force
  • Used to improve function and motion
17
Q

When are dynamic splints used?

A
  • Can be substitute for lost muscle function
  • Can assist weakened muscles
  • Can correct deformity
  • Can minimize adhesion formation
  • Helps move affected areas earlier in recovery process
18
Q

What is a dorsal blocking splint?

A
  • No longer used because contractures can result
  • Was used for tendon injuries
  • Provided dynamic traction for flexion tendon repairs
19
Q

What do static progressive splints do and when might they be used?

A
  • They are similar to dynamic splints but there are no moveable components
  • They apply low-load to joint while maintaining the tissue at its maximum length
  • Worn for extended periods of time so that the tissues can adapt and “grow” to new length.
  • Increase ROM and correct soft tissue contractures
  • Serial static splints
  • Ex: static progressive splints, static progressive finger flexion splint, static progressive finger extension splint, dynamic wrist splint. Phoenix Wrist Hinge,
20
Q

What are goals of splinting?

A
  • To protect or support injured, weakened, or repaired joints and soft tissue
  • To immobilize or restrict joint ROM. Ex: carpal tunnel syndrome, cubital tunnel syndrom, dequervain’s tenosnovitis
  • To correct or prevent joint deformity. Ex: arthritic ulnar deviation
  • To substitute for weak or absent muscle function. Ex: radial nerve splint
  • To inhibit abnormal muscle tone. Ex: stroke
  • To increase ROM. Ex: static progressive splints
21
Q

What are anatomical landmarks that are important to keep in mind when splinting?

A
  • Creases of hand: splinting should clear the creases of mobile joints in order to allow full movement of joint
  • Arches of the hand: custom made splints should maintain/support the arches of the hand. Arches maximize amount of surface contact with an object and enhances stability and increases sensory input
  • Longitudinal arch: maintained by activity in the hand’s intrinsic muscles. Should be a flexible arch
  • Proximal transverse arch: a stable bony arch that forms the posterior border of the carpal tunnel. Should be a rigid arch and located at the level of the carpometacarpal joints with the keystone being the capitate
  • Distal transverse arch: formed by the metacarpal heads. Combination of “radial” stability and “ulnar” mobility. It should be a flexible arch at the level of the metacarpophalangeal joints with the keystone being the 2nd and 3rd metacarpals. The 1st, 4th, and 5th metacarpals rotate around the 2nd and 3rd metacarpals to either flatten or increase the arch
22
Q

What should be considered when making an orthotic?

A
  • The normal axis of motion should be maintained
  • Try not to splint unaffected joints
  • When possible, allow contact of palmar surface of palm and digits with the environment to permit greater sensory discrimination
23
Q

What is the resting hand splint position?

A
  • 10-20 degrees of wrist extension
  • Neutral wrist
  • Flexion and abduction of the thumb
  • 15-20 degrees of MCP flexion
24
Q

Where should fingers point to when flexed?

A
  • Towards the scaphoid bone
25
Q

Where should hooks be attached in order to obtain optimal leverage?

A
  • Proximal and central aspect of the nail
26
Q

How can the strength of a material be increased?

A
  • By adding contours to the material
27
Q

What is the rule of area of force when making orthotics?

A
  • By increasing the area of force applied on skin, it will reduce the amount of pressure in area
  • Forearm trough should be 2/3 forearm length
  • Thumb or forearm troughs should 1/2 the circumference
  • Rolled edges reduce pressure
28
Q

What precautions should be taken with orthotics in order to reduce chances of injury?

A
  • Round corners to avoid sharp points
  • Remember areas of impaired sensation
  • Use padding over bony prominences before splinting. Padding afterward will increase pressure
  • The pt should wear the splint for approximately 20-30 minutes. Then it should be removed and checked for red areas. Red areas should not last for more than 20 minutes after splint removal
29
Q

What are common areas of injury due to pressure?

A
  • Ulnar styloid: can use theraputty to create negative space when making splint
  • Metacarpal joints
  • Tips/pads of fingers for pts that have tone
30
Q

What are other splinting precautions to educate pts on?

A
  • Time: when can pt wear splint (bathing?), for how long, how often is it tightened?
  • Edema: sign that splint may be too tight, could be agitating a nerve, or strap is on too tight (you should be able to fit one finger under straps)
  • Moisture: macerations may result, keep splint clean
  • Circulation: look at color and capillary refill
  • Tingling/numbness: straps may be too tight, digital nerves can become irritated and feel like the finger is falling asleep
  • Temperature of materials: do not want material to get too hot
  • Additional splinting materials: rubberbands and monofilaments can snap/break, what should the pt do if this happens?
31
Q

What are important points to make when educating pts on orthotic care?

A
  • Explain purpose of the orthotic
  • Pts need to know that heat may melt or change the shape of the orthotic
  • Pts should be discouraged from making self-adjustments
  • Clean orthotic with mild soap and water - only if pt is allowed to come out of splint
  • Provide pt with a contact phone number in case of problems or questions
32
Q

What should be included in orthotic documentation?

A
  • Type of splint, anatomical position, and purpose of splint
  • Pt education: wearing schedule, splint care, precautions, HEP

Follow Up Visits:

  • Any changes/modifications to design or schedule
  • Patient’s wearing tolerance and compliance
  • Efficacy of splint
33
Q

How are orthotics billed?

A
  • L-Codes

- Facility must be a DME provider, otherwise must bill under orthotic management and training 97760

34
Q

What are important things to remember when making an orthotic?

A
  • Use gravity whenever possible
  • Use palmer surface of hand and digits and not fingertips when molding material
  • Use lotion on the material to keep it from sticking to itself and to reduce fingerprints
  • Heat the adhesive on the velcro to make it stick better and not peel up
  • Round edges of straps and velcro hook

Musculoskeletal (17 decks)

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