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Unit 17 > Pediatric Orthoses > Flashcards

Pediatric Orthoses Flashcards

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1
Q

how often can you justify needing a new brace for pediatric patients. how many months?

A

6 months

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2
Q

what are the two big considerations for the growth of pediatric patients

A

night-splinting: to prevent contracture in growing children

life of the orthotic: 6 months rather than 3 years

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3
Q

True or false: Ease of use and independence of donning is more important for pediatric patients than adult patients?

A

False! they generally have a parent around to help

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4
Q

what kind of brace materials can be used in pediatric patients rather than adult patients for temporary braces?

A

plastic because they are more malleable, against an adult they likely wouldn’t hold against forces

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5
Q

are off the shelf or custom orthoses more common in peds?

A

off the shelf because they have more flexible deformitiese

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6
Q

what don’t you expect with low tone feet?

A

don’t expect arches

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7
Q

what are two potential indicators for foot orthoses in pediatric patients

A

low tone feet

pronation with or without eversion

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8
Q

what are two precautions of using foot orthoses in pediatric patients?

A

sensory defensiveness

Level of evidence: not a lot of evidence longitudinally over time!

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9
Q

What is the defining characteristic of UCBL?

What kind of person is it mostly used in?

A

totally cups the heel, trim line goes up to malleoli

For someone who has unwanted flexibility in their foot or hindfoot is everted

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10
Q

what is one step up from the UCLB?

Characteristics of it?

A

cricket: flexible sillicone and then a hard plastic liner

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11
Q

what size orthotic do you order for a child?

A

next size up from what you measure due to growth

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12
Q

What is the difference in orthotic between when you are trying to deal with a flexible vs. fixed deformity

A

flexible deformity you may be able to go off the shelf.

A fixed deformity you need to ACCOMMODATE therefore you would do a custom orthoses

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13
Q

Where do SMO look like

what do they control

A

supramalleolar so above the ankle

control ML instability NOT DF

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14
Q

Who are SMO’s good for

A

people with ML instability with no need for DF assist in swing

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15
Q

what are three indications for SMO use?

A

pronation

ligamentous laxity

mild gastroc spasticity

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16
Q

Who would you definitely not use an SMO for?

A

persistent toe walking or PF contracture: doesn’t assist with DF

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17
Q

what kind of orthoses is the “surestep”

what is special about it

A

SMO

first ray is free for extension and push off vs. the other brand of the cascade

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18
Q

what kind of orthoses is the kiddie gait?

A

toe off

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19
Q

what are the two indications for toe-off/kiddigait orthoses?

A

foot drop (DF assist)

mild crouch

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20
Q

What are three precautions for Toeoff/kiddigait?

A

insufficient DF PROM (need 5 degrees)

quad spasticity

knee hyperextension

insufficient ML control

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21
Q

three indications for PSL?

A

foot drop (DF assist)

poor pushoff? potentiall

hemiplegic CP and insufficient power

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22
Q

PLS vs. solid AFO?

A

narrow trim lines, doesn’t come all the way to malleolo. So if the person needs ML control or has greater muscle tone the AFO is a better choice

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23
Q

2 precautions for use of PLS

A

low trimline: insufficient ML control

gastroc spasticity: its a little maliable

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24
Q

4 indications for articulating AFO

A

insufficient DF in swing

GASTROC SPASTICITY

active DF present

idiopathic toe walking: have DF and PF actively allowing tibial translation

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25
2 precautions for articulating AFO
PF contracture: must address this first or they'll just hang out in PF severe proximal weakness: alignment may be compromised
26
solid vs. articulating AFO things to think about
if you have no active DF no need for articulating
27
Tamarack and ultraflex are what kind of orthoses
articulating AFO
28
an ankle brace controlling knee hyperextension would stop what motion at the ankle?
PF: blocking posterior translation of tibia
29
articulating knee braces still allow what
strengthening of the quads through squats
30
4 indications for articulating AFO with free DF and PF block
toe-heel gait: not just toe walking, toe heel gait means they're getting active DF at some point just not getting good heel strike early heel rise gastroc tone knee hyperextension
31
2 precautions for articulating AFO with free DF and PF blocked
gastroc contracture persistent toe walking pattern for both they need more help with getting DF than free bracing allows
32
what is the purpose of check strap
can be tightened down to ankle orthoses a solid AFO
33
4 indications for solid AFO
poor foot alignment in standing PF spasticity risk of PF contracture PF paralysis: no DF or PF
34
what orthoses would you use for an individual who is non ambulatory in a standing program
Solid AFO
35
what activity is super difficult with solid AFO
stairs
36
3 precautions of solid AFO
if they are able to independently ambulate without AD potential for recovery of DF or ambulation blocking of transfers, functional mobility such as stairs and floor mobility in kids!
37
what kind of orthoses is a turbo/
solid AFO
38
DRAFO is used for what?
accomodate contractures (she doesn't like them)
39
what does a floor reaction AFO look like?
part that opens and closes is anterior
40
what are the 3 indications for floor reaction AFO?
crouched gait PF weakness hamstring spasticity
41
2 precautions of floor reaction AFO
toe walking: brace still allows for PF set the angle to accomodate knee contracture/functional standing position.
42
if a child has crouched gait what kind of orthoses are you thinking abuot using witht hem
floor reaction AFO solid AFO
43
your pt is unable to maintain knee extension in standing what kind of orthoses do you want to use?
KAFO
44
2 indications of KAFO, HKAFO's, RGO use
inability to maintain knee extension in standing weakness/paralysis
45
2 precautions to KAFO's and HKAFO's/RGO's
spasticity align for A/P weight line
46
what is the major consideration for HKAFO or RGO?
they're super heavy!! decreases energy efficiency
47
high level spina bifida would use what kind of orthses?
parapodium
48
what is the major precaution of parapodium?
lots of points of contact, want to make sure skin integrity is good
49
when would you consider a parapodium
independence with transfers not possible
50
define plagiocephaly brachycephaly scaphocephaly
plagiocephaly: flattness on one side more than the other brachycephaly: flattened on posterior side scaphocephay: long narrow head
51
what age is the precaution for cranial molding helmets?
>1 year
52
when do you think about intervening for asymmetry of a babies head?
moderate or severe asymmetry: positioning education, refer to an orthotist to get a scan done, neurology
53
what is the wear schedule goal for a hemet?
23 hrs/7days a week
54
What are some things to keep in mind for cranial molding helmets?
skin checks! (red should go away in 30 minutes) perspiration Remove for an hour a day for PROM/ROM work up to wear schedule
55
red marks due to helmets should go away in what time frame?
30 minutes within taking it off
56
true or false: it is okay to leave helmets on for bathing and swimming
false, take them off
57
where do you typically start for a helmet wear schedule? end?
1 hour on, 1 hr off, not during naps or night 23 hrs/day during all sleeping
58
every time the helmet is removed you do what?
skin check!
59
what is the goal of wear time for night splinting?
4-6 hours
60
what are the three most commonly night splinted LE muscles
PF, knee flexors, ADD
61
can you get over the shelf night splints?
yes! can also get custom
62
what is the point of dynamic night splints?
the joint has a resistance function: it allows you to relax into the position that you can get to and applies resistance.
63
what is the con of dynamic splints
they're very expensive! only order it if you think your pt is going to use it
64
where do you begin the wear time for nightsplinting?
1-2 hours increase by half an hour every day or every other day. working up to 6 hours
65
if they cannot sleep with nighsplint on what is a good alternative
4 hours after school

Unit 17 (9 decks)

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