Pediatric orthotics

Question 1

Denis Brown Bar vs wheaton brace

Answer 1

• both for club feet
• can break
• wear all day and night

Question 2

Rhino brace

Answer 2

• for hip dysplasia

Question 3

Pavlik Harness

Answer 3

• for hip dysplasia
• the harness needs to be adjusted for growth every 2-4 weeks by an orthotist

Question 4

Scoliosis bracing/orthotics

Answer 4

• brace needed to be worn for best results
• can have skin breakdown

Question 5

Cogential Scoliosis

Answer 5

• malformation of spinal segments

Question 6

Idiopathic scoliosis

Types based on when it is diagnosed

Answer 6

• infantile: < 3 years old
• juvenile: 3-10
• Adolescence: > 10 years old
• Degenerative usually >40

Question 7

Scoliosis and orthotics

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Answer 7

• bracing concepts for scoliosis TLSO
• three point pressure system to correct the curve
• daytime and night time
• both anterior or posterior open designs
• expectation is prevent progression
• curve will be corrected in the brace but present once brace is removed

Question 8

How long are spine orthotics for scoliosis worn (until when)

Answer 8

• worn until skeletal maturity (adult height)
• goal is final curve of < 40º
• always some spring back once out of the brace

Question 9

Pediatric orthoses: motion controlling or motion-altering

Answer 9

• accommodative devices are less frequently required in this age group
• the relatively light weight of a child means materials that are more forgiving with increased flex in a heavier individual such as an adult will resist collapse more readily in a child
• choose from a wide range of material properties, shell thicknesses and filler options while still achieving the desired goal or motion control
• ideally limit excessive or undesired motions while still allowing normal motions that are so important for ideal development

Question 10

LE orthotics key posting considerations

Answer 10

• dynamic compensations for varus deformities of the rearfoot and leg require posting
• the amount of control a post provides is determined by numerous factors

Question 11

Factors that determine the amount of control a post provides

Answer 11

• the number of degrees the post is angled
• the stiffness or resistance to compression of the posting material
• anterior-posterior length of the post and the width of the post
• a longer, wide post made of a stiffer materal-the most control to the rearfoot
• there is a reduced need for forefoot posting in children under the age of 6

Question 12

Predisposing risk factors in the pediatric pronated foot

Answer 12

• weak foot structure leading to pronation, may affect the foot in its overall development and function
• these factors include: ligamentous laxity, obesity, reational and angular disorders
• ankle equinus
• shells made of more rigid materials and/or of increased thickness are the best choices for treating children who have generalized ligamentous laxity

Question 13

Ankle adaptations for orthotics

Answer 13

• locked ankle need good quad strength
• poly AFO heel lift on the heel tips forward and creates plantar flexion stop
• hinged ankles
• open DF must have a lot of strength with this
• DF stop
• DF assist
• PF stop
• PF assist

Question 14

AFOS vs SMO

Answer 14

• AFO ankle foot orthosis => provides more control in the saggital plan
• SMO: supra-malleolar orthosis

Question 15

Pullover AFO indications

Answer 15

• pronation
• low muscle tone
• mild-hemiplegia
• drop foot
• weakened DF
• saggital plane instability

Question 16

4 solid ankle AFO w/ pre-tibial shell

Answer 16

• this solid ankle AFO with anteiror panel is designed to prevent DF and PF
• the ground reaction will also help to push the knee into extension during WB

Question 17

Floor reactions orthosis

Answer 17

• brace within a brace
• application: CP crouch giat
• apply knee extension momen during stance pahse to prevent knee buckling

• *floor reaction AFO functions to maintain the affected joints in proper alignment to accentuate knee extension at midstance and compensate for weak or absent gastroc soleus calf muscles
• places the extensions force closer to the knee than other AFOs and uses a rigid anterior shell*

Question 18

6 UCBL

Answer 18

• custom made insert for controlling a hypermobile pes-planus or cavus
• it supports the arches of the foot and maintains the relative position of the hindfoot, midfoot, and forefoot

Question 19

5 articulating AFO

what does this brace do?

Answer 19

• allow flexion at the ankle and has an adjustable/removable plantar flexion stop
• it is also possible to add DF assist or check straps

Question 20

Hinge AFO

what is it used for

Answer 20

• screw that can be adjusted
• low muscle tone
• high muscle tone
• flexiable pronation or supination
• poor proprioceptive awareness
• sagittal and/or frontal plane weakness
• excessive plantarflexion

Question 21

Adavanced AFO indications

Answer 21

• low muscle tone
• joint hypermobility
• delayed standing
• inability to stand for prolonged times
• pronation

Question 22

Sure step SMO

indications

Answer 22

• low muscle tone
• pronation (heel,arch, forefoot)
• if rotation problems add De rotation straps
• indi stage 2

Question 23

Double adjustable AFO

Answer 23

• seen more in the adult population
• closed chain biomechanics
• DF step: promotes knee flexion
• PF flexion stop: to prevent thurst of tibia
• remove posterior screw and place a spring for DF assist AFO