Orthotics Mid-Term Review
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| What is an orthosis? | Orthopedic appliance/apparatus used to support, align, prevent, or correct deformities or to improve fxn of movable parts of the body. Enhances fxn.
An orthopedic device used to support or sustitute function and correct abnormalities in gait.
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| 3 Orthotic Principles | 3-pt pressure systems
Increase circumferential pressure
Modify end point support systems
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| How much DF is needed for normal gait? | 10 degrees
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| How much knee flexion is needed for normal gait? | 65 degrees
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| 3 components in patient eval process | Gait Analysis,
Fxnal ROM,
Fxnal MMT
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| Design Considerations | Available ROM,
Weight of pt,
Necessity,
Control of motion,
Cost,
Cosmesis,
Adjustability,
Effectiveness,
Functionality,
Compliance
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| What materials can orthotics be made of? | Laminates
Soft foam ,
Thermoplastics,
Metal
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| Uses for compression hose | Diabetes (including pressure ulcer),
Lymphedema,
Prevent DVT,
Varicose veins
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| Purpose of a diabetic insert | Distribute weight to prevent breakdown,
Reduce & eliminate irritations & abrasions,
Reduce excess pressure to the foot,
Increase activity level to enhance circulation,
Promote healing of foot,
Decrease incidence of amputations
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| Modifications that can be made to shoes to better accommodate the foot | Lifts for LLD, Heel or sole wedging, steel spring, metatarsal bars, rocker bottoms, Thomas heels, Offset heels, Heel counters, Orthosis attachment, Stretching, Gussets
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| Foot Pathologies | Pes planus*, Pes cavus*, Plantar fasciitis*, Heel pain*
Metatarsalgia, Sesamoiditis, Morton’s Syndrome, Morton’s Neuroma, Hallux Rigidus, Hallux Valgus, Hammertoes, Claw toes, Mallet toes, Pes Equinus, Arthrodesis, Achilles Tendonitis
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| 3 components of equinovarus | Forefoot adduction,
PF,
Inversion
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| What position is foot in with clubfoot (Talipes Equinovarus) | Forefoot adduction,
Midtarsal supination,
Equinus at the ankle,
Medial deviation at the foot
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| What position do you put the foot in to correct clubfoot? | Abduct forefoot,
Pronate midfoot,
DF ankle
Serial casting
Fillauer night splints
Dennis Browne Bar
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| What does SMO stand for? | Supramalleolar Orthosis
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| What is the purpose of an SMO? | Extends proximal to malleoli;
Better mediolateral control than UCBL;
Allows DF & PF
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| Custom AFO characteristics | Extended/permanent use
Severe deformities
Individual fit
Good for basic foot drop
Maximum fxn
Moderate to severe involvement
Cost more
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| Pre-fabricated AFO characteristics | Temporary usage,
Mild to moderate involvement,
Limited fit & fxn,
Dx procedures,
Cost less
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| Advantages of plastic AFOs | Light weight,
Cosmesis,
Change shoes (more shoe options),
Total contact
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| Disadvantages of plastic AFOs | Non-adjustable,
Not appropriate for those who have edema or insensate feet
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| What kind of motion does a posterior leaf spring have? | Allows DF & PF assist, but no medial-lateral stability
• Prevents PF during swing phase to allow for limb clearance
• Control foot lowering during loading phase in stance phase
• Indications – drop foot deformity
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| Purpose of a full foot plate on a solid ankle AFO? Indications? | Controls drop foot; Provides limitation for toes to roll over in gait (hammer toe/diabetes); Prevents excessive DF in instance of knee buckling; Indirectly controls knee hyperext & buckling
- Ankle fusions, mm tone in LE, CMT, traumatic injury, arthrits
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| What is the purpose of a medial extension on the forefoot of an AFO? | Control supination & varus
Prevent inversion & forefoot adduction
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| What kind of motion does a DF assist PF stop AFO have? | Minimal ankle motion
Free DF
Limited PF
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| Purpose of a floor reaction AFO? | Helps facilitate knee extension moment & control ankle DF/PF
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| What is the purpose of a Patellar Tendon Bar AFO? | Reduces WB forces to heel & midfoot
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| What kinds of ankle joints are used in metal AFOs? | Free,
Variable ROM,
DF assist,
Double action
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| What is a PRAFO (pressure-reducing AFO) or multi-podus boot used for? | PF contracture- limits joint contractures,
Foot drop,
Plantar fasciitis,
Achilles tendonitis,
*Heel ulcers
*Bed sores
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| What is unique about a cam walker? | Rocker bottom.
Can change amount of ankle motion
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| What is a night splint used for? | Prevent PF during sleep,
Club foot ,
Prevent contractures,
Plantar fasciitis
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| How does an AFO affect the knee? | Provides indirect support by creating a stable base,
DF assist will create knee flexion moment,
PF limit will stop knee hyperextension
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| What is a knee immobilizer used for? | Prevent movement at the knee post-surgically,
Post-injury,
To prevent contractures
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| What is an IROM & what is it used for? | Variable ROM hinge on knee brace,
Used to control amount of flexion/extension ROM, at the knee post-operatively
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| What is a chopat strap? (T-strap) | Applies pressure to patellar tendon, & causes patella to be elevated
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| What dx would use a chopat strap? (T-strap) | Osgood-Schlatter's,
Patellar Tendonitis,
Chondromalacia,
Patellofemoral chondrosis
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| What are functional knee braces used for? | Stability during functional movement
• Worn by those who are returning to actvty. Control medial & lateral stability, ant Tib translation 7 torsion. Often use a 4 point system. The molded tibial shell is the anchor and reduces anterior Tibial translation
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| Knee joint for KAFOs | a. Single Axis
- Free motion
b. Single axis locking
- Drop lock
- Cam or bail lock
- Trigger release
c. Variable ROM
- Dial lock
- Step lock
d. Posterior Offset
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| How can knee be controlled in a KAFO? | Posterior offset locks out hyperextension,
Droplock & bail lock locks out knee,
Medial/lateral straps
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| 2 ways to control the ankle in a KAFO | Use of a joint,
T-strap for the ankle (pulls foot out of pronation or supination depending upon side you put strap)
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| What is a stance control orthosis? | Computerized knee joint,
Stability during stance,
Free knee flexion during swing,
Reduces gait deviations,
Decreases energy expenditure
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| Indications for a stance control orthosis (SCO) | Weak quads,
No contractures,
No spasticity,
Good or normal hip and ankle mm.
Grade 3 hip flexors & extensors
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| What is the purpose of a reciprocal gait orthosis (RGO)? | Maintain fxn,
Prevent deformity,
Facilitate sitting, standing, or walking,
Allows forward flexion of opposite leg- swings leg through
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| Pathologies commonly treated with RGOs? | Spina bifida,
Low thoracic/high lumbar injuries,
SCI
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| Difference b/t RGO & HKAFO? | RGO allows hip movement- helps swing opposite leg through.
HKAFO is more fixed- doesn't help leg swing through- you have to have active muscle
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| Different Hip Joints | Abduction,
Combined motion,
Drop locks
Variable ROM
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| Types of hip orthoses | Abduction pillows,
Static hip abduction orthosis,
Active hip abduction orthosis,
Hip spica,
Pavlik harness,
Scottish Rite
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| Hip pathologies | Traumatic dislocation,
Developmental dysplasia resulting in chronic dislocation,
Total hip replacement,
Legg-Calve-Perthes
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| What are the standard orthotic fitting guidelines for an active hip abduction brace? | Waist/pelvic components are even on pelvis,
Hip abduction at least 15 degrees or as determined by physician,
Hip joint set to allow limited flexion to 70 degrees or as determined by physician
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| What position does a pavlik harness hold the hips? | 30-60 degrees hip abduction.
90-100 degrees hip flexion
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| Methods of fracture treatment | Splinting,
Casting,
Surgical Reduction and Stabilization,
Orthosis
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| What is Wolf's Law & how does it work? | Body adapts to stresses placed on it- bone is a dynamic organ system, continuously remodeling due to mechanical force & metabolic demands
Increases in stress on bone will lead to increased bone growth
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| What is a pneumatic AFO? | Additional compression
Total contact,
Reduces shearing of skin,
Effective for volume changes
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| What orthotic principle does fracture bracing exemplify? | Increase circumferential pressure
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| 4 reasons follow-up is important in orthotics | Pt acclimation process,
Continued fitting & follow-up,
Re-eval,
Maintenance of orthotic
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| How can gait change with an orthosis? | Change overall trunk & limb alignment,
Improving function which makes gait more functional
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| Morton's Neuroma | Thickening of the nerve b/t the 3rd & 4th toes or 2nd & 3rd toes, treat with arch support to take pressure of area of MT heads
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| Plantar Fasciitis | Inflammation of plantar fascia.
Treatment- night splint & arch support.
gastroc stretching, ice massage.
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| Hallux Rigidus | Big toe doesn't bend; need 60 degrees extension of big toe to walk.
Treatment- carbon foot plate to stop shoe from bending at toe crease
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| Posterior Tibialis tendon dysfunctoin | Helps support arch, so arch collapses leading to severe pronation
Treatment- leather laced solid ankle AFO, if not sever treat with arch support
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| Charcot-Marie-Tooth | Inherited neuro disorder affecting mm, causes atrophy & high arches & hammer toes.
Treatment- AFO with full foot plate b/c mm are atrophied
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| Charcot Joint | Diabetes, degeneration of ankle joint b/c of loss of sensation due to decreased proprioception.
Treatment- custom shoe that accommodates.
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| What is closed chain pronation? | Hip & knee- Flexion;
Ankle- DF, IR, pronation;
Talus- PF, adduction, inversion
Sub-Talar joint- DF, abduction, eversion
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| What are the 5 functions of the foot? | Leverage.
Shock absorption.
Balance.
WB.
Protection
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| Full Foot Plate (PF stop) | Prevents PF at ankle.
Prevents DF at 1st ray.
Prevents buckling at the knee b/c of weak quads.
Prevents genu recurvatum
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| Functions of the spine | Support.
Mobility.
Control.
Housing & Protection
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| How many vertebrae are there at various levels? | Cervical- 7.
Thoracic- 12.
Lumbar- 5
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| What muscles extend the spine? | Erector spinae/ Paraspinals
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| What muscles flex the spine? | Psoas.
Abdominals
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| How does a spinal orthosis obtain the biomechanical concept "increase intracavity pressure"? | Provides circumferential pressure to the trunk, spinal orthoses increase intracavity pressure. This in turn increases the effectiveness of abdominal musculature, making the core more stable
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| Spondylolysis | Stress fracture of the pars interarticularis
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| Spondylolisthesis | Forward slippage of one vertebra over the lower vertebra (most common at L4-5, L5-S1)
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| Spondylosis | Degeneration of the articulating part of the vertebra
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| Various vertebral levels | C3-4: chin in neutral position
T3- root of spine of scapula
T5- axilla
T7- inferior scapular angle
T10- xiphoid
L3- natural waist
L4- iliac crest
S2- ASIS
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| What is a compression fracture? | Fracture that occurs when pressure on the vertebral body exceeds the ability of the bone to support the load. This causes the front part of the vertebral body to be crushed. Manage conservatively. Put spine into hyperextension
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| What is a burst fracture? | Fracture of the vertebra where the entire vertebral body fractures, & is usually caused by shear forces
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| 3 ways a soft collar can assist | Assists in spinal alignment.
Limits ROM (Flexion).
Kinesthetic reminder
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| What is the most common semi-rigid cervical orthosis prescribed in this area? | Miami J
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| What does SOMI stand for? | Sterno-Occipital Mandibular Immobilizer
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| For the most part, what is the highest fracture you would treat with a CTO? | T1-2 - lower than this you would need to stabilize more of the thoracic region
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| What do HALO pins get torqued down to on an average adult? | 6-8 lbs
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| Why is the posterior pin located contralateral from the anterior pin on a HALO? | To maintain symmetry - to keep it optimally stabilized at 180
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| Why would a patient need an SI belt? | SI joint dysfunction/instability, or during pregnancy
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| What is the proper location for an SI belt? | Above the trochanter, but must be on the pelvic crest
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| 3 functions a maternity support can provide | Assist in spinal alignment.
Limit ROM (particularly flexion).
Kinesthetic Reminder
Can also decrease varicose vein
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| Explain the proper donning procedure of a back brace. Why is this important? | Put it on in supine. Important b/c this reduces the effects of gravity
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| What happens when you tighten the shoulder straps on a thoracolumbar corset? | Pulls into thoracic extension
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| Name 3 indications for a hyperextension TLSO | Compression fx (anterior).
Arthritis.
Kyphosis
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| Compare/contrast Jewett TLSO & CASH brace | Both have: pubis pad, sternal pad, posterior thoracolumbar pad, & thoracolumbar flexion control
CASH has lateral pads & a "cross" design
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| What is the purpose of the thigh extension on a TLSO? | Reduce lumbosacral motion at S2
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| What is a CTLSO & why would it be used? | It is a TLSO with a cervical extension & is used to control a high thoracic fracture & provide total contact, pressure distribution & intracavitary support
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| 3 ways an accommodative TLSO helps the patient | Maintains head & trunk over pelvis to level shoulders & reduce or minimize shear forces;
Assists pts with pulmonary compromise;
Allows pt to increase UE use or decrease dependence (more fxnal)
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| Accommodative TLSO | Helps maintain head/trunk over pelvis.
Enhances mobility base.
Assists pt with pulmonary compromise.
Used with fixed position W/C, tilt in space, molded seats
Allows pt to increase UE use/decrease dependence
Helps maintain better position to increase
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| Corrective TLSO | For progressive idiopathic spinal curvatures.
Helps prevent &/or correct deformity.
Helps correct a PROGRESSIVE deformity
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| 5 clinical s/sx for scoliosis | Uneven shoulder.
1 or both shoulder blades may stick out.
Waist may be lopsided.
May have rib hump on 1 side.
May lean to 1 side
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| 3 indications for a corrective scoliosis TLSO | Progressive correction of idiopathic spinal curvatures.
Stabilization of congenital spinal curvatures.
Prevent &/or correct deformity
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| What is a Milwaukee TLSO? | Single & double curves.
Controls curves with apex above T7.
Also used for Scheurmann's Kyphosis & thoracic kyphosis
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| When would you use a Milwaukee TLSO? | Curve above T7 or kyphosis
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| What is normal thoracic kyphosis? | 20-40 degrees
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| What is Scheuermann's Disease? | Kyphosis caused by osteochondrosis. Usually more severe than regular kyphosis with a more rigid apex & causes more pain.
Common in adolescent boys
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| 3 negative effects of a spinal orthosis | Psychological dependence.
Weakness/atrophy of muscles.
Tightness
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| 4 orthotic principles in hand orthotics | Maintain palmar arch.
Maintain thumb opposition.
Maintain web space.
3 point prehension
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| Components in functional hand position | 30 degrees wrist extension.
35-40 degrees MCP flexion.
30 degrees PIP flexion.
5-10 degrees DIP flexion.
Webspace & thumb opposition.
Neutral in coronal plane.
No radial/ulnar deviation
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| What nerve is damaged if you need a hand orthotic with 1st interosseus assist? | Ulnar nerve
- Abducts index finger
- Holds thumb in abduction
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| Pathologies thumb spicas treat | Arthritis?
Scaphoid injuries,
Lunate injuries,
1st MC fractures,
Injury to UCL ,
Positioning for deQuervain's tenosynovitis
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| What nerve is damaged is you have drop wrist? | Radial nerve
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| What nerve is damaged if you have "claw" hand? | Ulnar nerve
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| What nerve is damaged if you have "ape" hand? | Median nerve
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| How does a WHO tenodesis brace work? | WHO wrist driven tenodesis.
Use wrist extension to achieve prehension.
C6 or C7- need finger flexion for pinch & grasp
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| What level of injury does a tenodesis brace treat? | C6-7
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| Carpal Tunnel Syndrome | Disturbance of median n. fxn in the wrist as the nerve passes thru the carpal tunnel. Buildup of scar tissue inside tunnel can lead to surgically correctable problem. Often tx with splinting/NSAIDs
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| Which tendons & what nerve are compressed by the flexor retinaculum? | FDP x4
FDS x 4.
FPL.
Median Nerve
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| Tennis Elbow (Lateral Epicondylitis) | Common cause of elbow pain, occurs over time from repeated use of mm of arm/forearm, leading to small tears of tendons
Most commonly ECRB
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| Golfer's Elbow (Medial Epicondylitis) | Pain on medial elbow due to wrist flexor overuse- medial epicondyle sore
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| How does a brace help tennis/golfer's elbow? | Pressure on condyles provides relief. It offsets pull of flexor tendons on the muscle & decreases the load placed on the epicondyle
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| What is Volkmann's ischemic contracture? | Volkmann's contracture is the most incapacitating complication following fx/dislocation. Occurs when there is ischemia to forearm due to inflammation. Often associated with supracondylar fx's.
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| Pathologies treated with a shoulder immobilizer | a. Adhesive capsulitis
b. Biceps patho: tendonitis, ruptures, sublux
c. SC jt patho: sprns, strns, fractures
d. AC jt patho: separations, degenerations
e. GH jt patho: dislocation, sublux, instability
f. RTC patho: tendonitis, impingement, tears
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| How does a Kenny Howard splint treat shoulder subluxation? | Provides downward pull & backward pressure at AC joint
Specifically treats subluxation of AC joint, not humerus
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| How does a Figure 8 harness treat a clavicle fracture? | Retracts shoulder, so it looks like it decreases compression through clavicle
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| What is plagiocephaly? | Unilateral abnormal head shape due to external forces
Parallelogram shape
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| What is brachycephaly? | Bilateral abnormal head shape
Wide, flat head, across occiput (good baby syndrome)
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| What is scaphocephaly? | Long & narrow head due to continual side-lying (Premature babies)
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| What is craniosynostosis? | Premature fusion of 1+ cranial sutures; looks like positional plagiocephaly
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| What to look for with craniosynostosis? | No soft spot palpable
No/minimal torticollis
No improvement with tx
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| What is torticollis? | Asymmetrical posturing of head & neck
- Tortus meaning twisted
- Collum meaning neck
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| Types of torticollis | Congenital muscular torticollis (CMT)- unilateral fibrosing of neck musculature (typically SCM) [scalenes, upper traps also involved)
Non-muscular origin- soft tissue/bony involvement
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| 3 ways to treat plagiocephaly | Positioning - Get them moving.
Stretching.
Strengthening.
Manual therapy
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| Possible causes of plagiocephaly | Premature births.
Multiple births.
Restrictive intrauterine positioning.
Congenital muscular torticollis (CMT).
Trauma at birth.
Cervical spine abnormalities.
Prolonged sleep positioning
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| How does a cranial band work? | Works during first 3-18 months of age;
Applies static pressure over prominent areas of skull;
Provides relief areas where skull is flat & allows growth in these areas
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| What is the ideal age to treat with a helmet? | 5-9 months ( or 4-12 months )
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| What is cranial vault? | Diagonal across head; Asymmetry measure in %age from normal
100%= normal; 95% & above accepted as normal
(long side-short side)/long side * 100
>3.5% considered significant
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| What is cephalic index? | ML/AP * 100
78% considered "normal"
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