Orthotics

uses of orthotics and type
this are only study perpeas

1. ORTHOTICS PATEL.YESH.G

2. INTORUCTION modern orthotic devices play a vital role in the field or orthopedic and neurological rehabilitation. They are given to improve function, restrict or enforce motion, or increase support to part of the body, like the spine or lower limb.

3. DEFINATION AN ORTHOSIS IS A MECHNICAL DEVICE FITTED TO THE BODY TO MAINTAIN IT IN AN ANATOMICAL OR FUNCTIONAL POSITION

4. GENRAL PRINCIPAL OF ORTHOSIS USE OF FORCE Orthoeses utilization force to limit or assist movement , for example Rigid material spanning a joint prevents motion , e.g. posterior tube splint. A spring in a joint is stressed by one and motion and then recoils to assist the opposite desired motion e.g leaf spring orthosis.

5. SENSATION An orthotic device often covers skin areas and decreases sensory feedback, proprioception should be preserved where possible. CORRECTION A MOBLIE DEFORMEITY A flexible deformity may be corrected by an orhosis, like the one given in gun recurvate or mobile scoliosis. The corrective, force mist be balanced by proximal and distal counter forces

6. FIXED DEFORMITY If fixed deformity is accommodated by an orthosis, it will prevent the progression or the deformity. ADJUSTABILITY Orthotic adjustability is indicated for children to accommodate their growth and patient with progressive or resolving disorders.

7. MAINTENANCE AND CLEANING The orthosis should be simple to maintain and clean APPLICATION The design should be simple for easy donning and doffing. The more complicateated the gadget the lees likely it is to be accepted for paramagnet use.

8. LIMITATION OF MOVEMENT Limitation motion to reduce pain, e.g. knee brace GRAVITY Gravity plays an important role in upper limb orthosis, especially in those joint where the heaviest movement masses are present. For example, rolyan should cuff can be used in hemiplegia to prevent subluxaination of the shoulder, which is the largest joint prone for the deleterious effects of gravity.

9. COMFORT The orthosis must be useful and serve a real purpose. If one hand is functional and normal , an upper extremity orthosis for the affected side may be not be used as most activities of daily living can be performed with the good hand. COSMESIS Cosmesis is important especially in the hand. A function but unsightly orthosis is often rejected if the patient values appearance over function.

10. DURATION Use only as indicated and for as long as necessary APPROPRIATENESS It should allow joint movement wherever appropriateness .

11. PRINCIPAL OF JOARDAN The basic mechanical principal of orthotic correction is the THREE POINT SYSTEM OF JORDEN This system applies corrective or assistive force, which are implemented at the surface of the orthosis throughthe skin and are transmitted to the underlying soft tissues and bones. To remain stable, the body has to have one point of pressure opposed by two equal point of counter pressure in such a way of that F1=F2+F3

12. The corrective force is directed towered the angular or deformed area to be corrected, and other two force counter forces are applied distal and proximal to the corrective force. The grated the distance between the force and the counter force, the less the counter force required.

13. BIOMECHANICS OF ORTHOSIS There are four different ways in which in an orthosis may modify the system of external force and moments acting across a joint. Control of rotational movements across a joint Control of translation force around a joint Control of line of action of ground reaction force. This involved modifying the point of application and line of action of the ground reaction force during static or dynamic weight bearing.

14. EXTRINAL FACTORS Pressure Shear - interface with the microenvironment.

15. INTRINSIC FACTORS Tissue mechanics –the compressibility of soft tissues influences their susceptibility to the breakdown process the more compressible the tissue the more like it is that blood vessels will be occluded. Load transmission across the interface b

16. CLASSIFICATION ACCRODING TO FUNCTIONAL SUPPORTIVE It stabilizes the joint and support the body in its anatomical position FUNCTIONAL It stabilizes the joint and also makes up for a lost function, CORRECTIVE To correct deformities

17. PROCTIVE To protect a part of the body during its healing PREVENT SUBSITUTION OF FUNCTION In a full length caliper, substitution of hip flexors by abductors or adductors of hip and other similar trick movements are prevented. STRENTHEN CERTION GROUPS OF MUSCLE Tenodesis splint

18. RELIEF OF PAIN The lumbosacral corset supports the parts the lower back, preventing painful movement PREVENT WEIGHT BRARING A weight relieving orthosis, prescribed for condition like fracture calcaneum will take weight away from the injured site to a proximal sit like the patellar tendon bearing area.

19. REGIONAL CLASSIFICATION They are classified according to the anatomical area fitted with the orthosis

20. CERVICAL ORTHOSIS

21. HEAD-CEVICAL ORTHOSIS(H-C-O)

22. HEAD-CERVICAL-THORACIC ORTHOSIS (H-C-T-O)

23. LUMBO-SCARL ORTHOSIS(l-S-O)

24. THOARCO-LUMBO-SACRAL-ORTHOSIS (T-L-S-O)

25. SHOULDER AND ARM ORTHOSIS

26. ELBOW ORTHOSIS

27. WRIST ORTHOSIS

28. HAND ORTHOSIS

29. FOOT ORTHOSIS (FO)

30. ANKEL-FOOT ORTHOSIS (A-F-O)

31. KNEE-ANKEL-FOOT ORTHOSIS (K-A-F)

32. HIP-KNEE-ANKEL-FOOT ORTHOSIS (H-K-A-FO)

33. ORTHOSIS SERVING SPECTIALIZED FUNCTION SWEDISH KNEE CAGE It is a knee orthosis that is used to control minor or moderate genu recurvation.

34. PEDIATRIC ORTHOSIS Used for a toddler with spina bifida or a T12 neurosegmental level lesion or a child with cerebral palsy.

35. PARAPODIUM It is used for leg length discrepancy and has a wide abdominal support pad to assist in upright poster.

36. RECIPRODIUM (swinel orthosis) These are bilateral hip, knee, ankle , foot orthosis to provide contra hip extension with ipislateral hip flexion.

37. TWISTER It is prescribed for lack of control of internal or external rotation or torsion of lower limb.

38. ORTHOSIS USED IN SPECIFIC CONDITIONS Orthosis are used for hand injuries flexors and extensor tendon injuries like volar and dorsal wrist splints.

39. ORTHOSIS USED FOR NERVE INJURY RADIAL NERVE INJURY A radial nerve glove is given with the wrist held in extended position or a wrist drop splint is given.

40. ULNAR NERVE INJURY Splints that maintain the flexion of metacerpophalangeal joint and extension at interphalangeal joint with a lumbrical bar E.g : knuckle duster splint

41. MEDIAN NERVE INJURY Splint is applied to the thumb in an abduction, opposed position.

42. ORTHOSIS USED FOR INFLAMMATION OF JIONT AND TENDONS: Static thumb spica orthosis with the proximal interphalangeal joint kept free.

43. ORTHOSIS USED FOR BURNS : Splinting done to hold the part in neutral position and this prevents stiffening of the metatarsophalangeal joints.

44. ORTHOSIS USED FOR STROKE AND BRAIN INJURY In stroke, large arm slings are used to prevent subluxation of the shoulder.

45. CONTRAINDICATIONS TO ORTHOSES Severe deformity which cannot be accommodated in the orthosis. Skin infection If it limits movement at other normal joint When the muscle power is inadequate to perform its function because of the weight of the orthoses. Lack of motivation or other psychological problems. Very young or old patient

46. DISADVANTAG OF ORTHOSIS Lack of cosmesis : An unsightly orthosis is often the reason for patient discontinuing it use. Muscles supporting the spine can become weak. Wherever segments are immobilized, we find increased movements at ends of these segments.

47. The person becomes psychologically dependent on it . Reduction in bone density. Skin ulcerations or calluses at the patient orthoses inferface .

48. PHYSICAL ASSESSMENT A THOROGH ASSESSMET IS IMPERATIVE BEFORE PRESCRIPITION OF AN ORTHOSIS AND WILL INCLUDE. Type of paralysis and prognosis. Poster static and deformity Rang of movement of joint

49. Deformity Gait Need for assistive devices Duration of gait Deviation Ability to rise from various type of chairs Ability to climb stairs and ramps.

50. Dexterity –ability to manage buckles and other fasteners Vision - waking safely indoors and outdoors needs good vision, especially in dim light. Spasticity Limb length discrepancy

51. Muscle power ; also of the hand grip especially when crutches are needed. Coordination . Deformity . Sensations touch and proprioception .

52. MATERIAL AND FABRICATION FOR LOWER LIMB ORTHOSES A wide variety of material have been used to fabric appliances, among them metals like steel aluminum rubber leather Canvas

53. CONSIDERATION WHILE SELECTING THE MATERIAL Strength Duration Flexibility Weight comfort Cosmesis Distribution of force over sufficiently large surface area Should accommodate a simple and inconspicuous design

54. METAL Traditional orthotic are mad of metal while leather is used for straps. PLASTICS They are lighter and close fitting and provide a fairly broader distribution of force than the metal orthosis. They are usually lined internally with thin padding They are two type TERMAL SETTING THERMOAL PLASTICS

55. THERMO SETTING Plastics designed to be set after heating will not return to fit their to original consistency if reheated, but they will soften. THRRMO PLASTICS Thermo plastics are plastics are plastics

56. COMBINATION OF PLASTIC AND MEATEL Usually aluminum and stainless steel uprights may be needed for heavy individuals. Light combination of plastic and metal are used for those with medium build to reduce the weight of the orthosis.

57. CARBON GRAPHITE It offers strength and low weight increased durability.

58. CALIPERS CALIPAERS ARE ORTHOSIS FITTED TO THE LOWER LIMB FOOT ORTHOSIS (FO) ANKLE FOOT ORTHOSIS (AFO) KNEE ANKEL FOOT ORTHOSIS (KAFO) HIP KNEE ANKEL FOOT ORTHOSIS (HKAFO)

59. CONSIDERATIONS WHLILE PRESCRIBING CALIPER Orthoses need to be prescribed, just like drugs. The specifications would include the nature and number of joint, the positioning of the straps and suspensions and accessory attachment to the shoe or boot. The reason for prescribing it must be explained to the patient, else there will be rejection.

60. The stability of the hip and knee should be good before deciding how high the caliper should be. This can only be done after doing a muscle power grading, paying special to the attention to the hip abductors extensors and knee extensor. Alignment is checked whether the ankle joint is over the medial malleoli, the knee joint over the prominence of medial femoral condyle and the hip joint permit a patient to sit upringt 90 degrees.

61. FOOT ORTHOSES (FO) The essential difference between a shoe and a boot is that a boot cavers the malleoli, while a shoe does not. The foot orthosis is nothing but a boot that has component like supports and wedge to manage different foot symptoms and deformities. These modification are made of various like rubber , foam or leather.

62. COMPONENTS OF THE LOWER PART SOLE It is the part of the shoe in contact with the ground. Inner part of the sole against which the foot rests is the insole. Bars straps and wedges, which arm common attachment to the foot orthoses get their leverage and attachment through the sole and exert their force.

63. BALL Widest part of the sole that is located in region of the metacarpal heads. SHANK It the narrowest part of the sole between t he heel and ball. The uprights of the AFO attach themselves to a stirrup at the shank region.

64. TOE SPRING It is the space between the outer sole and the foot, which helps to produce a rocker effect toe off phase of the gait.

65. UPPER PART (also called shoe upper) COMPONENTS QUARTER This is the posterior portion of the shoe upper. A high quarter is referred as a HIGH TOP and is used by runners and footballers for greater sensory feedback, and to prevent retrocalcaneal pain. HEEL COUNTER IN sports shoes there is reinforcement of the quarter postieriorly called a heel counter which provides posterior stability to the shoe and supports the calcaneus.

66. VAMP Vamp is the anterior portion of the upper and is often reinforced with a toe box anteriorly. In front is the tongue which protects the upper force foot behind the lace stays. Extra-depth shoes allow more room inside the shoe for orthotic intervention,.

67. THORAT This is the opening of the shoe located at base of the tongue, thorough which the foot is inserted. TOE BOX It prevent the toes form suffering trauma when the person kicks as in football. Even normally it is provided In the shoe to avoid stubbing of the toes.

68. TONGUE This is the part of the vamp which extends down in front of the throat. STIRRUP This is a piece on the outer sole in the shank region just in front of the heel offering attachment to the metal uprights.

69. ANKLE-FOOT ORTHOSIS METAL ANKLE-FOOT ORTHOSIS The AFO is boot to which an ankle joint is fixed through the stirrup. There are metal uprights as ascending up to the calf region. The components Proximal calf band with leather straps. Medial and later bars articulating with medial and lateral ankle joints help in control of planter and dorsiflexion.

70. Stirrups anchor the upright to the shoe. Other modifications tot the shoe , like medial and lateral support can also be prescribed for the AFO concomitantly.

71. METAL ANKLE-FOOT ORTHOSIS

72. PLASTIC ORTHOSIS

73. ANKLE JIONT There are five type of artificial ankle joints fit to the AFO, prescribed according to the power to the power of the muscles controlling the ankle . FREE ANKLE Given when there is normal ankle power. LIMITIED ANKEL JIONT Is prescribed when the muscles operating the ankle are totally flail have no power.

74. 90 DEGREE FOOT DROP STOPE Is when the ankle joint allows dorsiflexion but stop short at the natural position that is 90 degrees. Thus it dose not allow planter flexion.it is recommended when there is foot drop-when the dorsiflexors are weak and plantar flexors are normal, or when the dorsiflexion are normal or near normal and plantar flexors are spastic.

75. REVERSE 90 DEGRESS ANKLE JIONT This is an ankle joint which allows planter flexion but stop short at the neutral position that is at 90 degrees. Thus it does not allow dorsiflexion and is prescribed to prevent a calcaneis deformity. This happens when planter flexors are weak, while dorsiflexors are normal. It is not commonly used.

76. FIXED ANKLE JIONT Sometime the foot need to be protected and weight is taken off injured protected as in combination with a weight relieving othosis it take it takes the weight off the foot. It is not very commonly used.

77. INDICATION ANKLE-FOOT ORTHOSIS IS PRESCRIBED FOR Muscle weakness affecting the ankle and sub-taller joints. Prevention or correction of deformities Reduction of inappropate weight bearing force.

78. DORSIFIEXION MUSCLE PARALYSIS AIM To prevent contracture of the Achilles tendon, and to assist dorsiflexion during heel struck a dorsiflexion assist plastic posterior leaf spring AFO can be prescribes shoes. The rationale for this option is that the spring prevents the foot from dragging during swing and permits only slight plantar flexion during early stance , thereby enabling the client to achieve a foot flat position without under knee flexion.

79. ANKEL AND FOOT PARALYSIS This is prescribed to provide stability and reduce gait deviation during the swing and stance phases. A polypropylene solid ankle AFO to be worn with a shoe prevents ankle dorsiflexion during midstance. Another option is prescribe a hinged AFO. Adjustable hinges enable the clinician to alter the rang of ankle excursion.

80. The limited ankle joint, prescribed quite often, permits ankle movement about a small rang, usually 10-15 of dorsi and planter flexion. A third option is to prescribe a metal and leather AFO with adjustable ankle joint for planter flexion and dorsiflexion and corrective straps for valgus and varus deformities.

81. SPASTICITY AFO are used in children with cerebral palsy to stabilize the foot during heel strike and foot flat phase. A polypropylene orthosis given as a shoe insert prevents planter flexion, and also dragging of the toe during the swing phase. If neglected the foot goes in for equinus contractures and may require injection Botox or surgery.

82. LIMITED WEIGHT BEARING This is rarer indication for the AFO, to reduce loading on the leg and foot in condition where the foot need to be protected. There is a socket at the patellar tendon bearing area, which has a weight-relieving brim similar to the below knee prosthesis. The heel of the foot does not come into contact with the innersole, and a window is provided for a finger to be introduced and confirm this.

83. KNEE-ANKEL-FOOT ORTHOSIS It provides stability to knee, ankle and foot COMPONENTS The components are the same as those in a metal AFO, In addition there are uprights extended to the knee joint and lower thigh band Thigh bands are suspension mechanisms to which the upright are attached.

84. KNEE JIONT Knee joint are provide in calipers, so that the wearer can sit down. During walking the joint is locked in full extension for stability, but at the expense of a good gait pattern because the person walks with a stiff knee gait.

85. There are three basic type of knee joint STRAIGHT SET KNEE JIONT Allows free flexion and prevents hyperextension. The upper segment rotates about a single transverse axis. It is used in combination with a drop lock to given further stability. The polycenting knee joint uses the double axis system to stimulate the flexion/ extension movement of femur and tibia at knee joint.

86. POSTERIOR OFFSET KNEE JIONT This given for patients with minimal quadriceps weakness., since it knee joint the knee joint extended, though there is not enough stance control. The criteria for prescribing a posterior offset knee joint is adequate power of hip flexion and extension and the ability to generate enough momentum to walk. The placement of the joint is just behind the anatomical knee joint to increase knee stability when walking.

87. STANCE CONTEROL The ideal joint should have stabilization during weight bearing and flexion during the swing phase of gait when it is non-weight bearing. This is more energy efficient , and decreases the exaggerated movement of the hip which is seen when the knee is locked. Some of these joint are mechanically operated other powered by computerized mechanisms controllers.

88. KNEE LOCKS There are locks incorporated into the knee joint, to stabilized the joint in extension. DROP LOCK = is a wedge metal piece that is placed on the lateral upright bar, when the knee extends it drops over joint and lock it. This is commonly used in our country. SPRING LOADED LOCK = sometime the patient is unable to reach the knee or may lose balance while doing so; or might feel embarrassed to do so in public. So a spring load lock may be added to the drop ring lock.

89. CAM LOCK = with spring loaded cam fits into groove in full extension. it is also easier to release and given good stability. In the double upring bar it provides simultaneous locking and unlocking thereby provides maximum rigidity. THE BALL LOCK = provides an easy method of unlocking medial and lateral knee joints. The patient can catch the ball on the edge pf the chair to release the lock mechanism to permit sitting. A DIAL LOCK = may be adjusted every 6 for precise control of knee flexion PLUNGER TYPE LOCK = it is cosmetically more acceptable since it is concealed in the knee mechanism. It is indicated in persons having hand weakness.

90. INDICATION The biomechanical indications for the use of KAFO are divided into three parts MUSCLE WEEKNESS : weakness of the muscle of the lower limbs, mainly those controlling the knee and hip joint. This will most commonly result from spinal cord damage or lower motor neuron disease such as poliomyelitis or injury to nerve to nerve. LOSS OF STRUCTURAL INTERITY : this is due to injuries to the main ligaments of the knee and joint disease, either due to inflammatory or degenerative processes.

91. GENU VARRUM/ GENU VALGUM : damage to the medial joint compartment with resultant varus instability , will result in a concentration of the joint force on the damaged condyle. In additional the increased knee adduction moment wlii result in increased tension on the ligament . Conversely there can be damage to the later joint compartment with a concentration of pressure on the joint, resulting in abduction movement and stress on the medial collateral ligament. The orthotic device will need incorporate knee joint which resist abduction or adduction but which permit a normal rang pf flexion-extension. It is recommended to prescribe a single upring KAFO with free knee and ankle joint.

92. GENU VARRUM/ GENU VALGUM ORTHOSIS

93. KNEE BRACES : knee braces are prescribed in severe osteoarthritis of the knee, to provide stability to the knee joint. They come with bilateral uprights and knee joint, and usually extend for mid thigh to mid calf.

94. OSTIOARTHRITIS

95. MENISCUS INJURY

96. HIP-KNEE-ANKLE –FOOT ORTHOSIS The HKAFO is an extension of KAFO. In addition to the KAFO there is an attached hip joint which allows hip flexion and extension only. The suspension is with a pelvic band, which a padded rigid steel band extending posteriorly and laterally, which fit between iliac crest and greater trochanter and which is used to control rotational movement at the hip joint. In the frant it is with a soft Velcro or buckle strap fastener. On the lateral side it is connected by a lateral upright, or bar to a normal KAFO and on the medial side the upright stops short of the ischia region.

97. Movement at hip is with an uniaxial hip joint with a drop lock, which is lock during walking. In condition where weight relief from the lower part of body is needed, the body weight is taken away from the foot or leg and transmitted from ischia seat through metal uprights to the ground. HKAFO provides improved posture, and balance during standing and a better controlled forwarded leg swing in patients with weak hip muscles. However it is difficult wear and remove, and permits only limiting step length.

98. USES The HKAFO is prescribed whenever the muscle controlling the hip and Iits stability are strained or weak. Of course muscle controlling the knee and ankle may be also he weak, and there may be tendency to varus or valgus of the ankle which can be accommodated in the orthosis. The prescription of the HKAFO must also take into consideration the problems at the knee ankle.

99. HIP ROTATION CONTROL Abnormal rotation at hip, seen in some children with cerebral palsy id not resolved by a general HKAFO, but by using: Pelvic bands with hip joint Spreader bars Silesian bandages. Single –axis hip joint attached to pelvic bands are quite common but are heavy and it is difficult donning and doffing them.

100. Spreader bars lock both legs but this restricts the leg form taking a step though each leg prevents the other’s rotation. Silesian bands that begging laterally posterior and superior to the grater trochanter, encircle the pelvis on the normal side between the greater trochanter and the iliac crest and attach anteriorly to achieve some hip rotation control. It reduces gait deviation, particular toeingin that is attributable to faulty hip control.

101. HIP-KNEE-ANKLE –FOOT ORTHOSIS

102. TEISTING ORTHOSIS

103. FUNCTIONAL ELECTRIAL STUMULATION The concept of FES was introduced by liberson and co workers to control foot drop during the swing phase in hemiplegic patient. The theory is based on the survival of the motor neuron in UMN lesion such as hemiplegia. Such stimulation is done to obtain a functional movement, such as picking up objects or walking. Multichannel stimulators are being used for paraplegics inresearch laboratories, to stimulate waking.

104. A typical functional stimulator consists of: Stimulator Leads Electrodes which may be superficial or implanted.

105. A miniature electrical stimulator producing currents between 90 and 200ma, of pulse duration between 20 to 300 microseconds, and voltage between 50 to 120 V is fitted to the patient. It must be light in weight and portable. A power pack which powers the stimulator is worn on a waist belt and in the typical peroneal stimulator, one skin electrical is applied to the common peroneal nerve below the fibular head on the affected side, while the inactive electrode is applied to the motor point of the tibialis anterior. A heel switch is incorporated in the shoe that turns on the stimulator when the heel leaves the ground and turns it off on hell strike.

106. Sometime electrodes are surgically implanted instead of being placed directly on the skin. This eliminates the need for wires passing all over the affected on site. When an implanted electrode is used, it must be plasced directly on the nerve with a flexible wire lead connected of the subcutaneously implanted receiver located over the anterior-medial aspect of the thigh. There is an antenna located over the implanted receiver, responding to the stimulation during the gait cycle is controlled by the heel switch. The power pack for the stimulator and transmitter is worn at the waist.

107. CRITERIA FOR SELECTION OF PATIENT Such patient should be able to walk independently at a speed more thane 25 m/min without an orthosis , and have good balanceand saving reactions. The major gait problem should be foot drop, with equinus contracture. Proprioception should also be intact. The regular use of FES system could result in an increases in the strength of foot dorsiflexors in the long-term, and may improve the gait pattern through re-education and over a period the patient may reach a stage where he may no longer need it.

108. This principle is also used to major hip and thigh muscle groups in patients with spinal cord injuries for muscle strengthening, maintaining standing posture and ambulation.

109. SPINAL ORTHOSIS The common thoracic or lumber orthosis consists of a plastic or aluminum frame, anterior abdominal support, two posterior uprights, and pelvic and thoracic band, which are fitted to the spine.

110. MECHANISM The three point force control system of Jorden is used in these orthoses by working on the principle of pelvic positioning, which acts as a base of support for spinal column alignment. Relief of longitudinal force is then provided by anterior positioning system. This arrangement provides increased comfort as the force are distributed over a wide area then the three-point pressure system.

111. In the three-point pressure system in the anterior spinal hypertension (ASH) brace, two anterior pressure point are balanced by a third opposing posterior pressure point. This control system is effective in preventing flexion deformities of the spine form becoming worse.

112. PRINCIPLES The client must be ale to sit and stand comfortably while wearing the orthoses. The should not be any problem with breathing, chewing or digestion.

113. FUNCTION The function pf spine orthosis are manifold. They prevent and sometimes even correct deformity like scoliosis and kyphosis. Where there is instability or displacement they offer stability as in spondylolisthesis. Chronic back sufferers get relief because these orthoses limit movement and weight bearing, by limiting axial loading and relieving muscle spasm. After a spinal surgical procedure or facture vertebra, they protect against further injury.

114. TYPE OF SPINAL ORTHOSIS CERVICAL ORTHOSIS Cervical orthosis surround and protect the cervical spine. They include the collars which are the lateral restrictive and providing partial rang of motion.

115. They are mad up of foam plastic and surround the neck from the lower jaw to the occiput and have rigid anterior and postThey can be used in restriction of neck flexion and extension up some extent . Cervical collars are freely available in 3 readymade sizes- small ,medium, large and ma be soft hard or medium depending on the restriction needed .

116. CONDITIONS USED Crush injuries of cervical spine In case of hyperextension injuries of cervical spine this type of collar is used to hold the neck in a slightly flexed position. Whiplash injuries. – this are caused by a sudden impact in which the head and neck are thrown forward and backward abnormally. This sort of impact is usually seen car accident, sport injury and child abuse. Springs or strain of the neck. Degeneration diseases of the cervical spondylosis.

117. USES In the above-mentioned conditions the collar remind the wearer not to move abruptly, thus reducing stress on the damage tissues. The collar retains body heart, which enhances circulation to the injured structures. Immobilization of spine also helps in relieving pain,. Prescription of the collar should only be done if the neck movement causes severe pain, giddiness or is otherwise injurious to the anatomical structures.

118. HEAD CERVICAL ORTHOSIS (HCO) The hade cervical orthosis incorporates both head and the cervical spine into the device, thus providing additional support and motion restriction.

119. FOUR POSTER CERVICAL ORTHOSIS It has padded mandibular and occipital supports attached to anterior and posterior plates by four rigid adjustable uprights. Laterally leather straps connect the mandibular occipital supports. This orthotic device provides greater reaction of flexion, extension, lateral bending and rotation than the ordinary collar.

120. MINERVA JACKET It is a suitable modified jacket, which is applied in all to the head and trunk. Anteriorly, the orthosis has a forehead strap that secures the upper posterior shell and a rigid mandibular plate. The axillae are also covered by a wool roll.

121. USED This provides excellent motion limitation in all direction. There is also the facility of selecting the optimal alignment of the head on the neck.

122. HEAD-CEVICAL-THORACIC ORTHOSIS HALO ORTHOSIS : better stabilization of the cervical spine is achieved through external fixation of skull with references of chest. Three major components include the rings and pins, plastic vest, and connection adjusted uprights. The pins penetrate the skin and outer table of skull and are treated to fix the halo ring assessment on the skull. Aluminum turnbuckles connecting the jacket and ring are adjustable to provide variable traction, flexion or extension.

123. CODITIONS USED Paralysis with or without fracture of the cervical spine. Major cervical vertebral fracture with dislocation

124. SOML BRACE SOMAL stands for sterno occipital mandibular immobilization , named for its points of attachment, the sternum , occipital and mandible. The orthosis point of attachment, the sternum, occiput and mandible. The orthosis consists of three part; a chin cup with adjustable bar, an occipital support attached to two bars for the anterior section and from which straps arise to attach to the chin piece, and a sternal plate with straps for the shoulder pieces.

125. THORACO-LUMBER-SACRAL ORTJOSIS These braces fix the pelvis and shoulder to prevent spinal movement in all directions. They may be classified according to whether they control flexion, flexion-extension, flexion-extension-lateral movement and all these including rotary movements. Hyperextension braces like the jewett and ASH orthosis do not prevent lateral or rotary movement.

126. Flexion extension control orthosis like the T aylor brace consist of two spinal uprights posteriorly. These are attached to pelvic band inferiorly and a band in the interscapular area above, to effectively control flexion extension. In addition an abdominal corset holds the abdominal muscles bracing them against bracing them against the spine.

127. An optional plastic body jacket is prescribed if maximum immobilization is needed as in potts spine, or fractures of spine. The flexion-extension-lateral-rotary control orthosis has an additional interscapular band extended anteriorly and superiorly to control rotary movement.

128. JEWETT ORTHOSIS This is anterior hyperextension orthosis which has a rectangular frame exerting pressure over the pubis and upper thorax. There is a fulcrum maintained by a thoracic strap attached to the sided of the frame offering counter support.

129. JEWETT ORTHOSIS

130. CONDITIONS USED Compression fracture of the vertebra. Intervertebral disc desiccation and prolapse. Non-operative and postoperative immobilization of spine. USES: restriction of flexion, extension and lateral flexion of the thoracolumbar spine.

131. ASH BRACE This spinal brace consists of a cross like frame anteriorly fixed with pads on the sternum and the pubic symphysis with the pads at the extremes. Posteriorly, in addition there is a padded support in the thoraco lumber region which maintains the spine extended by the principal of Jordan. ASH brace more comfortable than the jewett brace.

132. MILWAUKEE BRACE The Milwaukee brace is a brace given for growing children with dynamic scoliosis. It directs and longitudinal force actively and passively. The orthosis consists of a custom moulded or prefabricated plastic pelvic girdle that serves as the foundation for pelvic positioning to control the lower spine. This is accomplished by flattening of the abdomen to encourage pelvic tilt and decrease lumber lordosis. The anterior pelvic girdle is extended superiorly to just below the xiphoid and the rids, providing an anterior compressive force.

133. The remainder of the frame consist of anterior uprights leading to neck ring. The neck ring has an anterior longitudinal distraction force. The lateral pads hold the lateral curves, but do not correct them. The pelvic band fixes the pelvic and decreases lordosis.

134. The collar head-band applies distraction forces that elongate the spine. Further modification include pads attached at various levels of the Milwaukee brace to correct other deformity spine. This is thus a dynamic spinal brace that can grow along with the children . Any lateral curvature of the spine- scoliosis and kyphoscoliosis .

135. LUMBOSACRAL ORTHOSIS

136. LUMBOSACRAL ORTHOSIS KNIGHT BRACE : it is a short spinal brace consisting of a pelvic band and a thoracic band joint by two posterior and two lateral metal uprights which provide considerably more rigidity than a corset.

137. BOSTON BRACE : The Boston brace is an example of modular orthosis that providing varying control and is useful for the treatment of scoliosis. It is made up semi rigid plastic and supports the lower trunk by controlling all lumbosacral motion.

138. CONDITIONS USED Lower back pain Spondylolisthesis Intervertebral disc diseases.

139. USES The orthosis remiands the wearer to avoid abrupt motion. Motion control i s achieved by means of various three-point force systems support for the spine is also by abdominal pressure.

140. LUMBOSACRAL CORSET These are very common, and routinely used . Lumbosacral corsets may vary in rigidity based on the amount and type of metal stays included. Longer length corsets generally are used for more extensive spinal problems. A corset has vertical reinforcement or a rigid posterior plate, but no rigid horizontal bands. They are made of leather or canvas and contain elastic straps with Velcro fastening for a close fit, and available off the shelf in various sizes.

141. CONDITIONS USED Osteoporosis Lumbar spondylosis Malignancy Bad poster Spondylolisthesis Lumbosacral strain Sciatica

142. SACRAL ORTHOSIS Sacral orthosis are the least restrictive spinal orthosis. They provide control of pelvis as a supportive base for the spinal column. They are used in healing pelvic fractures, and relieving sacro-iliac pain.

143. SACRO-LLIAC CORSET It is a prefabricated device that can be adjusted anteriorly, posteriorly or laterally with laces or hooks. Its superior borders lie at the level of the iliac crest. Inferior its anterior border lied 0.5 to 1 inch above the pubic symphysis and its posterior border extends to the gluteal fold.

144. SPLINS Technically the term splint refers to a temporary device that is part of a treatment program. Classification STATIC SPLINT DYNAMIC SPLINT

145. STATEC SPLINT Static splint have no moving part , prevent motion and are used to rest or rigidly support the splint part. USED : there are used to stretch joint contracture progressively or align specified joint after a surgical procedure for optimal healing. A static splint should never include joint than those being treated and should be discontinued the movement its usefulness is over.

146. DYNAMIC SPLINT Dynamic splint are moving splints their praters permit, control, or strengthen movement. The movement in a dynamic splint may be intrinsically powered by another body part or by electrical stimulation of the patient’s muscle. Extrinsic power may be provided by elastic band or pulleys.

147. GENRAL FUNCTIONS OF SPLINTS To prevent undesirable movement To provide a functional position for the hand To reduce pain To hold fracture bone ends in position until they are untied. To strengthen specific muscles. To promote grip and pinch. To diminish muscle spasm.

148. TYPES OF STATIC SPLINTS AEROPLANE SPLINT The aeroplane splint maintains the shoulder in abduction and external rotation. It immobilizes should and elbow joint. It consist of chest, arm , fore arm and wrist pieces joint tot one another almost at right angles.

149. INDICATIONS erb’s palsy. Supraspinatus tendon rupture. Avulsion of the greater tuberosity of the humerus. Tuberculosis arthritis of the shoulder joint. Paralysis of the deltoid muscle. Abduction fracture of the neck of the humerus.

150. ADVANTAGES AND DISADVANTAGES The advantages of this splint are that it keeps the shoulder joint in is optimal position and dose not confine the patient to the bed. The disadvantages are that it is inconvenient to the patient and that it tendes to slide down the torso.

151. COCK-UP SPLINT The cock-up splint immobilizes, or stabilize the wrist in dorsiflexion with volar or dorsal support . It may be static or dynamic. It allows full metatarsophalangeal flexion and carpometacarpal motion of the thumb. The splint should be worn all the time except during exercise and bath.

152. INDICATIONS : Wrist drop ( radial nerve palsy)

153. KUNCKLE BENDER SPLINT Maintain the metatarsophalangeal joint in 90 flexion and interphalangeral joint in extension. FUNCTION Immobilization of fingers It provides support and stabilization the wrist in extension. It assists in prehension.

154. INDICATION Total claw hand in case of medial and ulnar nerve injury, as in Hansen’s disease Ulnar claw hand

155. HAND POSITION This splint comprises a light padded bar across the dorsal aspect of the proximal phalanges of the third and fourth fingers and a similar one over the upper end of the metacarpal. These are attached to another padded bar in the palm of hand by small spring which pulls the metacapophalangear joint in to flexion but allows the patient to extend them. The interphalangeal joint of fingers are placed in extension. this is typical example of a splint using the 3-point principle.

156. C- SPLLNT This splint maintains the thumb in abduction and partial rotation under the secondary metacarpal and supports it. It also stretches the first web space. INDICALTIONS Medial nerve injury Contracture Burns.

157. OPPONENS SPLINTS SHORT OPPONENS SPLINT The short opponens splint maintains thumb in abduction and rotation under the second metacarpal. The wrist and other fingers are free.

158. FUNCTIONS Immobilization of the thumb Improve prehension by providing a stable position against which the fingers can pinch. Protects the joint from pain Stretches the web space

159. INDICATION Low medial nerve injury opponens transfer (6 weeks after surgery postoperative splint)

160. DORSAL LONER OPPONENS SPLINT This splint hold the thumb in abduction and partial rotation under the second metacarpal , and in addition supports the wrist dorsally in a functional position. The wrist in 20 to 30 of dorsiflexion, and the thumb is abduction and rotated under the 2 metacarpal , with the metatarsophalangeal joint in 0 to 5 of flexion. The interphalangeal joint is free unless required to be help in extension.

161. INDICARIONS Scaphoid fracture Benner’s fracture De quervains tenosynovitis.