Orthotics

INTRODUCTION

1. ORTHOTICS INTRODUCTION QURATULAIN MUGHAL BATCH IV DOCTOR OF PHYSICAL THERAPY ISRA UNIVERSITY 1

2. TABLE OF CONTENT DEFINITIONS PRE-ORTHOTIC PRESCRIPTION EXAMINATION CLASSIFICATIONS OF ORTHOSES IMPORTANT MECHANICAL PROPERTIES OF ORTHOTIC MATERIALS 2

3. DEFINITIONS ORTHOSIS: (Plural:  orthoses ) is "an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system also restrict or assist motion or to transfer load from one area of the body to another”. Older term brace , is a synonym.   ORTHOTIST: Is the health care professional who designs, fabricates, and fits orthoses . ORTHOTICS: (Greek:  ορθός ,  ortho , "to straighten" or "align") is a specialty within the medical field concerned with the design, manufacture and application of orthoses . PEDORTHIST : is the health care professional who designs, fabricates, and fits only shoes and foot orthoses . 3

4. PRE-ORTHOTIC PRESCRIPTION EXAMINATION Examine patient : Interview Physical examination Functional assessment (Biomechanical analysis) Medical records 4

5. 2. Evaluate findings (Identify): Pathology Impairments Functional limitations Participation restrictions Functional needs Client goals 5

6. 3. Identify functional goals 4. Hypothesize— all methods to improve function If Orthosis is given then: Develop specific orthotic goals Use biomechanics: How orthoses apply forces If Other interventions are given then: Stretching Strengthening CV exercise Functional/gait training Ambulatory aid e.c.t . 6

7. CLASSIFICATIONS OF ORTHOSES Manufacture Materials and components used in fabrication Biomechanical terminology 7

8. CLASSIFICATION BY METHOD OF MANUFACTURE 1. Custom manufactured Local manufacturing Central manufacturing 2. Prefabricated With custom fit (“off the shelf”) Without individual fitting (“over the counter”) 8

9. CLASSIFICATION BY TYPES OF MATERIALS AND COMPONENTS USED IN FABRICATION 1. Conventional: Primary components and materials: Metal uprights and components Uprights attached directly to shoe for most lower extremity devices Leather cuffs; cloth, canvas, or elastic parts Made from measurements taken from the involved limb. 9

10. 2. Molded: Primary components and materials: Thermoplastics, thermosetting plastics, reinforced plastics, and composite materials Manufactured over custom mold of client Usually total contact design Usually made of one piece without moving parts or joints Has a shoe insert that slides into shoe without attaching for most lower extremity devices 10

11. 3. Hybrid: Composed of both molded and conventional materials: Limb cuffs, shells, and shoe insert are usually molded Usually has articulations (hinged, moving joints) that include some nonmolded and conventional componentry 11

12. Classification by Biomechanical Terminology Acronym made from the names of the joints enclosed by the orthosis: 1. Upper Extremity Orthoses HdO : Hand orthoses WHO: Wrist–hand orthosis EWHO: Elbow–wrist–hand orthosis EO: Elbow orthosis SEWHO: Shoulder–elbow–wrist–hand orthosis 12

13. 2. Lower Extremity Orthoses FO: Foot orthosis SMO: Supramalleolar orthosis AO: Ankle orthosis AFO: Ankle–foot orthosis KAFO: Knee–ankle–foot orthosis KO: Knee orthosis HKAFO: Hip–knee–ankle–foot orthosis LS-HKAFO: Hip–knee–ankle–foot orthosis with lumbosacral support 13

14. 3. Spinal Orthoses SIO: Sacroiliac orthosis LSO: Lumbosacral orthosis TLSO: Thoracolumbosacral orthosis CTLSO: Cervical thoracolumbosacral orthosis CTO: Cervicothoracic orthosis CO: Cervical orthosis 14

15. b) Type of biomechanical control exerted by the orthosis on the limb and joints: Free: No control is exerted, and the joint is free to move in a designated plane. Assist: Assists motion by applying an external force to increase the range, velocity, or force of a desired motion ( eg , a spring, elastic band, motor, pneumatic force, muscle electrical stimulation). Resist: Resists unwanted motion by applying a force to decrease the velocity or force of an undesirable movement. 15

16. Stop: Stop or limit motion at a joint. The prescription must indicate the specific motion to be stopped and when the stop is to occur in the range of motion (ROM) ( eg , an AFO with a plantarflexion stop at 0°. This orthosis allows the ankle to plantarflex only to neutral or 0°.) Hold: Controls and eliminates all motion at a joint in all planes. The prescription must indicate the specific joint position for the hold ( eg , AFO to hold the ankle at 5° dorsiflexion [ df ] and subtalor neutral). When the hold is at the ankle, it is often described as a solid ankle orthosis ( eg , AFO-SA at 5° df ). 16

17. Variable: May be used with the terms stop, resist, or assist to indicate the need for an adjustable system, with the desired ROM specified ( eg , a KO with a variable stop set at 90° flexion stop and –20° extension stop). Lock: An optional mechanism that when engaged or “on” holds or locks the joint in a fixed position. When the lock is disengaged, movement is permitted. Deweighting -Weight : An orthotic design that reduces axial loading through part of a limb. The prescription includes the amount of loading to be carried by the orthosis as a percent of normal limb loading Relieving: ( eg , AFO to reduce axial loading of the calcaneous 15%). 17

18. Important Mechanical Properties of Orthotic Materials Strength Brittleness Ductility Stiffness Elasticity Plasticity Viscoelasticity Hardness Density Durability or fatigue resistance Corrosion resistance 18

19. THANK YOU 19