Introduction to Orthosis.pptx
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An introduction to basic principles of orthotic devices and spectrum of applications. This is not an exhaustive list of all orthotics but a short and crisp presentation on the most commonly used orthotics intended for a wider audience of healthcare professionals
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Introduction to Orthosis.pptx
- 1. Empowering with “ORTHOSES” Maj Vignesh S Dept of Orthopaedics, Physiotherapy & Rehabilitation Base Hospital Barrackpore
- 2. What is an Orthosis? • “Orthos” = straight • A device externally applied to the body to • Promote function (or) • Stabilise a part (or) • Correct a deformity (or) • Just provide comfort • Key – “externally applied”, “do not replace a body part” • An inclusive term compared to “brace” or “splint”
- 3. Some indications for orthotic use • To relieve pain. (e.g., Arm sling support) • To limit motion. (e.g., long knee immobiliser) • To correct deformity. (e.g., Scoliosis correction brace) • To prevent secondary injury from instability. (e.g., Cervical collar) • To relieve symptoms of a disease by supporting/assisting neuromuscular structures. (e.g., Wrist cock-up splint for wrist drop) • To reduce axial loading. (e.g., Sarmiento functional brace for tibia fractures) • To improve function of certain segment of body. (e.g., Spring loaded dorsiflexion assist for foot drop cases)
- 4. • Site – Upper limb, lower limb, spine, etc. • Material – Metallic, plastic, leather, fabric, etc. • Type – Resistive, Accommodative, Corrective, etc. • Mode – Static, dynamic, etc. • Energy – Mechanical, electric, etc. Classification of orthoses
- 5. International classification of orthoses • Based on body region • Upper limb – SEWHO, SEO, WHO, SO, EO, HO, etc. • Lower limb – HKAFO, KAFO, KO, AFO, etc. • Spine – CO, CTO, TLSO, LSO, etc. • Modifiers used to indicate functional type (Resistive, accommodative, progressive, static, dynamic, corrective, etc) • At times the material may be indicated along with certain design features. (e.g., Posterior leaf spring thermoplastic AFO, Ground reaction AFO moulded thermoplastic, dynamic WHO = dynamic cock- up splint wrist)
- 6. Principle of working of orthotic device • BASIC PRINCIPLE - Jordan’s three point pressure principle • Mechanical advantage by increasing length of segments • Pressure reduction by increasing the surface area of contact • Rotational effect control in dynamic splints • Use of ground reaction force to support joint instability/facilitate movement – SPECIAL PRINCIPLE
- 7. Prescribing an orthosis • Indication • Part of the body • Function • Mechanism of fastening • Fabrication • Duration of wear • Patient acceptability • Cosmesis • Durability
- 8. Disadvantages of indiscriminate prosthesis • Limit mobility and ROM of the joint • Restrict movement in a certain direction • Muscle weakness in the opposite direction • Needs care, maintenance • Pressure sores from tight ill-fitting devices • Nerve compression, skin complication • Psychological dependence !!
- 9. Commonly Prescribed orthoses - FO • Metatarsal Pad – • Morton’s neuroma • Transverse-metatarsalgia • Longitudinal Arch support • Heel Wedge – • Heel varus • Heel valgus • Morton’s Toe extension • Hallux rigidus • Bunion splint/Toe separator • Hallux Valgus
- 10. • Static AFO – • To accommodate foot drop • Prevent equinus contracture • Dynamic AFO – • Allows hinge movement at ankle • Assistive AFO – • Spring loaded DF assist AFO • GR-AFO – • Quadriceps weakness • Knee buckling e.g., in Polio Commonly Prescribed orthoses - AFO
- 11. Commonly prescribed orthoses - KO • Long Knee Immobiliser – Donjoy • Acute trauma to knee • Traumatic synovitis • Hinge Knee brace – • Lateral ligament sprains • OA with lateral instability • Range of Motion lock Knee brace • Lenox-Hill type with hinges • Can lock in various flexion/extension • Post-op protocols • Patellar support brace
- 15. Spine Orthoses • LSO • LS belt – fabric • LS corset – metallic frame with leather • TLSO • Lower thoracic upper lumbar vertebral injury • Correction of scoliosis – lower thoracic curves. E.g., Boston’s brace • CTLSO • Spinal deformity correction. E.g., Milwaukee brace • CO • Halo brace • Philadelphia collar
- 16. How to apply Philadelphia collar in Trauma • Just ONE part of TRIPLE immobilisation of cervical spine.
- 17. Commonly prescribed orthoses – SO/SEO • Clavicle strap • Shoulder abduction/ Gun slinger • Rotator cuff repairs • Posterior shoulder instability repair • Arm Sling • Shoulder Immobiliser • Sarmiento brace – Functional brace • Fracture mid shaft humerus • Conservative management
- 18. Commonly prescribed orthoses – EO, EWO • Static Posterior splint • Range of Motion Elbow Brace • Static Progressive brace with turn- key • To achieve progressive ROM in stiff elbow • Dynamic ROM brace with spring/coil • Dynamic ROM brace –advanced with resistance control with adjustable tension spring • Tennis Elbow brace
- 19. Commonly prescribed orthoses- WO • Resting wrist splint, Carpal tunnel splint • Post-op comfort position • Carpal tunnel syndrome, Burns, Dupuytren’s release • Wrist Forearm brace • Static cock-up splint • In cases of wrist drop • Tendinitis, tenosynovitis • Dynamic cock-up splint • Radial nerve palsy
- 20. • Thumb spica brace with wrist • De Quirvans, Scaphoid #, Bennett’s # • Anti-spasticity hand splint – dorsal volar • Anti-spasticity cone splint • Head injury, cerebral palsy, CVA, MS • Dynamic splint post tendon repair – • Belfast, Klinert • Knuckle Bender splint • Ulnar nerve palsy, Claw hand Commonly prescribed orthoses- WHO
- 21. • Metacarpal Fracture brace • Finger cot splint • Support for whole finger • For PIP and DIP immobilisation • Extended splints for MCP immobilisation • Mallet splint • Extensor tendon rupture • Frog splint • Flexion blocking at PIP and DIP • Dorsal blocking splint • In MCP, PIP fracture/dislocations Commonly prescribed orthoses- HO