Special Populations, Clinical Reasoning and Pre-Fab Orthoses

Age related changes/medical conditions

cognition

cardiovascular/hematological

digestive/metabolic/endocrine

genitourinary

skin functions

neuromuskuloskeletal

sensory functions

Considerations of orthotic in short term setting

prevent secondary conditions

monitor recovery

optimize positioning

forward info to discharge setting

Considerations of orthotic in long term setting

choose safe materials for clients with cognitive impairment or restricted mobility

train team members to monitor skin integrity

Considerations of orthotic in community based setting

provide pictures and written instructions for use and care

provide contact information in case questions arise

orthoses typically enable functional participation

orthoses must be versatile and durable

For older adults, keep the design...

simple for easy donning/doffing

For older adults, you can label the orthosis with

name

left/right

hand/foot

landmarks for proper positioning

Written and oral instructions should be provided which include...

application

wearing schedule

precautions

Goals of pediatric orthoses for positioning

mobilize joints

reduce contractures

provide stability

rest

proper alignment

Goals of pediatric orthoses for function

enable existing function to continue

improve existing function

substitute for weak or absent muscles

augment benefits of therapy

Goals of pediatric orthoses for hygiene

improve or prevent hygiene problem

Goals of pediatric orthoses for protection

keep child safe

prevent undesired behaviors

Fabrication considerations for children

different proportions

they're constantly growing

parent/caregiver education

Foundational movement patterns are set within the first...

2-3 years

Approaches to pediatric orthoses fabrication

engage child in the process

frequently monitor for physical growth and psychosocial development

caregiver engagement

safety

prepare the child

custom designs

material selection

pattern making

time

padding and strapping

Wearing schedule should align with ______

purpose

Purpose/goals of orthoses for arthritis

manage pain

improve function

joint protection

Fabrication considerations for orthoses for arthritis

pressure areas

joint alignment

Wearing schedules for orthoses for arthritis

patient and condition specific

Precautions for orthoses for arthritis

do no harm

Purpose/goals of orthoses for fractures

immobilize for healing

Fabrication considerations of orthoses for fractures

fluctuation in edema

anticipate potential pressure ares

Wearing schedules for orthoses for fractures

condition and protocol specific

Precautions for orthoses for fractures

do no harm

Purpose/goals of orthoses for extensor tendons injuries

position and protect healing tendon

prevent scarring

Fabrication considerations for orthoses for extensor tendons injures

allowing as much movement without compromising healing structure

Wearing schedules for orthoses for extensor tendons injures

condition/patient and protocol specific

Precautions for orthoses for extensor tendons injures

follow healing protocol

Purpose/goals of orthoses for flexor tendon injuries

position and protect healing tendons

prevent scarring

Fabrication considerations for orthoses for flexor tendon injuries

allowing as much movement without compromising healing structure

Wearing schedules for orthoses for flexor tendon injuries

condition/patient and protocol specific

Precautions for orthoses for flexor tendon injuries

following healing protocol

Intrinsic plus/Antideformity position

MCP flexion 50-80

PIP extension

DIP extension

Wrist extension 15-20

Thumb abducted with IP extended

Intrinsic plus/Antideformity position is considered safe to immobilize for...

long periods of time without developing hand stiffness/contractures

Advantages of prefabricated orthoses

time efficient for therapists

immediate feedback

lightweight

sportier look

some have soft material

supports and allows movement

may be more sensitive on scars/skin

less pressure over bony prominences

Disadvantages of prefabricated orthoses

compromised joint position

may be less supportive

may allow for more mobility

dont conform

difficult to fit

does not address all conditions

difficult and expensive to stock