DPT 983 final

What are the goals of orthotics for neurological patients?

To manage motion and alignment, correct, maximize, accommodate, and prevent further deformities.

What does optimal alignment in orthotics improve?

Effectiveness and efficiency.

What are the benefits of using orthotics?

Promotes stability and support, manages weakness, deformity, and pain, reduces falls, enables safer ADLs, increases ROM, improves proprioception, and promotes confidence.

What is the significance of the triplanar control in orthotics?

Triplanar has the most control over motion.

What is a 3 point pressure system in orthotics?

A system used to support or immobilize the body, such as for foot drop or heel valgum.

What are the types of AFO (Ankle-Foot Orthosis)?

Conventional (double upright, solid stirrup, hybrid) and Thermoplastic (custom molded, total contact, triplanar control).

What are the indications for using conventional AFOs?

Volume change, durability, heat/skin sensitivity, and previous wearer.

What is the purpose of mild compression in orthotics?

Mainly for comfort and unloading.

What does total contact in thermoplastic AFOs allow for?

Unloading of pressure points, such as ulcers and fractures.

What is the relationship between the stabilization point and effectiveness in orthotics?

The farther the stabilization point is from the brace's center, the less effective it is.

What is the function of orthotics in relation to activities?

Enable safer ADLs, general activity, and sports.

What is the role of orthotics in proprioception?

Improves proprioception and serves as a kinesthetic reminder.

What is the significance of managing three planes in orthotics?

To resist, stop, free, or assist motion effectively.

What is the primary focus of the orthotics lecture by Mark Graham?

Goals and functions of orthotics for neurological patients.

What is the importance of putting the patient in neutral alignment with orthotics?

It helps to correct and maximize alignment, improving overall function.

What is an ankle gauntlet made from?

Carbon fiber.

What are the criteria for custom molded orthoses?

1. Unable to fit OTS or custom fitted orthosis. 2. Condition necessitating long term use (6+ months). 3. Need to control limb in more than one plane. 4. Documented neurological, circulatory, or orthopedic status requiring custom fabrication to prevent tissue injury. 5. Lacks normal anatomical integrity or normal anthropometric proportions. 6. Weakness or limb deformity which requires stabilization to achieve functional benefit.

What types of free motions are allowed by custom molded orthoses?

1. Sagittal plane movement. 2. Coronal plane support. 3. Free plantarflexion. 4. Free dorsiflexion. 5. Provides ML stability.

What are the indications for custom molded orthoses?

ML instability, such as PTTD and Ankle OA.

What is the function of the Denver T/Ritchie AFO?

It allows for free motion or solid ankle and holds the limb in the coronal plane.

What does the PTB AFO do?

It holds sagittal and coronal motion and has an anterior panel to unload the ankle/foot, indicated for ulceration, fracture, CVA, and quad weakness.

What are the benefits of a carbon fiber AFO?

1. Less weight and bulk. 2. Controlled loading response. 3. Ground clearance. 4. Energy return at toe off. 5. Smooth, efficient gait. 6. Mild M/L stability at midstance.

What conditions indicate the use of a carbon fiber AFO?

1. Dorsiflexion weakness due to CVA, MS, CMT, CP, or peroneal palsy. 2. Mild knee instability. 3. Partial foot amputations for increased lever arm.

What are the knee joint control options for orthoses?

1. Single Axis. 2. Offset. 3. Polycentric. 4. Lock. 5. Lock + Variable Flexion.

What are the universal indications for stance controlled orthoses?

1. Weak or absent quadriceps. 2. Knee instability. 3. Slight genu varum/valgum, such as in post-polio syndrome, multiple sclerosis, trauma, or incomplete SCI.

What are the contraindications for stance controlled orthoses?

1. Persistent knee spasticity. 2. Weak hip musculature. 3. Significant recurvatum or ML instability. 4. Knee flexion contracture. 5. Inability to dorsiflex.

What are the advantages of stance controlled orthoses?

1. Secure, energy efficient gait. 2. Knee flexion during swing phase. 3. Locked knee during stance. 4. Reduces typical gait deviations like hip hiking and circumduction.

What are the disadvantages of stance controlled orthoses?

1. Require motion sequence. 2. Lacks stumble recovery, except for the microprocessor C-brace. 3. Cumbersome and heavier, except for the UTX & Free Walk.

What is the role of physiatrists in spasticity management?

They assess by listening to the patient and family regarding their challenges, expectations, and goals.

What are the key focuses of a physical examination for spasticity?

Strength, Sensation (especially Proprioception), Range of motion, Muscle spasticity, Coordination & Balance, Walking.

What are the main treatment goals for managing spasticity?

Improve function, improve quality of life, and prevent secondary problems.

How does treating spasticity improve function?

By enhancing grasping & releasing objects, transfers, and walking.

What aspects of quality of life can be improved by treating spasticity?

Ease of hygiene/toileting/dressing, wheelchair positioning, pain, and sleep.

What are some secondary problems that can be prevented by managing spasticity?

Maintaining skin health and avoiding pressure ulcers.

What factors can exacerbate spasticity?

Cold weather, noxious stimuli, pain, infection (e.g., UTI), fracture, prolonged inactivity, stress, and fatigue (especially in people with MS).

Can spasticity be cured?

No, spasticity cannot be cured but can be managed.

What are some management strategies for spasticity?

Stretching (slowly), daily movement/exercise, physical and occupational therapy, estim, static splints, dynamic splints, yoga/acupuncture.

What is the role of oral medications in managing spasticity?

They are useful for diffuse spasticity or spasms affecting multiple parts of the body and may cause drowsiness.

What is Baclofen and how does it work?

Baclofen is a GABAB receptor agonist that inhibits reflexes at the spinal cord and brain level.

What are the side effects of Baclofen?

Drowsiness, cognitive slowing, weakness, dizziness, nausea, and dry mouth.

What is Tizanidine and its mechanism of action?

Tizanidine is a centrally acting Alpha-2 adrenergic agonist that provides presynaptic inhibition of motor neurons in the brain and spinal cord.

What are the side effects of Tizanidine?

Drowsiness, dizziness, hypotension, dry mouth, and fatigue.

What is Diazepam used for in spasticity management?

Diazepam suppresses GABA-mediated spinal reflexes and is better on flexor than extensor spasms.

What are the side effects of Diazepam?

Drowsiness and weakness.

What is Dantrolene and how does it function?

Dantrolene works at the muscle level to manage spasticity.

What is the effect of blocks on calcium release in skeletal muscle?

Blocks release of calcium within skeletal muscle, thus decreasing muscle contraction.

What are some common side effects of the treatment mentioned?

Side effects include hepatitis (monitor liver enzymes), weakness, lightheadedness/drowsiness, nausea, and diarrhea.

What is BoNT and when is its maximal response observed?

BoNT (Botulinum Toxin) onset is usually appreciated within a few days after injection, with maximal response seen at 4-8 weeks.

Why is reassessment important after BoNT injection?

Reassessment within the therapeutic window is key to maximizing physical therapy (PT) and occupational therapy (OT).

How often are injections typically administered?

Injections are typically administered every 3 to 4 months.

What are the two types of nerve blocks mentioned?

Diagnostic (temporary) and therapeutic (semi-permanent treatment with phenol).

What is the purpose of diagnostic nerve blocks?

To determine if the issue is severe spasticity versus contracture, lasting several hours.

What is the therapeutic nerve block used for?

Most frequently for hip adductor, plantar flexor, or elbow flexion spasticity, lasting several months.

What are the potential side effects of nerve blocks?

They can cause numbness along with weakness of the targeted areas and may be painful for the patient (temporary dysesthesia).

What is the goal of motor point blocks?

To avoid numbness and dysesthesia, although they can be technically challenging to perform.

What is the current approach to optimizing gait?

Treat underlying quad and gastro-soleus spasticity or contracture, optimize AFO fit, and adjust Shank-to-vertical angle (SVA).

What are the characteristics of standard manual wheelchairs (K0001)?

Standard wheelchairs weigh 38-45 lbs, suitable for short or occasional use, with limited sizes and options.

What distinguishes high strength lightweight wheelchairs (K0004)?

They weigh 28-36 lbs, designed for moderately active lifestyles, with a wider range of sizes and options.

What is the weight capacity of heavy-duty bariatric wheelchairs (K0006)?

They are designed for clients weighing over 250 lbs or those with severe spasticity and weigh 41-48 lbs.

What are ultra-lightweight manual wheelchairs (K0005) known for?

They weigh 20-30 lbs, are available in many sizes, have a large variety of options, and are very light yet durable.

What is the purpose of adjustable axle plates in wheelchairs?

They allow for optimal placement of rear wheels for efficient propulsion, adjustable seat to floor height for transfers/foot propelling, and 'bucketing' the wheelchair frame for improved postural control/stability.

What benefits do tilt-in-space manual wheelchairs (E1161) provide?

They provide gravity-assisted positioning to enhance head and trunk control, pressure relief by transferring weight from the buttocks to the trunk, and decrease spasticity by maintaining a fixed hip angle.

What are the qualifications for a client to receive power assist add-ons for manual wheelchairs under Medicare?

The client must be a full-time manual chair user for at least 12 months.

What are some examples of power assist add-ons for manual wheelchairs?

Smartdrive, Smoov, Twion, and E-fix.

What are indications for the use of a power wheelchair?

Upper extremity weakness, spasticity or paralysis, limited upper extremity range-of-motion, decreased endurance due to cardiac or respiratory disease, and the need for independent pressure relief.

What are the pros and cons of using scooters?

Pros: simple, can be taken apart for transport, cheaper than power chairs. Cons: minimal sizing, large turning radius, requires balance and range of motion to get on/off.

What types of power wheelchairs exist?

Lightweight folding power wheelchairs, power wheelchairs with programmable electronics and specialty controllers, power tilt-in-space, power recline, heavy-duty power wheelchairs, mid-wheel-drive or front-wheel-drive power wheelchairs, and pediatric power wheelchairs with growing frames.

What constitutes a seating system in wheelchairs?

A cushion, back, and seating accessories.

What is the price range for wheelchair cushions?

They range from basic foam ($90) to custom molded ($1200).

What materials are used in wheelchair cushions?

Cushions can be made from foam, gel, and/or air.

What features can wheelchair cushion covers have?

Covers can be breathable or moisture resistant.

What is the thickness range for wheelchair cushions?

Thickness can range from 2 inches to over 4 inches.

How can wheelchair cushions influence transfers and activities of daily living (ADLs)?

The type and design of the cushion can affect ease of transfers and the ability to perform ADLs.

What is the price range for wheelchair backs?

Backs can range from $200 to $2500.

What are some types of controls available for power wheelchairs?

Programmable electronics, sip-n-puff, head control, and chin control.

What is the advantage of power tilt-in-space and power recline features in power wheelchairs?

They enhance user comfort and positioning for pressure relief and postural support.

What is a potential disadvantage of using scooters compared to power wheelchairs?

Scooters may require more balance and range of motion to get on and off.

What are heavy-duty power wheelchairs designed for?

They are designed for users who require more robust support and durability.

What is the benefit of mid-wheel-drive or front-wheel-drive power wheelchairs?

They provide enhanced maneuverability in small areas.

What is the purpose of pediatric power wheelchairs with growing frames?

They accommodate growth in children, allowing for adjustments as the child grows.

What are some types of back support in seating systems?

They can include basic sling back, adjustable back upholstery, basic solid back, and solid back with lateral contouring of the trunk.

What is the purpose of trunk lateral pads in seating systems?

They can be adjusted and moved out of the way for transfers.

What should be considered if 'off the shelf' seating cannot meet a client's needs?

Custom molding or custom contoured seating can be done.

What are some examples of supplemental positioning devices?

Headrest pad/hardware, lateral thigh pads, medial thigh pads, position belts, trays, ankle huggers, and amputation support pads.

What is the primary cause of Guillain-Barré Syndrome (GBS)?

It is an immune-mediated disorder associated with bacterial and viral infections, surgery, and vaccination.

What are some risk factors associated with GBS?

Military service and chronic intoxication of heavy metals.

What is Polio and when was it eradicated?

Polio is a viral infection that was eradicated in the 1950s and 1960s.

What is Post-Polio Syndrome related to?

It is related to the initial disorder of the motor neuron cell body affected by the poliovirus.

What are some conditions that can affect peripheral nerves?

Metabolic disorders (like diabetes), nutritional deficiencies, infections (like HIV), inflammation, toxins, hereditary conditions, and trauma.

What neurological structures are primarily involved in conditions affecting peripheral nerves?

Lesions to spinal nerve roots, peripheral nerves, myelin sheath, axons, and cranial nerves.

What happens to motor neurons in conditions like ALS and GBS?

There is degeneration of motor neurons and proliferation of astrocytes and microglia in degenerating neurons.

What is the effect of poliovirus on motor neurons?

It causes ongoing muscle denervation and evolution of motor neuron dysfunction.

What are some sensory impairments reported in neurological conditions?

Numbness, tingling, pain, and muscle strength decline.

What are common motor impairments in conditions like GBS and ALS?

Loss of sensation, difficulty with balance and coordination, and faster deterioration of strength compared to aging.

What autonomic nerve involvements can occur in neurological conditions?

Sweating or blood pressure issues, paresthesia, numbness, pain, proprioceptive loss, and allodynia.

What is the relationship between lower extremity deterioration and upper extremity use?

Lower extremity deterioration predisposes people to overuse their upper extremities.

What are some common symptoms of muscle weakness in neurological conditions?

Muscle atrophy, pain, myalgias, joint pain, and new weakness.

What is the significance of axonal sprouts in neurological recovery?

Nervous system pruning back axonal sprouts occurs when reinnervation cannot maintain muscle fiber innervation.

What is the role of Betz cells in motor function?

Loss of Betz cells from the primary motor cortex affects motor control.

What is the impact of sensory impairments on daily activities?

They can lead to difficulties in balance, coordination, and increased risk of falls.