OTH 212 – Interventions to Support Occupation I

orthosis

externally applied device used to support, align, prevent, correct deformity, improve function, or protect a body part

orthotics

science and practice of designing, fabricating, fitting, and applying orthoses

According to ASHT, what terminology should therapists use instead of "splint"?

orthosis

articular orthosis

An orthosis that crosses one or more joints to control joint motion

non-articular orthosis

An orthosis that does not cross a joint and primarily protects or supports a body segment

How many ASHT classification systems exist?

6

What are the six ASHT classification systems?

Articular/non-articular, location, direction, purpose, type, and total joint count

What does the location classification describe?

The body region where the orthosis is applied

What does the direction classification describe?

The body surface from which the orthosis is applied

What does the purpose classification describe?

The intended clinical function of the orthosis

What does the type classification describe?

The mechanical design of the orthosis

What are the four major orthosis types?

Static, serial static, static progressive, and dynamic

What does total joint count describe?

The number of joints crossed or controlled by the orthosis

What is a static orthosis?

An orthosis with no moving parts that immobilizes or positions a body part

What is a serial static orthosis?

A static orthosis that is periodically remolded to gradually increase tissue length and joint motion

What is a static progressive orthosis?

An orthosis with nonelastic adjustable components that gradually increase joint motion

What biomechanical principle does a static progressive orthosis rely on?

Tissue creep

What is tissue creep?

The gradual elongation of soft tissues under a prolonged low-load force

What type of force is used in tissue creep?

Low-load prolonged stretch

What is a dynamic orthosis?

An orthosis containing moving parts that applies continuous controlled force while allowing movement

What is the primary purpose of a dynamic orthosis?

To improve motion while permitting functional movement.

What biomechanical principle is important for dynamic orthoses?

90-degree angle of pull

Which orthosis is most appropriate immediately after tendon repair?

Static orthosis

Which orthosis is most appropriate for a chronic joint contracture?

Static progressive or serial static orthosis

Which orthosis is generally used later in rehabilitation after tissue healing begins?

Dynamic orthosis

What is torque?

A rotational force acting around a joint (Force x moment arm)

Why is torque important in orthotic design?

It determines how effectively an orthosis controls joint motion

What is the moment arm?

The perpendicular distance between the force and the joint axis

How can an orthosis reduce pressure while maintaining control?

Increase the contact surface area

What biomechanical principle explains pressure reduction by increasing surface area?

Pressure = Force ÷ Area

What is a three-point pressure system?

One corrective force opposed by two counterforces to control alignment

Which force is usually the corrective force on a three-point pressure system?

Middle force

Where are the counterforces located?

Opposite sides of the corrective force

What orthosis is commonly indicated for wrist drop?

A wrist-hand orthosis (WHO), often a dynamic wrist extension orthosis or cock-up splint

What should be considered first when selecting an orthosis?

The diagnosis, stage of healing, functional goals, tissue status, and patient needs

What is the first question to ask when choosing an orthosis?

"What clinical problem am I trying to solve?"

If a joint requires complete protection after surgery, which orthosis type is most appropriate?

Static orthosis

If increasing passive ROM is the primary goal, which orthosis types are appropriate?

Serial static or static progressive orthoses

If active movement is desired while providing assistance, which orthosis is indicated?

Dynamic orthosis

Which tissue healing stage generally requires immobilization?

Acute inflammatory phase

Which healing stage commonly introduces controlled mobilization?

Proliferation/early remodeling phase

Which healing stage focuses on restoring ROM and function?

Late remodeling phase

What is the main goal during the inflammatory phase?

Protect healing tissues

What is the main goal during remodeling?

Restore motion and function while preventing reinjury

What is the preferred stretching approach for contracted tissues?

Low-load prolonged stretch, it promotes tissue remodeling while minimizing tissue injury

How long should redness remain after removing an orthosis?

20 mins

Which patients require especially careful skin monitoring?

Patients with diabetes, neuropathy, spinal cord injury, or impaired sensation

Why is patient education considered part of treatment?

It improves compliance and treatment outcomes

What are the four essential components of patient education?

Purpose of the orthosis, wearing schedule, skin monitoring, and when to contact the therapist

What is clinical reasoning?

The process of integrating evaluation findings, diagnosis, evidence, and patient goals to make treatment decisions

Why is edema important during orthotic fabrication?

It affects fit and may require future adjustments

What is the difference between impairment and occupation?

Impairment is a body function limitation, occupation is meaningful daily activity

What should always determine orthosis selection?

The diagnosis, tissue healing stage, clinical goals, and functional needs

What is the primary goal of a wrist orthosis?

Stabilize the wrist while allowing appropriate hand function

What is the primary goal of a thumb spica orthosis?

Immobilize the thumb while maintaining functional positioning

What is the primary goal of a resting hand orthosis?

Prevent deformity, reduce pain, and maintain proper hand positioning

Which elbow orthosis is commonly used for elbow extension contractures?

Anterior elbow orthosis

Which elbow orthosis is more commonly used immediately after surgery?

Posterior elbow orthosis

What forearm position is commonly used for elbow immobilization?

Neutral

What is an ulnar gutter orthosis?

An orthosis supporting the ring and small fingers along the ulnar side of the hand

What diagnoses commonly require an ulnar gutter orthosis?

Fractures or injuries involving the fourth and fifth metacarpals or phalanges

When is circumferential wrist orthosis indicated?

When maximum stability and immobilization are required

What is a thumb spica orthosis?

An orthosis designed to immobilize the thumb while allowing appropriate wrist or finger motion

What is the difference between a forearm-based and hand-based thumb spica?

A forearm-based thumb spica includes wrist immobilization, a hand-based thumb spica allows wrist motion

When is a forearm-based thumb spica preferred?

When both the thumb and wrist require stabilization

When is a hand-based thumb spica preferred?

When only the thumb requires immobilization

What thumb joints are commonly immobilized in a thumb spica?`

CMC & MCP joints, IP left free

Resting hand orthosis

An orthosis that positions the hand in a functional or antideformity position during rest

What are the two resting hand positions commonly tested?

Functional position and antideformity (safe) position

What is the functional position of the wrist?

Slight wrist extension

What is the functional position of the MCP joints?

Slight flexion

What is the functional position of the IP joints?

Slight flexion

What is the functional thumb position?

Palmar abduction and opposition

What is the antideformity position also called?

The intrinsic-plus position or safe position

Why is the antideformity position also called the safe position

It minimizes collateral ligament shortening during immobilization

What is the wrist position in the intrinsic-plus position?

Approximately 20-30° extension

What is the MCP position in the intrinsic-plus position?

Approximately 70-90° flexion

What is the IP position in the intrinsic-plus position?

Full extension

What thumb position is maintained in the intrinsic-plus position?

Palmar abduction

What is the difference between the functional position and intrinsic-plus position?

Functional position optimizes function, while intrinsic-plus prevents joint contracture

Why is the intrinsic-plus position protective?

It maintains collateral ligament length and preserves joint mobility

Which orthosis is most appropriate for a patient with carpal tunnel syndrome

A volar wrist cock-up orthosis that holds the wrist in neutral to slight extension

What is the primary goal of splinting for carpal tunnel syndrome?

Reduce median nerve compression while allowing tendon gliding

Which orthosis is commonly prescribed for cubital tunnel syndrome?

elbow orthosis that limits prolonged elbow flexion, often positioning the elbow around 30-45° of flexion or as prescribed

Which orthosis is most appropriate for De Quervain's tenosynovitis?

A forearm-based thumb spica orthosis

Which tendons are involved in De Quervain's tenosynovitis?

Abductor pollicis longus (APL) and extensor pollicis brevis (EPB)

What is the primary purpose of a thumb spica for De Quervain's?

Reduce tendon irritation by immobilizing the thumb and wrist

Where is pain typically located in De Quervain's?

Radial styloid

Which special test is commonly positive in De Quervain's?

Finkelstein's test

Which orthosis is commonly prescribed for a patient with first CMC osteoarthritis?

A thumb spica orthosis

Which orthosis is commonly required for a scaphoid fracture?

A forearm-based thumb spica orthosis

Why is thumb immobilization necessary for a scaphoid fracture?

The scaphoid articulates with the thumb and wrist, requiring stabilization during healing

A patient has a TFCC tear. Which orthosis is commonly indicated?

A wrist orthosis that limits wrist motion and forearm rotation

What does TFCC stand for?

Triangular Fibrocartilage Complex

Where is TFCC pain usually located?

The ulnar side of the wrist.

A patient has a Colles fracture. Which orthosis is commonly used?

A wrist-hand orthosis following immobilization

Colles fracture

A distal radius fracture with dorsal displacement

A patient has a boxer's fracture. Which orthosis is commonly indicated?

An ulnar gutter orthosis

Which metacarpal is most commonly fractured in a boxer's fracture?

The fifth metacarpal

Which fingers are supported in an ulnar gutter orthosis?

The ring and small fingers