Orthotics Study Notes

Definition: An orthotic is an external appliance worn to restrict or assist motion or to transfer loads from one area of the body to another.
Benefits:
- Provides support or stabilization
- Improves functional abilities
- Corrects deformities
- Distributes pressure from one area to another
Material Composition:
- Can be made from a variety of materials.
Design Requirements:
- Should be lightweight.
- Must be adjustable.
- Should be easy to don (put on) and doff (take off).

Key Functions:
- Preventing deformity
- Maintaining proper alignment
- Inhibiting tone (muscle tone control)
- Assisting weak limbs
- Protecting against injury
- Facilitating motion.

Foot Orthosis (FO):
- Devices applied to the foot, placed inside or outside the shoe.
Ankle-Foot Orthosis (AFO):
- Encompasses the shoe and ends somewhere below the knee.
Knee-Ankle-Foot Orthosis (KAFO):
- Extends from the shoe to the thigh.
Hip-Knee-Ankle-Foot Orthosis (HKAFO):
- KAFO with a pelvic band that surrounds the lower trunk.

Functionality:
- Provides the foundation for most lower extremity orthoses.
Characteristics:
- Should distribute weight-bearing forces evenly.
- Need to ensure comfort, support, and maintain the function and appearance of the foot.

Types and Benefits:
- Viscoelastic Inserts:
- Reduces shear and impact shock.
- Metatarsal Pad:
- Transfers stress from the metatarsal heads to the metatarsal shafts.
- Arch Supports:
- Prevents flattening of the arch of the foot.
- Cushion Heel:
- Absorbs shock at heel strike; indicated with orthoses that have a rigid ankle.

Primary Prescription:
- Most AFOs are prescribed to limit dorsiflexion (DF) or plantarflexion (PF) or to assist with motion.
Types of AFO:
- Posterior Leaf Spring:
- Assists with dorsiflexion.
- Benefits patients with conditions such as:
  - Peripheral neuropathy (weakness due to nerve damage, often seen in diabetes).
  - Peroneal lesions (injury to the peroneal nerve, resulting in drop foot).
  - Hemiplegia (post-stroke paralysis, results in drop foot).
Specific Types of AFO:
- Solid AFO:
- Controls medial/lateral motion of the ankle; does not allow foot inversion or eversion.
- It pushes the foot into dorsiflexion.
- Prevents foot drop by restricting plantarflexion.
- Spiral AFO:
- Spirals from medial foot around the lower leg.
- Controls motion but does not eliminate it in all planes.

Usage:
- Frequently seen in pediatric patients.
Functionality:
- Provides medial/lateral stability while allowing for dorsiflexion and plantarflexion.
- Does not permit inversion or eversion.
Indications:
- Recommended for patients with conditions such as cerebral palsy (CP) or muscular dystrophy.

Functionality:
- Provides support and stability to both the knee and ankle, maintaining knee extension.
Common Uses:
- Most prevalent in compensating for paralysis of the entire leg.
- Useful in:
- Paraplegia due to spinal cord injury (SCI), where patients retain the use of hip flexors.
- Hemiplegia resulting from stroke.

Indications:
- Used for patients with weakness in the hip, knee, ankle, and foot.
Limitations:
- Rarely used due to gait restrictions; can be awkward to don and uncomfortable for patients.
Specific Application:
- Often indicated for patients with SCI who lack use of hip flexors or extensors.

Design:
- An HKAFO that incorporates a cable system to assist with lower extremity advancement during gait.
Gait Mechanism:
- Gait occurs in a four-stage procedure:
1. Shift weight to the right leg.
2. Tuck pelvis by extending the upper thorax.
3. Press on crutches.
4. Allow the left leg to swing through.

Assessment Components:
- Joint mobility
- Limb length
- Motor function
- Sensation
- Upper extremity (UE) strength and coordination
- Psychological status.

Involves assessing the patient while standing still.
Evaluate patient standing and sitting positions; should weight bear equally on both lower extremities.
Mechanical knee joints should be congruent with anatomical knee joints.

Patient Education:
- Teach the patient proper methods for donning their orthosis.
- Ensure the patient wears clean, properly fitting socks.
Special Considerations:
- Patients with KAFOs will need crutches for independent gait.
- Provide specific instructions for transfer techniques.

Types of Cervical Collars:
- Soft Collars:
- The least restrictive, allowing the closest to normal range of motion (ROM).
- Hard/Rigid Collars:
- Most prescribed for cervical spine stabilization.
- Indications include following trauma, surgery, fractures, or dislocations.

Purpose:
- Provides external immobilization in the following planes:
- Flexion
- Extension
- Rotation
- Lateral bending.
Indications:
- Cervical or high thoracic fractures or dislocations.
- Post-operative immobilization.
- Trauma.

Description:
- An invasive cervical thoracic orthosis.
Functionality:
- Provides full restriction of all cervical motion.
Indications:
- Usually used for cervical spinal cord injuries to prevent further damage or dislocation.

Function:
- Prevents all trunk motions.
Indications:
- Post-surgical stabilization related to:
- Compression fractures
- Herniated/bulging discs
- Post-laminectomy stabilization
- General spinal stabilization
- Spinal stenosis.
Characteristics:
- Typically features a rigid shell.

Functionality:
- Promotes realignment of the spine due to scoliotic curvature.
Definition:
- Scoliosis is defined as a lateral curvature of the spine.
Brace Specifications:
- Custom made and does not correct curve but prevents it from worsening.
Coverage:
- Extends from the pelvis to the upper chest.
Padding:
- Padding is applied to the areas of greatest severity of the curve.

Information Sources:
- Giles, S. M. (2015). PTA Exam: The Complete Study Guide. Scarborough, ME: Scorebuilders.
- Online Resources (list provided in the original transcript).