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ORTHOSIS

o An orthosis is an external device applied on the body to limit motion, correct deformity, reduce axialloading, or improve function in a certain segment of the body.

orthosis (orthotic)

o is a device that is applied externally to a part of thebody.o ortho, meaning straighto Orthoses are sometimes calledorthotics

Brace

o is a device that corrects irrigularities.Splint

o usually used after surgry and does not allow for movement.Orthotist

o the person who designs, fabricates and r epair the orthotic deviceDesign characteristics of an orthotic device:

Most important features include the following:

Weight of the orthosis Adjustability Functional use Cosmoses Cost Durability Material Ability to fit various sizes of patients Ease of putting on (donning) and taking off (doffing) Access to tracheostomy site, peg tube, or other drains Access to surgical sites for wound care Aeration to avoid skin maceration from moisture

Duration of orthotic use:

It is determined by the individual situation. In situations where instability is not an issue, recommend use of an orthosis until the patient can tolerate

discomfort without the brace.

When used for stabilization after surgery or acute fractures, allow 6-12 weeks to permit ligaments andbones to heal.

Effects of the orthosis may lead to:

Decrease pain Increase strength Improve func Improve posture Correct of spinal curve deformity Protect against spinal instability Assist healing of ligaments and bones

o FUNCTIONS: Prevention of deformity Correction of deformity Maintenance of correction Instability control Relieving weight bearing Facilitating ambulation Relieving pain

Benefits of orthosis:

Improve function. Save energy. Increase endurance.

The main aim of orthotic intervention is to function without dis-function. o CLASSIFICATIONA. General

o Statico Dynamic

B. Functionalo Supportiveo Functionalo Correctiveo Protective

C. Regionalo Upper & Lower extremityo Spine

A. GENERAL

1. Static orthoses:o No movement allowedo Eg. Cockup splint2. Dynamic/functional orthoses:o Permits movement.o Eg. Lively splint

B. Functional

Supportive Orthosiso Hip Knee Ankle Foot Orthosis (Calipers)

Functional Orthosiso Foot drop splint (Ankle Foot orthosis)

Corrective Orthosiso Dennis Brown splint (Club foot boot)

Protective Orthosiso Cockup splint (wrist drop splint)

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Upper extremity

Elbow Support

Lower extremity

Spine

Clavicle Brace

Knuckle Bender Splint

Finger Cot Splint

Hip Knee Ankle Foot Orthosis wit pelvic

band

Ischial weight relieving Orthosis

Ankle brace

CASH Brace Jewett Brace Knight Taylors B

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COMPLICATIONS

Discomfort & Local pain Osteopenia Skin breakdown Nerve compression Ingrown facial hair for men Muscle atrophy with prolonged use Decreased pulmonary capacity Difficulty with transfers Increased energy expenditure with ambulation Difficulty donning and doffing orthosis Psychological and physical dependency Increased segmental motion at ends of the orthosis Unsightly appearance Poor patient compliance

Orthotic Prescription

Muscle power Deformities Locomotion Type of paralysis Range of movement Length of limb

References

Orthotics and Prosthesis in Rehabilitation - Michelle M. Lusardi & Caroline C. Nielsen Physical Rehabilitation Susan B O Sullivan Textbook of Rehabilitation - Sundar

Notes from photocopy:

Goals and Purposes of the Clinic

1. Coordinated Pattern of Treatmento Contribution of each of the specialists should be coordinated with that of otherso Uniform plan for the best txo Prosthetic-Orthotic Clinic Procedures

permit a more uniform evaluation of the px help to prevent some of the pro blems inherent in uncoordinated care

2. Staff & Patient Educationo There are no standard procedures which apply with equal effectiveness to every patiento Need for an interchange of ideas and a distillation of the best thinking through group disco Clinic serves as vehicle permits limited , selected group of physicians and surgeons and

experts in the prosthetic and orthotic fields

o Encourages the establishment of competent groups with sufficient experience and educaprescribe and checkout P-O devices

o Teach the use and value or P & OProfessional Status of the Prosthetist Orthosist

o Pxs satisfaction is related to:- Attitude- Evaluation of P & O

o 2 considerations which may prompt a less than satisfactory attitude- Lack of status- Lack of training & experience of P & O in the proper handling of psychological and

interpersonal aspects of their vocation

Prosthetic-Orthotic Clinic Procedures (* = major responsibilities)

1. Pre Prescription Examination2. Prescription*3. Pre Fitting Treatment4. Prosthetic- Orthotic Fabrication5. Initial Checkout (Evaluation)*6. Prosthetic Orthotic Training7. Final Check out (evaluation)*8. Follow Up

1. Pre Prescription Examinationa. Prescription meeting first meeting of the clinicb. Physical & Psychological Examc. Treatment:

- Medical- Surgical- P-O- Combination

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2. Prescription*o For developing Medical Surgical, P-O prescriptiono At this point, preprescription exam are evaluated & pxs conditions are recheckedo Detailed consideration of the appropriate Tx procedureso Should be detailedo P-O should obtain approval by the clinic chief

3. Pre Fitting Treatmento Px referred for PT- Mm strengthening- ROM improvement- Mm coordination- Procedures designed to encourage shrinkage of the stump & relief of sx related to surgicaltrauma

4. Prosthetic- Orthotic Fabrication- Completed by P-O- Involves implementation of the prescription

5. Initial Checkout (Evaluation)*- Systemic examination of the px wit the prosthesis or orthosis as a biomechanical entity - Accomplished before the device is delivered to the px & initiation of training - Performed wit the appliance in the unfinished states, so that minor improvements may be

introduced at min cost

- Important :(1) Provide assurance that the prescription developed by the c linic has been followed

precisely

(2) Evaluate the biomechanical adequacy of the prosthetic-orthotic device against set

standard of quality

- Corrections can be introduced before the development of undesirable physical orpsychological reactions- P-O must be satisfactory

6. Prosthetic Orthotic Training- If P-O is found to be satisfactory, px referred for P-O training by therapist- Length, type & intensity of training depend upon the:

nature of disability Characteristic of px Other lesser considerations

7. Final Check out (evaluation)*- Assures the P-O clinic- Biomechanical adequacy is reviewed- Eval is made of the:

extent effectiveness of the pxs use of O or P physical & psycho status of px

8. Follow Up- Px-P/O rel is transitory (device & px are subject to change)- May be periodic (ex 1x/6 mo)- To determine that no changes have taken place in the physical characteristics of px wc

adversely affect fit & alignment of the appliance

- To determine that no mechanical deficiencies have developedThree Fundamental Steps in P-O clinic process

1. Prescription*2. Initial Checkout (Evaluation)*3. Final Check out (evaluation)*

Other considerations that affect clinic operations

1. Clinic Administration or Coordination- Schedules for px- Proper preparation of forms- Care of check out equipment- Reduction of waiting time- Availability of single person (for counsel)

2. Physical ArrnagementClinic meeting: ( a well run clinic)

- Quiet, large, well lighted room- Dressing area- Waiting areas- Reasonable scheme for control of visitors- Use of P-O, pics, charts etc for px orientation

3. Interaction Among Clinic members Dominated by the PHYSICIAN OR PROSTHETIST-ORTHOTIST- Experience and status to set a desirable pattern Clinic Chiefs- Set the tone for this interaction

4. Psychological Effects on Patients- Provides px wit a clear cut understanding of the tx process and P-O equipm

Can be combined for px being seen

soley for the replacement of the app