SCI Orthotics

SCI Orthotics

Review Nomenclature Spine support orthoses

Neck, ThoracoLumbarSacral Joint support orthoses

Typically lower limb motor loss adaptations Motor augmentation orthoses

Typically upper limb motor presence augmentation Protection orthoses

Orthotic Definition

Device used to assist, resist, align or simulate function of a body part or system.

Typically applies forces to affected extremity.Force has magnitude, direction and application point.

Effectiveness depends on all 3.

Movement = rotation, translation or combination of 2.Torque is strength of rotational force.

Orthotic Nomenclature

1971 – American Orthotic and Prosthetic Association promoted standardized nomenclature

1972 – new language put into use

Committee on Prosthetic-Orthotic Education of the National Academy of

Sciences

All exoskeletal devices called orthotics Described by joints they encompass

Abbreviate each joint name to 1 letter Combination of symbols to indicate desired

control of designated function

Orthotic Materials

Thin metal, plastic, foam, epoxy, plaster. Short use = low durability need High frequency & load = high durability need

Spine Support

Goal is stabilization in desired plane of motionFlex/ext, sidebending, rotation

Absolute vs. relative restriction

Cervical Orthoses

Halo SOMI, molded MINERVA cervical orthosis ASPEN, Miami, PHILLY MNDA for weak extensors (ALS) Headmaster collar Soft collar

Cervical Orthoses Philly: AP motion limited to 30% normal, 43%

rotation, 67% side bend. SOMI: 13-27% sagittal motion, 34% rotation, 66%

side bend HALO: believed most restrictive, least overall C-spine

motion but individual “snaking” of vertebrae. Koch – 31% sagittal motion reduction in tetraplegia,

suggested intimate fit body vest was best. 1978

ASPENCollar

Miamicollar

MNDA

ThoracoLumbarSacral Orthoses

3 point force application theory No true immobilization, just limitation of

interspinous motion Limited sagittal control For effectiveness, must provide “inhibitory

feedback signal” over bony prominences to reduce patient movement efforts.

LS Orthoses

Commonly used for back pain syndromes Little consistent data to support idea that disk

pressures reduced in lifting tasks.Nachemson A.

TLSO types

Jewitt Knight-Taylor LS corsett Clamshell or turtleshell

Limb Support Orthoses

Reciprocating gait orthosis HKAFO KAFO AFO

Motor Augmentation Orthoses Cervical deficits can use substitution or enhancement Upper limb’s job = terminal device (hand) placement

in environment Feeding most important!

Balanced forearm orthosis (BFO), tenodesis devices, hand & digit flexion or extension assist orthoses, built up grips for grip loss.

General environmental control units Oromotor adaptive equipment

Static Position Maintenance Orthoses

Common use in SCI, CVA Prevent contracture, maintain functional

position of hand.

Interface technology for high cervical injuries

Eye movement tracking Sip & puff Voice recognition

Eye Movements During Visual ScanEye Movements During Visual Scan

Eye Movement Measurement Eye Movement Measurement TechniquesTechniques

• EOG

• Photoelectric

• Pupil Corneal Reflection

• Scleral Search Coil

Electrooculography (EOG)Electrooculography (EOG)

Cornea Positively Charged Relative to Retina - A Rotating Dipole

Scleral Search CoilScleral Search Coil

Contact Lens with Embedded Induction Coil

PhotoelectricPhotoelectric

Infrared Reflectance TechniqueLimbus Eye Tracker

Pupil Corneal Reflection SystemPupil Corneal Reflection System“Dark Pupil”“Dark Pupil”

IR Image of the Eye

Estimate ofPupil Center & Corneal Reflections

“Original” Hockey Helmet System

Mapping of Eye onto 2D CCD Array

Human-Machine InterfacesHuman-Machine Interfaces Visual control of movement, Visual control of movement,

function or processesfunction or processes Visual control of systems from Visual control of systems from

a remote locationa remote location Combined ControlCombined Control

Protection Orthoses

Skin protectionPRAFO, multi-Podus – many brand names

Not = heel pads, key is suspension of calcaneal posterior surface in space, no contact!

Risk of Achilles tendon irritation