ORTHOSIS o An orthosis is an external device applied on the body to limit motion, correct deformity, reduce axial loading, or improve

function in a certain segment of the body. orthosis (orthotic) o is a device that is applied externally to a part of the body. o ortho, meaning straight o Orthoses are sometimes called orthotics 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 repair the orthotic device Design 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 and bones to heal.

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. CLASSIFICATION General o Static o Dynamic Functional o Supportive o Functional o Corrective o Protective Regional o Upper & Lower extremity o Spine

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A. GENERAL 1. Static orthoses: o No movement allowed o Eg. Cockup splint 2. o o Dynamic/functional orthoses: Permits movement. Eg. Lively splint

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

B. Functional Supportive Orthosis o Hip Knee Ankle Foot Orthosis (Calipers) Functional Orthosis o Foot drop splint (Ankle Foot orthosis) Corrective Orthosis o Dennis Brown splint (Club foot boot) Protective Orthosis o Cockup splint (wrist drop splint)

Upper extremity

Clavicle Brace

Knuckle Bender Splint

Ankle brace

Elbow Support Lower extremity

Spine
Finger Cot Splint

CASH Brace

Jewett Brace

Knight Taylors Brace

Hip Knee Ankle Foot Orthosis wit pelvic band

Ischial weight relieving Orthosis

Notes from photocopy: 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 Goals and Purposes of the Clinic 1. Coordinated Pattern of Treatment o Contribution of each of the specialists should be coordinated with that of others o Uniform plan for the best tx o Prosthetic-Orthotic Clinic Procedures permit a more uniform evaluation of the px help to prevent some of the problems inherent in uncoordinated care 2. Staff & Patient Education o There are no standard procedures which apply with equal effectiveness to every patient o Need for an interchange of ideas and a distillation of the best thinking through group discussion o Clinic serves as vehicle permits limited , selected group of physicians and surgeons and become experts in the prosthetic and orthotic fields o Encourages the establishment of competent groups with sufficient experience and education to prescribe and checkout P-O devices o Teach the use and value or P & O Professional 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 Examination 2. Prescription* 3. Pre Fitting Treatment 4. Prosthetic- Orthotic Fabrication 5. Initial Checkout (Evaluation)* 6. Prosthetic Orthotic Training 7. Final Check out (evaluation)* 8. Follow Up 1. Pre Prescription Examination a. Prescription meeting first meeting of the clinic b. Physical & Psychological Exam c. Treatment: Medical Surgical P-O Combination

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Prescription* o For developing Medical Surgical, P-O prescription o At this point, pre prescription exam are evaluated & pxs conditions are rechecked o Detailed consideration of the appropriate Tx procedures o Should be detailed o P-O should obtain approval by the clinic chief Pre Fitting Treatment o Px referred for PT Mm strengthening ROM improvement Mm coordination Procedures designed to encourage shrinkage of the stump & relief of sx related to surgical trauma Prosthetic- Orthotic Fabrication Completed by P-O Involves implementation of the prescription 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 clinic 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 or psychological reactions P-O must be satisfactory 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 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 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 developed Three Fundamental Steps in P-O clinic process 1. Prescription* 2. Initial Checkout (Evaluation)* Can be combined for px being seen 3. Final Check out (evaluation)* soley for the replacement of the app

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 Arrnagement Clinic 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 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 Psychological Effects on Patients Provides px wit a clear cut understanding of the tx process and P-O equipment

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