ORTHOSES FOR

PARAPLEGIA & HIP

DISORDERS
Dr. Ali Farhad

Hip Knee Ankle Foot Orthosis

Addition of pelvis band and hip joints

convert the KAFO to an HKAFO.
Hip joint is a metal hinge that connects the
lateral upright of KAFO to a pelvic band
The joint prevents abduction and
adduction as well as rotation
Hip Orthosis is prescribed in problems
associated with femoral head and
acetabulum

Hip Knee Ankle Foot Orthosis

Indication
Indicated for
individuals with little
or no control of their
lower extremities
Cerebral palsy
Polio
Spina bifida
Muscular dystrophy
Traumatic paraplegia

Hip Abduction Orthosis

A hip abduction
orthosis is a brace
that is typically used
following a revision of
a hip replacement or
after a hip dislocation
It is used to help
prevent excessive
flexion or extension
and to limit adduction

Specific Case Hip Orthosis (HO):

S.W.A.S.H Orthosis

Standing Walking And

Sitting Hip Orthosis
The
S.W.A.S.H.bracesystem is
a unique design for
individuals who have
sitting imbalance and a
scissoring gaitassociated
with cerebral palsy
Plastic pelvic section
extends from L2/L3 to the
coccyx
Reduce the risk of hip
dislocation

Trunk Hip Knee Ankle-Foot Orthoses

Patients who
require more
stability than
provided by
HKAFOs may be
fitted with
THKAFOs
THKAFO is very
difficult to don
and is very heavy

Standing Frame

A standing frame, also known as a standing aid

is specifically designed for wheelchair users.
The standing frame consists of a broad base,
posterior non-articulated uprights extending
from a base to a mid-torso chest band with a
transverse thoraco-lumbar band
The frame has a chest strap and a knee strap
Standers are used by people with mild to severe
disabilities such as spinal cord injury. TBI, CP,
spina bifida and Muscular dystrophy

Standing Frame

Parapodium

The parapodium was also referred to in

the past as a swivel Orthosis.
A parapodium is an appropriate
prescription for children who are unlikely
to become functional walkers because of
the severity of their impairment.
It is most commonly prescribed for
children between 2.5 to 5 years of age

Parapodium

A parapodium allows crutchless gait.

Ambulation occurs by the child pivoting
the hips and using body English to
swivel one side of the oval-based stand
forward and then repeating the same
event for the other side.

Parapodium

Reciprocating Gait Orthoses

The RGO is a THKAFO in which the orthotic hip
joints are connected by one or two metal cables
or rods. The knees are stabilized with knee
locks, and the feet are encased in solid ankle
orthoses. To walk, the wearer follows a fourstage procedure:
shift weight to the right leg.
tuck the pelvis by extending the upper thorax,
press on the crutches, and
allow the left leg to swing through

Reciprocating Gait Orthoses

Ambulation Aids
The purpose of using ambulation aids is to
increase the area of support for patients
who have difficulty maintaining their center
of gravity safely over their own support
area. A variety of aids are available for the
individual needs of patients. Ambulation
aids improve balance, redistribute and
extend the weight-bearing area, reduce
lower limb pain, provide small propulsive
forces, and provide sensory feedback

Ambulation Aids

Canes
Walker
Axillary Crutches
Forearm Crutches

Canes
Measure the tip of the cane to the level of
the greater trochanter with the patient in
an upright position to determine the proper
cane length.
The elbow should be flexed approximately
20 degrees, which is a desirable elbow
position for all ambulation aids. Canes are
made of wood or aluminum, with the
aluminum alloy cane having adjustable
notches so that one cane fits all

Canes
Advantages
light weight
Adjustable
Variable base of support
Disadvantage
Costly
Less support as compare to crutches
No lateral support
Not suitable for partial and non weight
bearing gait

Canes

Crutches
Crutch length:
First Method: Measure the distance from the anterior
axillary fold to a point 6 inches lateral to the fifth toe
with the patient standing with the shoulders relaxed.
Second Method: Measure the distance from the 2 inches
below the level of axillary fold to a point 2 inches lateral
and 6 inches anterior to foot.
A crutch is defined as a device that provides support from
the axilla to the floor. Although there are different
types of crutches and canes, they can all be referred to as
orthoses because they are applied to the external surface
of the body to improve function.

Axillary Crutches
Advantages
Provide lateral support
Ideal for partial and non weight bearing
gait
Wide base of support
Disadvantages
Not suitable for crowded and narrow
spaces
Can cause injury to radial nerve and
adjacent vascular structures

Crutches

Forearm Crutches

Lofstrand Forearm Crutches

Wooden Forearm Crutches (Kenny Stick)
Platform Forearm Crutches
Triceps Weakness Crutches

Lofstrand Forearm Crutches

Measure with the patients elbow flexed 20
degrees, the wrist in maximal extension,
and the fingers forming a fist. This is
measured after the total crutch height is
determined with the crutch 3 inches
lateral to the foot.

Lofstrand Forearm
Crutches
Advantages
Ideal for stair climbing
Cosmetic
More functional in out door activities
Disadvantages
No lateral support
The cuff may be difficult to remove

Lofstrand Forearm Crutch

Wooden Forearm Crutches (Kenny

Stick)
It was named after Sister Kenny, who sawed off
the top half of wooden crutches and placed a
leather band around the proximal portion of
the forearm. It was designed for polio patients
who had satisfactory proximal upper limb
musculature but were weak distally and unable
to effectively hold and control the orthosis.
This orthosis is same as the axillary crutches
except the unique design and it was especially
made for Polio patients

Kenny Stick

Platform Forearm Crutches

Have the patient stand upright with the
shoulders relaxed and the elbows flexed
90 degrees. The distance from the ground
to the forearm rest is the proper length.
This orthosis is helpful for patients with
painful wrist and hand conditions, as well
as for those with elbow contractures

Platform Forearm
Crutches
Advantages
Ideal for conditions in which weight
bearing is contra-indicated through wrist
and hand like colles fracture, arthritis
and neuro-vascular injury to forearm or
wrist
Disadvantages
Heavy to carry
Expensive

Platform Forearm Crutches