An orthosis (orthotic) is a device that is applied externally to a part of

the body.
The word is derived from ortho, meaning straight.
Orthoses are sometimes called orthotics

Brace: is a device that corrects irrigularities.

Splint: usually used after surgry and does not allow
for movement.

The orthotist is the person who designs, fabricates and repair the
orthotic device.
Indications for recommending
orthotic devices:
 To relief pain.
 To limit motion,
 immobilization after surgery
 immobilization after traumatic injury
 Compression fracture management
 Kinesthetic reminder to avoid certain movements.
 To correct deformity e.g. Scoliosis management
 To relieve symptoms of a disease by supporting or
assisting the musculo-neuro-skeletal system.
 To reduce axial loading
 To improve function in a certain segment of the
body.
 Assist and improve movement and function
 Reduce muscle tone.
 Protect against injury.
 Provide proprioceptive feedback.
 Provide rest.
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, or other drains
 Access to surgical sites for wound care
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.
Effects of the orthosis may lead to:
 Decrease pain
 Increase strength
 Improve function
 Increase proprioception
 Improve posture
 Correction of spinal curve deformity
 Protect against spinal instability
 Minimize complications
 Assist healing of ligaments and bones
Associated drawbacks of the use of an
orthotic device:

 Discomfort
 Local pain
 Skin breakdown
 Nerve compression
 Muscle atrophy with prolonged use
 Decreased pulmonary capacity
 Increased energy expenditure with ambulation
 Difficulty donning and doffing orthosis
 Difficulty with transfers
 Psychological and physical dependency
 Increased segmental motion at ends of the orthosis
 Poor patient compliance
Benefits of orthosis:
 Improve function.
 Save energy.
 Increase endurance.

 The main aim of orthotic intervention is

to function without dis-function.
Disadvantages and limitations
of orthoses.
 Limit mobility and ROM of the joint.
 Restrict rotation around a joint.
 Movement is usually limited to certain direction.
 Weakness of other muscles in opposite direction.
 The device is exposing to wear and tear.
 It needs maintenance, care, cleaning, repairing,
and frequent changing of shoes.
 Principles and
considration for orthoses:
Orthoses should :

 provide support and stability to the hip, knee

and ankle joints.
 be designed to permit safe and effective
ambulation by patients.
 Provide the need and requirements of the
patient to support or to mobilize.
 Correlate to the findings of tests &
measurements.
 Correlate with patient personality and the
impact of device upon him.
 Prevent the development of deformity and
require modifications in design.
 Orthoses is only one component of
the treatment and is not the whole
treatment.
 Conserve the time and energy of
the patient.
 The materials used should be light
and resistance to wear.

 It should meet the functional

requirements of the patient.
So each patient should be
evaluated individually.
Role of physical therapist
 Identify functional problems of the patient.
 Determine orthotic needs.
 Prescribe the orthoses according to each patient
problems and requirements.
 Evaluate orthotic adequacy.
 Teach the patient to don and doff the orthoses.
 Train the patient for proper use of the orthoses.
Maintenance of orthosis:

Orthosis should be simple and durable

as possible.
 Patient should be taught for:

 Cleaning the leather.

 Oiling the joints.

 Wash the orthosis if possible.

 Types of orthoses

 Temporarily orthoses: Used for certain time

after injury or operation.
 Permanent orthoses: Used for even when
there is muscle weakness, paralysis or
deformity which cannot be corrected.

Static orthosis does not allow movement.

Dynamic orthosis allows movement.
MATERIALS

 An orthosis can be constructed from

metal, plastic, leather, synthetic
fabrics, or any combination.
 Plastic materials, such as
thermosetting and thermoplastics,
are the materials most commonly
used in the orthotic industry.
 Plastics
 Thermosetting materials can be molded into permanent shape
after heating. They do not return to their original consistency
even after being reheated.
 Thermoplastic materials soften when heated and harden when
cooled.
 Low-temperature thermoplastics can be fabricated easily and
rapidly with hot water or hot air but they are used mainly in low
stress activities.
 High-temperature (polypropylene) thermoplastics require higher
temperature (150°C) to mold, but they are ideal for high stress
activities.
Leather
 is used for shoe construction because it conducts heat and
absorbs water well.
Rubber
 Rubber has an shock-absorbing qualities.
 Rubber is used for padding in body jackets and limb
orthoses.
 Metal
 Metals, such as stainless steel and aluminum alloys
are adjustable, but they are heavy and not
cosmetically pleasing.
 Metals can be used for joint components,
metal uprights, springs, and bearings.
Selecting the appropriate material characteristics for
fabrication of an orthotis device requires careful
consideration of a number of factors

 Strength: the maximum external load that can be

sustained by a material.

 Stiffness: the amount of bending or compression that

occurs under stress. e.g. when greater support is required,
a stiffer material is used; when a more dynamic orthosis is
desired, a more flexible material is used.

 Durability (fatigue resistance): the ability of a material

to withstand repeated cycles of loading and unloading.
( selection of a material for orthotic appliances is based on
the ability of the material to withstand the day-to-day
stresses of each individual client.
 Density: the greater the volume or thicker a material the
more rigid and more durable. (this usually increases the over
all weight of the orthosis.

 Corrosion resistance: the material may be affected by

chemical degradation. Most materials will exhibit corrosion
over time, metal will rust and plastics become brittle.
Contact with human perspiration and environments such as
dirt, temperatures and water accelerate the wearing effect
on the materials. Knowing the client‘s daily environment can
assist in material selection.

 Ease of fabrication: the equipments needed for fabrication

of orthosis
Biomechanichal principles of orthotic
design
 The biomechanical principles of orthotic design assist in
promoting control, correction, stabilization, or dynamic
movement.
 All orthotic design are based on three relatively
principles:

These principles are:

Pressure equilibrium The lever arm

The pressure principle
 the pressure should be equal to the total force per
unit area.

Force
P = ------------------------
Area of Application

 It means that the greater the area of a pad or plastic

shell of an orthosis, the less force will be placed on
the skin.
 Therefore, any material that creates a force against
the skin should be of dimension to minimize the force
on the tissue.
The equilibrium principle:
 The sum of the forces and the bending forces created
must be equal to zero.

 This means that three-point pressure or loading system

occurs when three forces are applied to a segment in
such a way that a single primary force is applied
between two additional counter forces with the sum of
all three forces equalizing zero.

 The primary force is of a magnitude and located at a

point where movement is either inhibited or facilitated,
depending on the functional design of the orthosis
The lever arm principle:
 The farther the point of force from the joint the
greater the moment arm and the smaller the
magnitude of force required to produce a given
torque at the joint.

 This why most orthosis are designed with long

metal bars or plastic shells that are the length of
adjacent segment.

 The greater the length of the supporting orthotic

structure, the greater the moment or torque that
can be placed on the joint or unstable segment.
These three principles act dependently on
each other
 So when designing or evaluating an orthotic device we
should check that
1) There is adequate padding covering the greatest area
possible for comfort.

2) The total forces acting on the involved segment is equal

to zero or there is equal pressure throughout the
orthosis and no areas of skin irritation.

1) The length of the orthosis is suitable to provide an

adequate force to create the desired effect and to avoid
increased transmission of shear forces against the
anatomic tissues
General othotic considerations:

 The forces at the interface between the orthotic

materials and the skin.
 The degrees of freedom of each joint.
 The number of joint segments.
 The neuromuscular control of a segment, including
strength and muscle tone.
 The material selected for orthotic fabrication.
 The activity level of the patient.
 The goal of orthotic fitting is to meet the functional
requirements of the patient with minimal restriction.
Functional orthotic considirations
1) Alignment: The correction of a deformity or maintenance of a
body segment. e.g.
a) Musculoskeletal disorders:
Milaukee brace for scoliosis.
Dynamic splint to prevent scar shortening in burns.
b) Neurological disorders:
Tone reducing AFOs in patient with cerebral palsy.
CTLSO to prevent motion of cervical region.

2) Movement: a joint may require assistance with motion or

resistance to excessive motion: example.
 Assistance with joint motion.
a) Muscloskeletal disorders:
AFO with dorsiflexion assist for dorsiflexor weakness.
b) Neurological disorders:
RGO assist with spinal cord injury with ambulation.
3) Weight bearing: to reduce axial loading and reduce the forces placed
on a joint.

a) Muscloskeletal disorder
Shoe insert with metearsal pad for a diabetic patient with foot
deformity.
b) Neurological disorders
Heel wedge for a child with cerebral palsy.

4) Protection: protect a segment against further injury or pain.

Examples
a) Muscloskeletal disorders:
Functional knee brace.
b) Neurological disorders;
Cock-up splints for post spinal cord injury.
 Types of orthosis

Trunk
Upper limb orthosis Lower limb orthosis
orthosis
Orthoses are named by the joints they encompass
LL orthoses AFO Ankle-foot orthosis
FO Foot orthosis KAFO Knee-ankle foot orthosis
KO Knee orthosis HKAFO Hip-Knee-ankle foot orthosis
HO
Hip orthosis RGO
Reciprocal Gait orthosis
Spinal orthoses CTO Cervical-Thoracic orthosis
CO Cervical orthosis CTLSO Cervical-Thoracolumbosacral
TO Thoracic orthosis orthosis
SO Sacral orthosis TLSO Thoracolumbosacral orthosis

SIO Sacroiliac orthosis Lumbosacral orthosis

LSO

UL orthoses WHO Wrist-Hand orthosis

HO Hand orthosis EWHO Elbow-Wrist-Hand orthosis
WO Wrist orthosis SEO Shoulder-Elbow orthosis
EO Elbow orthosis SEWHO Shoulder-Elbow-Wrist-Hand
orthosis
SO Shoulder orthosis
 TYPES OF ORTHOSES
• LOWER LIMB
• Insoles - These are used to help cushion the feet, reduce high
pressure areas or alter the biomechanics of the feet are
abnormally shaped so do not fit ordinary footwear.
• Footwear adaptations - Adaptations are made to either
compensate for a leg length discrepancy or to alter the angles
of the feet when walking.
• Ankle Foot Orthoses - (plastic or conventional
metal) These can be supplied to help control or
stabilise the ankle and foot. For example, for
controlling foot drop or stabilising an
osteoarthritic ankle.
• Knee Ankle Foot Orthoses - (plastic or
conventional metal) These are used to help
control or stabilise the knee, ankle and foot.
• Knee braces - There are various types to help
control the knee joint.
• Stockings - These are used to help control
swelling, help improve circulation and help
prevent ulcers and Deep Vein Thrombosis.
 TRUNK
• Corsets and Abdominal Supports - A fabric
support to provide some support to the
back or stomach.
• Plastic Spinal Supports - Provides firmer
support than the corset. They will control
movement, as well as support the body to
prevent surgery, or after surgery.
• Collars - Varying types to provide different
degrees of support and control to the neck.
 UPPER LIMB
• Wrist Splints - To support or control
movements of the wrist and help reduce
pain.
• Some of our supports are stock items but
most are custom made devices to suit the
individual needs of the patient. This is
why you are usually required to have more
than one visit to the department.
 FOOTWEAR
• These are supplied to those patients who
are either diabetic, have a biomechanical
need for additional control of the foot and
ankle or whose feet no longer fit into
conventional footwear.
• Repairs to this footwear are only carried
out through the hospital if a war pensioner
wears them or if the shoes are have
adaptations