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orthotics 1

orthotics 1

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Published by ajaycasper

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Published by: ajaycasper on Apr 23, 2009
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01/31/2013

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An orthotic device (commonly just referred to as an orthotic) is an external deviceapplied on the body to limit motion, correct deformity, reduce axial loading, or improve function in a certain segment of the body.Design characteristics of an orthotic device are crucial to function. Most importantfeatures include the following:
Weight of the orthosis
Adjustability
Functional use
Cosmesis
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 moistureIndications for recommending orthotic devices include the following:
Pain relief 
Mechanical unloading
Scoliosis management
Spinal immobilization after surgery
Spinal immobilization after traumatic injury
Compression fracture management
Kinesthetic reminder to avoid certain movementsDuration of orthotic use is determined by the individual situation.
In situations where spinal instability is not an issue, recommend use of anorthosis until the patient can tolerate discomfort without the brace.
When used for stabilization after surgery or acute fractures, allow 6-12weeks to permit ligaments and bones to heal.Use of an orthotic device is associated with several drawbacks, including thefollowing:
Discomfort
Local pain
Osteopenia
Skin breakdown
Nerve compression
Ingrown facial hair for men
 
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
Unsightly appearance
Poor patient complianceSuccess of the orthosis may lead to any of the following:
Decreased pain
Increased strength
Improved function
Increased proprioception
Improved posture
Correction of spinal curve deformity
Protection against spinal instability
Minimized complications
Healing of ligaments and bonesPhysicians must understand the biomechanics of the spine and each individualorthosis. The cervical spine is the most mobile spinal segment with flexiongreater than extension. The occiput and C1 have significant flexion andextension with limited side bending and rotation. The C1-C2 complex accountsfor 50% of rotation in the cervical spine. The C5-C6 region has the greatestamount of flexion and extension. The C2-C4 region has the most side bendingand rotation.When compared to the cervical and lumbar spine, the thoracic spine is the leastmobile. The thoracic spine has greater flexion than extension. Lateral bendingincreases in a caudal direction, and axial rotation decreases in a caudal direction.The lumbar spine has minimal axial rotation. The greatest movement in thelumbar spine is flexion and extension. Immobilization of the spine increaseserector spinae muscle activity since normal rotation that occurs with ambulationis limited by the orthosis.The biomechanical principles in orthotic design include balance of horizontalforces, fluid compression, distraction, construction of a cage around the patient,placement of an irritant to serve as a kinesthetic reminder, and skeletal fixation.Construction of a cage around the patient, like a thoracolumbar brace, increasesintraabdominal pressure. Increased intraabdominal pressure converts the softabdomen into a semirigid cylinder, which helps to relieve part of the vertebralload. In general, structural damage to posterior elements of the spine creates
 
more instability with flexion, whereas damage to anterior elements creates moreinstability with extension.Orthotic devices (orthoses) are generally named by the body regions that theyspan. For example, a CO is a cervical orthosis, while a CTLSO is acervicothoracolumbosacral orthosis, spanning the entire length of the spine.Many of these devices are also known by eponymsSeveral drawbacks to cervical orthotic (CO) use have been noted. The soft tissuestructures around the neck (eg, blood vessels, esophagus, trachea) limitapplication of aggressive external force. The high level of mobility at all segmentsof the cervical spine makes it difficult to restrict motion. Cervical orthoses offer nocontrol for the head or thorax; therefore, motion restriction is minimal. Cervicalorthoses serve as a kinesthetic reminder to limit neck movement.Observe appropriate precautions associated with orthotic use. Keep in mind thatcontinued long-term use has been associated with decreased muscle functionand dependency.The soft collar (seeImage 1) is a common orthotic device made of lightweightmaterial, polyurethane foam rubber, with a stockinette cover. It has Velcro closurestrap for easy donning and doffing. Patients find the collar comfortable to wear,but it is soiled easily with long-term use. The average soft collar costs $50.Indications for use of the soft collar include the following benefits for the patient:
Warmth
Psychological comfort
Support to the head during acute neck pain
Relief with minor muscle spasm associated with spondylolysis
Relief in cervical strainsThe soft collar provides some limitations of motion for the patient, including thefollowing:
Limits full flexion and extension by 5-15%
Limits full lateral bending by 5-10%
Limits full rotation by 10-17%The hard cervical collars are similar in shape to a soft collar but are made of Plastizote, a rigid polyethylene material shaped like a ring with padding. Heightcan be adjusted in certain designs to fit patients better. Velcro straps are used for easy donning and doffing. The hard collar is more durable than a soft collar withlong-term use. A hard collar costs approximately $60.

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