Assignment

Prosthetics and
orthotics
Submitted to
Dr Fatima
Mazhar
Submitted by
Rimsha Ehsan
Roll no
317-T-084
Hajvery University SKP

Orthosis specifically used in

orthosis
Orthosis
Orthosis is the medical term for a brace while orthoses is the plural
form. The term orthotics refers to the science and practice of patient
assessment, fabrication, fit and adjustment of an orthosis. Orthotic
device can be used interchangeably with the term orthosis. An orthosis
or orthotic device is applied to the body to modify or control skeletal
structure or function. A basic principle for limb orthoses is to use three
points of pressure to perform at least one of the following functions:
1) stabilize or immobilize a body part;
2) improve alignment;
3) prevent deformities;
4) protect against injury;
5) assist with motion,
6) off load a joint or body part or 7) improve function. Orthoses are
named for the joints/segments they manage according to the
International Organization for Standardization (ISO), and are classified
based on action (static vs. dynamic or accommodative vs. corrective).
A static orthosis has no motion across the joint or segment involved. A
dynamic orthosis indicates that there is motion across the joint. A static
progressive orthosis is a type of mobilization orthosis that applies force
to a joint and hold it in its end range position with a goal to improve
passive joint range of motion.
Orthoses in acute injury tend to focus on maintaining range of motion,
preventing contractures, managing pain, protecting damaged or
weakened soft tissue, or providing immobilization. Chronic orthosis use
aims to prevent or control unwanted motion, enhance desired motion,
decrease abnormal tone, alleviate pain, or maximize function. These
interventions apply to all phases of a rehabilitation plan and depend on
the patient’s level of impairment.
Some medical conditions which warrant the use of limb orthoses or
therapeutic footwear may include: trauma, stroke, brain injury, spinal
cord injury, multiple sclerosis, cerebral palsy, peripheral nerve injury,
peripheral neuropathy, arthritic conditions, burns, hypotonia,
hypermobility, neuromuscular disorders, and contracture management
in both pediatric and adult populations.
Common complications that can be seen with orthotic management
include pressure injuries, infection, and pain. Thus, it is essential that
special attention made to examine the skin, neurological function,
vascular status, and musculoskeletal system in patients who will be
using an orthosis.

Upper Limb Orthoses

Upper limb orthoses differ in scope and purpose from lower extremity
orthoses due to the functional difference between fine motor control in
upper extremity and gross motor control and weight-bearing in the
lower extremity. 1
Upper limb orthoses generally focus on achieving a functional range of
motion rather than seeking to achieve a normal range of motion.
Hand Orthoses:
 Commonly used for intrinsic hand musculature weakness or
paralysis with intact wrist extensors.1
GOALS/
TYPE OF HAND ACTION OF THE
INDICATI
ORTHOSES ORTHOSIS
ONS

INCREASE
THE
ABILITY
TO
PERFORM
THUMB MAINTAINS
FUNCTION
ADDUCTION THE THUMB
AL
STOP ORTHOSIS WEB SPACE
TASK(S)
(“C-BAR AND POSITION
WITH
ORTHOSIS) OF THE HAND
THUMB 
IN
ABDUCTE
D
POSITION

THUMB SPICA PROVIDES DECREAS

ORTHOSIS SUPPORT FOR E PAIN
POSITIONING AND/OR
OF THE THUMB PROVIDE
CARPOMETACA THUMB
RPAL AND STABILIT
 Y IN
PATIENTS
WITH
OSTEOAR
THRITIS,
METACARPOPH
HYPERMO
ALANGEAL
BILE
(MCP) JOINTS
JOINTS
AND/OR
THUMB
INSTABILI
TY

PROVIDES
THUMB SUPPORT TO
SUPPORT
INTERPHALANG WEAK
WEAK
EAL (IP) EXTENSOR
MUSCLES
ORTHOSIS POLLICIS
LONGUS

MAINTAIN
FUNCTION
AL HAND
STOPS MCP
METACARPOPH POSITION
HYPEREXTENSI
ALANGEAL WHEN
ON TO SUPPORT
(MCP) RECOVER
TRANSVERSE
EXTENSION Y OF
ARCH
STOP ORTHOSIS STRENGT
WEAKNESS
H IS
EXPECTE
D

BOUTONN
PROXIMAL
BLOCKS IERE OR
INTERPHALANG
EXAGGERATED SWAN
EAL JOINT
DISPLACEMENT NECK
ORTHOSIS
OF THE JOINTS DEFORMI
(PIPO)
TY

Wrist-hand orthoses (WHOs):

 Resting WHOs preserve wrist and hand architecture by positioning
the wrist and hand in functional alignment with the thumb
abducted and flexed.
 Dynamic WHOs protect and assist weak wrist extensors by
transferring power from active wrist extension into finger flexion
by utilizing tenodesis.
  Dynamic dorsal WHOs for radial nerve injuries position the hand
with wrist and MCP in extension.1
Elbow orthoses (EOs):
 EOs address functional limitations caused by soft tissue
contractures at the elbow. O
 EOs are used after surgery or trauma for limb stabilization instead
of casting. These can be static or dynamic
 Functionally, dynamic EOs are commonly used for assistance with
elbow flexion in patients with weak elbow flexors.1
 Static elbow-wrist-hand orthoses (EWHOs) are used for fractures
such as those involving the radius/olecranon and distal humerus.
Shoulder-elbow orthoses (SEO):
 SEO supports the shoulder to reduce pain and/or provide position
due to muscle weakness, e.g., brachial plexus injuries or shoulder
subluxation after stroke.
 A mobile arm support SEO (MAS-SEO) is used in severe arm
paralysis to improve limb function by supporting the weight of the
arm while assisting shoulder and elbow motion by reducing the
effects of gravity and are used in a seated position (often in a
wheelchair).
Shoulder-elbow-wrist orthoses (SEWO):
 SEWO are used post-operatively in rotator cuff and anterior-
posterior capsular repairs to relieve tension on the deltoid and
rotator cuff. SEWO externally rotate the glenohumeral joint and
stretch the shoulder internal rotators while protecting soft tissue
and preventing contractures.
Other upper limb orthoses:
 Typically, tone reduction orthoses are used to reduce flexor tone
in patients with significant spasticity. One example is a Bobath
finger spreader orthosis that uses digit abduction to decrease
finger flexor tone.
Lower Limb Orthoses
Ankle foot orthoses (AFOs):
 AFOs are commonly prescribed for weakness of ankle dorsiflexors,
plantar flexors, invertors, and evertors. AFOs improve gait
 deviations by taking advantage of ground reaction force, such as,
controlling the progression of the tibia over the ankle and limiting
knee flexion and/or extension during stance. An AFO can also
assist pre-swing phase toe off and foot clearance during swing
phase.
 Carbon fiber AFOs are effective for patients without abnormal
tone and neutral foot alignment with distal muscle weakness.
TYPE OF MECHANI INDICATION
ORTHOSIS SM S

METAL
AFO THAT
CAN
CONTROL FLUCTUATI
ANKLE NG EDEMA;
DOUBLE MOVEME INSENSATE
UP RIGHT NTS WITH FEET AT
AFO PINS AND RISK FOR
SPRINGS PRESSURE
(SEE WOUNDS
BELOW
FOR
DETAILS)

PRESSURE
POINT AT
THE
ANTERIO ANKLE
R TIBIA INSTABILIT
SEMI- CAN Y OR FOOT
RIGID ASSIST DROP;
PLASTIC WITH EXTENSOR
AFO KNEE TONE IN
EXTENSIO PEDIATRIC
N DURING PATIENTS,
THE MID-
STANCE
PHASE

POSTERIO ALLOWS DORSIFLEXI

R LEAF SOME ON ASSIST
SPRING MEDIO-
AFO LATERAL
ANKLE
MOVEME
 NTS AND
PROVIDES
FOOT
CLEARAN
CE
DURING
THE
SWING
PHASE

LIMITS
ANKLE
MOVEME
NTS
(INCLUDI
NG
LIMITING
SEVERE
MEDIO-
TONE/SPAST
RIGID LATERAL
ICITY WHEN
PLASTIC CONTROL
IMMOBILIZA
AFO ) AND
TION IS
ASSISTS
NEEDED
WITH
ANKLE
CONTROL
DURING
THE
SWING
PHASE

FOR
CROUCHED
GAIT, A
CAN SET
SOLID AFO
TO THE
IN PLANTAR
DESIRED
ARTICUL FLEXION
RANGE OF
ATED/ WITH
ANKLE
HINGED DORSIFLEXI
DORSIFLE
AFO ON STOP
XION OR
CAN HELP
PLANTAR
KNEE
FLEXION
EXTENSION
DURING THE
STANCE.

OFF THE LIGHT ASSIST

SHELF WEIGHT, WITH
CARBON LOWER DORSIFLEXI
 ON
PROFILE,
WEAKNESS
CAN
AND GIVE
FIBER PROVIDE
MINIMAL
AFO DYNAMIC
PLANTARFL
RESPONS
EXION
E
ASSIST

AFOs with metal upright(s) are less common than plastic AFOs.
However, some patients (such as those with morbid obesity or edema)
may benefit from a metal AFO.
The construction of a hinged AFO with ankle joints with channels allows
for a greater control of gait. The following table explains the ankle joint
motion control with pins (stop) or springs.
Permutations for articulated/hinged AFO
ANT
POST
ERIO
ERIO
R MECHANIS INDICATIO
R
CHA M NS
CHA
NNE
NNEL
L

DORSIFLEXI
ON STOP.
ASSISTS
WITH PRE-
SWING AND
WEAK
THE KNEE
ANKLE
EXTENSION.
PLANTAR
ANTERIOR
FLEXORS
PIN/ STOP SET
FREE AND/OR
STOP AT 5
WEAK
DEGREES
KNEE
CAN MIMIC
EXTENSOR
THE
S
FUNCTION
OF
GASTROCN
EMIUS/
SOLEUS

FREE PIN/ A PLANTAR FACILITAT

STOP FLEXION ES
STOP AT 90 DORSIFLEX
 ION
MOMENT
DEGREES
AND
OR AT
PROVIDES
NEUTRAL
PLANTAR
PRODUCES
FLEXION
A FLEXION
STOP; USED
MOMENT
FOR
AT THE
SPASTICIT
KNEE
Y OR
DURING
PLANTAR
HEEL
FLEXION
STRIKE
CONTRACT
URES

DORSIFLEXI
ON ASSIST.
MIMICS
CONCENTRI
C
CONTRACTI
SPRI ON OF FLACCID
FREE
NG DORSIFLEX FOOT DROP
ORS.
MINIMIZES
PLANTAR
FLEXION AT
HEEL
STRIKE

Knee ankle foot orthoses (KAFOs):

 KAFOs extend the AFO to control the knee. Quadriceps weakness
below antigravity strength or knee hyperextension not controlled
by an AFO are indications for a KAFO.
TYPE OF GOALS/
KNEE MECHANISM INDICATIO
JOINT NS

STRAIG ALLOWS FREE PREVENTS

HT FLEXION BUT KNEE
KNEE PREVENTS HYPEREXT
JOINT KNEE ENSION
HYPEREXTENSI AND
ON. CAN BE PROVIDES
USED WITH MEDIAL-
VARIOUS KNEE LATERAL
 STABILITY
WITH
LOCKING
LOCKS FOR MECHANIS
SPECIFIC M
INDICATIONS/F PROVIDES
UNCTIONS KNEE
EXTENSOR/
FLEXOR
STABILITY

DOUBLE AXIS
SYSTEM,
CLOSER
APPROXIMATIO  TO ALLOW
POLYCE
N OF THE KNEE TO
NTRIC
NORMAL KNEE FLEX IN
KNEE
KINEMATICS SWING
JOINT
THAT PHASE
INCLUDES
FEMORAL
ROLLBACK

ALLOWS FREE FOR WEAK

FLEXION AND KNEE
EXTENSION OF EXTENSOR
THE KNEE S AND
DURING THE WITH SOME
POSTERI SWING PHASE. HIP
OR THE CENTER OF EXTENSOR
OFFSET GRAVITY IS STRENGTH
KNEE POSTERIOR TO USE WITH
JOINT THE KNEE AT AN ANKLE
THE HEEL JOINT THAT
STRIKE HELPS IS LIMITED
CREATING IN
KNEE FLEXION DORSIFLEX
MOMENT ION. 3

In order to stabilize the knee, one of four locks can be used at the knee –
cam lock, bail lock, ratchet lock, and drop lock. The most common is the
Ratchet lock with 12 degree increments built into the joint. A lever
allows for the knee to be released for flexion and to allow sitting.
Knee orthoses (KO):
 KO provide support or control of the knee joint. KO can limit
motion in the sagittal, axial, or coronal planes. Generally KOs are
 prescribed to prevent knee hyperextension and provide
mediolateral stability.4Flexible KOs are made from elastic or
rubber, and mostly provide comfort, proprioceptive feedback,
mechanical support, and stabilization of patellar tracking.
TYPE
OF GOALS/
MECHANISM
ORTH INDICATIONS
OSIS

MADE FROM
FLEXIBLE
MATERIAL;
PROVIDES
PROPRIOCEP
KNEE PAIN
FLEXI TIVE
PATELLOFEM
BLE FEEDBACK,
ORAL
KO MECHANICA
INSTABILITY
L SUPPORT
AND
STABILIZE
PATELLAR
TRACKING

CONTROLS
KNEE OSTEOARTH
SWEDI HYPEREXTE RITIS, GENU
SH NSION VARUS,
KNEE WHILE FLEXIBLE
CAGE PERMITS GENU
FULL VALGUM
FLEXION

PROVIDES A
FRONTAL
PLANE
THRUST
RIGID AND OSTEOARTH
KO UNLOAD RITIS
THE
AFFECTED
COMPARTM
ENT

Hip orthoses (HOs):

 HO are indicated for isolated acetabular region problems and are
commonly used for post-operative care, hip dislocation,
 dysplasia, and injury.1 Fracture bypass orthoses also can be used
post fracture.
Hip-knee-ankle-foot orthoses (HKAFOs):
 HKAFO are typically used in patients with spinal cord injury to
stabilize the entire lower limb in order to stand and walk with
assistive devices.
 Reciprocal gait orthoses (RGO) are a type of bilateral HKAFO with a
set of cables or a rocker bar linking the legs together to couple hip
flexion with opposite side hip extension in order to create a
reciprocal gait pattern.1 Successful RGO use requires antigravity
hip flexion strength but attainment is limited as they are heavy,
bulky, and with high energy expenditure.
Other lower limb orthoses
 Stretching AFO, KO, and KAFO are dynamic orthoses that can be
utilized to improve range of motion by applying a constant, low-
load, passive stretch. Static progressive stretch orthoses are set
just beyond the current range of motion to improve range of
motion or prevent further contractures but compliance can be
difficult due to the need for prolonged wearing time.6
 An off the shelf ankle brace with air cell is a semi-rigid shell ankle
orthosis with air cells on both sides of the ankle that is worn in a
shoe in order to support ankle instability after ankle sprains. It has
shown to improve ankle joint function in ankle sprains.
Foot Orthoses and Therapeutic Footwear
Foot orthoses (FOs)
 FOs are used as the foundation for other lower limb orthoses or
can be used alone. FO align and support the foot and prevent,
correct, or accommodate foot deformity, or improve the overall
function of the foot. FOs are commonly used with therapeutic
shoes which should be properly fitted and have adequate room
for the foot to expand during weight bearing.1
 Supramalleolar orthoses (SMO) are used primarily in pediatric
patients with hypotonia and those with flexible foot pronation.
 Leg length discrepancies less than 2cm without symptoms
typically do not require correction. The total leg length
discrepancy is never corrected; at most, 75% of the discrepancy
 should be corrected. Only 1cm lift can fit in a shoe. For shoe lifts
that need more than 1cm, the patient would need a custom built
shoe with a shoe lift or would need to get an external shoe lift.
Therapeutic Footwear
 Both internal and external shoe modifications can be made to the
sole or body of the shoe. Heel and internal sole excavation can
relieve pain or ulcers over bony prominences. Pad placement
provides arch support or relieves pressure; heel and lateral
wedges promote appropriate foot positioning or alignment. Bars
on the soles of shoes can be placed to assist with weakness,
relieve pressure, transfer load, or promote dorsi or plantar flexion.
 Heel flares widen the base and support with different heel
material providing cushioning, stability, positioning, and arch
support.11
 High top shoes or boots can provide ankle stability in patients
with mild ankle instability or mild foot drop, especially in young
patients.