Orthotics, Prosthetics and Assistive devices.

Question	Answer
What muscles should be strengthened if long term ambulatory aids are to be used	shoulder depressors including lower trap, pectoralis major and latissimus dorsi
Three point gait	both assistive devices and the involved leg are advanced together then the uninvolved leg
two-point gait	one assistive device and the opposite extremity move together followed by the other assistive device and extremity
Four point gait	slow gait pattern one assistive device advances forward and placed on floor then advancement of opposite leg repeat for the other side- maximum stability
swing to gait	assistive devices are advanced forward together then the legs are swung forward to meet the assistive devices
swing through gait	assistive devices are advanced forward together then the legs are swung forward beyond the assistive device-not as safe as swing to and can only be done using crutches
Which assistive devices can be used for stair ascending/descending	crutches or small based canes
When in a wheelchair when are pressure relief push ups done	every 15-20 minutes or 3-4 times per hour
When are elevating leg rest contraindicated	patients with knee flexor hypertonicity
When is a tilt in space wheelchair indicated	for patients with trunk extensor spasms or pressure relief
When using a Body Weight Support System(BWS) without a treadmill what is the initial % of weight supported	40% body weight progression is to decrease by 10% increments until there is no support BWS>55% is contraindicated as it interferes with achieving foot flat during stepping
Three-point principle with orthotics	single force is placed at the area of deformity or angulation with two additional counter forces applied in opposite direction above and below the deformity
Heel insert FO	heel spurs and plantar fasciitis
Scaphoid pad FO	supports longitudinal arch used for pes plantus-flatfoot
Semirigid plastic insert FO	applies medial or lateral force to calcaneus used for subtalar (rear foot) eversion or inversion abnormalities
Metatarsal pad FO	takes pressure off metatarsal heads used for metatarsalgia (metatarsal pain)
Metatarsal Bar FO	flat strip of leather or plastic placed posterior to the metatarsal heads used for metatarsalgia (metatarsal pain)
Thomas or medial heel wedge FO	used for pronation and flexible pes valgus (flat foot-arch is present when non-weight bearing and gone when weight bearing)
Lateral heel wedge FO	used for excessive pes varus (supination) or genu varum (bow legged)
Medial/Lateral SOLE wedges FO	used for fixed lateral forefoot valgus or varus problems
Rocker bar FO	builds up soles allows more push off in weak or inflexible feet used for metatarsalgia and with weak plantarflexion
Solid AFO	limits all foot and ankle motion used for severe pain or instability
Metal posterior stop AFO	limits plantarflexion used to correct for knee recurvatum in stance and toe drag during swing phase of gait
Metal anterior stop AFO	limits dorsiflexion used to prevent knee buckling or excessive knee flexion during early stance
Posterior leaf spring AFO	dorsiflexion assistance from a plastic insert that lifts the foot during swing phase used for weak dorsiflexors
Dorsiflexion spring assist AFO	not appropriate if spasticity is a factor
What does a valgus correction strap do	it is attached to the medial portion of shoe exerting a lateral force to restrain pronation it controls the subtalar or rear foot
What does a varus correction strap do	it is attached to the lateral portion of the shoe exerting a medial force restraining supination or the rear foot
Which type of AFO molded or conventional allows for volume change of the lower leg	conventional AFO
Offset joints in KAFO	hinge is placed posterior to the midline of the leg assists in knee extension contraindicated with knee flexion contractures
Drop ring lock KAFO	MOST COMMON KNEE CONTROL locks the knee in extension
Craig-Scott KAFO	commonly used for individuals with papraplegia (T9-12 lesions)
Reciprocating gait orthosis (RGO) THKAFO	used for patients with T9-12 level of spinal cord lesion or spina bifida lesion usually with children
ParaWalker THKAFO	limit hip flexion and resist hip ABD/ADD used for patients with lower throracic spinal cord lesions
Toronto hip/Scottish Rite HO	used for Legg-Calve' Perthes disease (avascular necrosis of the hip) affected hip is held in ABD and IR
scoliosis orthoses	used to prevent the lateral curve from increasing
milwalkee orthoses- scoliosis	used for scoliotic curves of 40 degrees or less
Boston orthoses-scoliosis	can be worn under clothes used for scoliotic curves of 40 degrees or less to treat spondylolisthesis (anterior slip) and conditions of severe trunk weakness
At what level would a wrist driven tenodesis orthosis be used	facilitates tenodesis grasp in patients with quadraplegia at C6 level
Transmetatarsal amputation	through the midsection of all metatarsals
Syme's amputation	ankle disarticulation with attachment of the heel pad to the distal end of the tibia for weight bearing
Transtibial (Below the knee) amputation	long BTK more than 50% of tibia is left standard BTK 20-50% tibia is left short BTK less than 20 % is left
Knee disarticulation	amputation through the knee with the femur intact
Transfemoral (Above the knee) amputation	long AKA more than 60% of femur is left ideal AKA 35-60% of femur short AKA less than 35% of femur left
Hip disarticulation	amputation through the hip jt pelvis intact
Hemipelvectomy	resection of the lower half of the pelvis
Hemicorporectomy	amputation of both lower limbs and the pelvis below the L-4, L-5 level
Wrist disarticulation	amputation through the wrist jt
Transradial	Below the Elbow (BE) amputation
Elbow disarticulation	amputation through the elbow
Transhumeral	Above elbow (AE) amputation
Shoulder disarticulation	amputation through the shoulder
Post-op amputation dressing- ridgid	immediate limits residual limb edema does not allow for daily wound inspection and dressing changes
post-op amputation dressing - soft	inexpensive elastic wrap and elastic shrinker poor control of edema
post-op temp prosthesis	can be fitted as soon as the wound is healed shrinks residual limb more effectively allows for early ambulation normally used for younger candidates whose amputation was not a result of vascular disease
What are the components of a prosthetic	socket and terminal device
prosthetic socket	custom molded to the residual limb with total contact and full load distribution with the goals of assisting circulation and providing maximum sensory feedback
prosthetic sock	provide soft interface between the residual limb and socket used to accommodate for changing residual limb volume should not exceed 15 ply thickness for proper fit and weight bearing of the socket
prosthetic terminal device	functions to provide an interface between the prosthesis and the external environment for LE prosthesis it is the foot for UE prosthesis it is the hook/hand
partial foot prostheses	needed more for transmetatarsal amputation
what does a Below-Knee prostheses consist of	foot-ankle assembly, shank, socket, and suspension
foot ankle assembly for BKA	absorbs shock at heel strike, PF in early stance
What are some non-articulated feet	SACH foot (Solid Ankle Cushion Heel) SAFE foot (Stationary attachment flexible endoskeleton) Seattle foot Fex-foot (Springlite foot)
SACH foot	MOST COMMON FOOT-non articulating, variety of cosmetic colors to match skin, durable, easy to use, rollover at terminal stance -cushion heel permits PF in early stance and allows for a small amount of mediolateral and transverse motion -can make many si
SAFE foot	-a version of SACH foot -allows for walking on moderately uneven terrain because of the greater range of mediolateral motion permitted in the rear-foot -active individuals -disadvantage: heavier than SACH foot
Seattle foot	-slightly flexible plastic keel bends at heel contact -keel stores energy and recoils in latte stance releasing energy for springy termination to stance -disadvantage: heavier than SACH foot
Flex-Foot	-includes a long band of carbon fiber material, which extends from the toe to the proximal shank and to the posterior heel section -the long bands acts as a leaf spring, enabling the foot to store energy in early and mid stance and the release it in late
What are some articulated feet	single-axis foot multi-axis foot
single-axis foot	MOST COMMON articulating foot that permits PF and DF, as well as toe break action -does not allow mediolateral or transverse motion -may be prescribed for individuals with bilateral transfemoral amputations -disadvantage: permits PF and DF only, limite
multi-axis foot	has components that move slightly in all planes to aid the patient in walking on uneven terrain and slopes -disadvantage: heavier and less durable than single-axis or non-articulated feet
Shank	-provides leg length and shape -transmits weight from socket to foot -exoskeletal-usually made of wood with a plastic laminate finish that can be colored to match the skin-very durable -endoskeletal-central aluminum or rigid plastic pylon covered with
Socket	patellar-tendon bearing (PTB) -total contact socket that allows for maximum distribution of the load and assistance in venous blood circulation -provides tactile feedback
Socket Reliefs	-reliefs are concavitites over PRESSURE SENSITIVE AREAs of the transtibial residual limb such a she anterior tibia, anterior tibial crest, fibular head and neck, and peroneal (fibular) nerve
Socket built-ups	are convexities over PRESSURE TOLERANT AREAs such as patellar tendon, medial tibial plateau, tibial and fibular shafts and distal end of tibia
Suspension	used to hold the socket onto the residual limb when non-weight bearing is occuring ex: swing phase
What types of suspension are there	-supracondylar suspension (SC) -Supracondylar/suprapatellar suspension (SC/SP) -Thigh corset suspension
Supracondylar suspension (SC)	-medial and lateral walls of the socket extend up and cover the femoral condyles -a removable medial wedge is placed between the socket and the medial epicondyle -more cosmetic with no buckles and increases mediolateral stability
Supracodylar/Suprapatellar suspension (SC/SP)	-similar to the SC with the addition of an anterior wall, which terminates above the patella -used for SHORT RESIDUAL LIMBS -may interfere with kneeling and is very visible when sitting
Thigh corset suspension	-has metal hinges attached distally to the medial and lateral aspects of the socket and proximally to a leather corset that may be as high as the ischial tuberosity -it provides a larger area for weight bearing -prescribed for individuals with SENSITIVE
what does an Above Knee prostheses (AK) consist of	-consist of foot-ankle assemble, shank, knee unit, socket, and suspension device
what type of knee unit AK prostheses are there	-enables to bend the knee when sitting and during ambulation -single axis -polycentric system (multiaxial) -friction mechanism -hydraulic knee units
Single-axis knee unit	permits knee motion around a fixed axis -knee flexion is needed during late stance and swing phase -knee locks in extension for heel strike and foot flat
Polycentric system knee unit	-allows for adjustment to the center of knee rotation -more stable -less used because of the greater complexity and other means to stabilize knee
Friction mechanism knee unit	-change the knee swing by modifying the speed of knee motion, providing resistance to pendulum motion at the knee -the most popular is the constant friction unit which has a clamp that can vary the friction easily -usually for older individuals who do n
Hydraulic knee units	-fluid controlled/pneumatic knee units (air controlled) -adjust to the individual's walking speed and vary the resistance accordingly -for younger more active individuals -heavier, more complicated, require increased maintenance and have higher costs t
extension aids	-many knee units have a mechanism to assist knee extension during the latter part of swing phase -elastic webbing located in front of the knee unit stretches during knee flexion (early swing)and recoils to extend the knee(late swing) -an internal exten
mechanical stabilizer	-most knee units do not have a device to increase stability -the prosthetic knee is aligned posterior to a line extending from the trochanter to the ankle assisting in maintaing knee extension -a manual lock is a pin that limits knee flexion and is rele
Socket AK	-designed to be a total contact device that emphasizes loading on PRESSURE TOLERANT structures such as the ischial tuberosity, gluteal muscles, lateral side of the thigh and to a lesser extent the distal end of the amputation -it limits the load on the P
Quadrilateral socket AK	-MOST COMMONLY USED FOR AKA -uses a horizontal posterior shelf to support the ischial tuberosity and gluteals -the medial wall is the SAME height as the posterior wall while the anterior and lateral walls are 2.5-3" higher -reliefs are provided for th
What types of suspension are there for an AKA	-suction -silesian bandage -metal pelvic band
Suction suspension for AK	-employed to maximize contact and suspension -air is pumped out a one way valve during weight bearing -the individual wears a sock -suction can be partial or total
Silesian bandage suspension for AK	-a strap that anchors the prosthesis by reaching around the pelvis -controls for rotation
Metal pelvic band suspension for AK	-Includes a hinged hip joint attached to a leather/metal band anchored around the pelvis -adds control for rotation, hip ADD/ABD -REDUCES TRENDELENBURG GAIT -adds extra weight