Orthotics and prosthetics

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Orthotics and prosthetics
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LE Prosthetics

• Residual limb shaping issues
• Weight bearing problems
• Use of stockings or socks
• Will they use it?
• Balance problems
• How hard is it to don/doff
• endoskeleton/exoskeleton

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Cosmetic replacement minimal functional use but
excellent appearancematched to skin color
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Myoelectric - use intact proximal muscles to give
electromyographic signals to move terminal device
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body powered use cables and harness to move
terminal device by more proximal muscle movements
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Hybrid systems - combination of body powered and
myoelectric
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Terminal devices

• Voluntary opening hook or hand
• each rubber band gives 1 lb. force
• Voluntary closing hook or hand
• Cosmetic glove
• Passive hook
• Otto Bock

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Remember...

• Skin should be unremarkable without irritation 10
  minutes after removal
• Initial wearing time on new prosthesis 20-30
  minutes
• if no redness which does not subside in 10
  minutes, increase wearing time by 30 minutes per
  day.
• gradually increase wear time to develop tissue
  strength
• wash limb daily
• wear sock over residual limb

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Terminal device operation

• Wrist flexion/extension

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Supination/pronation

• Add thin washers to adjust sup/pro
• Small allen screw adjusts tension on sup/pro

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Shoulder harness

• Northwestern ring goes slightly toward uninvolved
  side of back
• Prosthesis is on this side

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AFO - Ankle foot orthosis
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AFO - Ankle foot orthosis

• used to limit or assist in dorsiflexion or
  plantarflexion
• prevent mediolateral motion
• can be used to prevent or correct deformities or
  contractures
• when ankle component in plantarflexion, extension
  moment created in knee
• when ankle in dorsiflexion, flexion moment in
  knee
• reduce energy expenditure during gait

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AFOs used on those with...

• CP
• foot drop
• peripheral neuropathy
• spastic hemiplegia
• polio
• MS
• TBI

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Pressure Relieving AFO
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Knee Stabilizing Orthoses
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KAFO - knee ankle foot orthosis

• Same as AFO component to thigh to limit knee
  motion
• Used for pts with paralysis or weakness in ankle
  and knee
• Used to prevent genu recurvatum, genu varum (bow
  leg), or valgus (knock knee)
• Difficult to don/doff

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Thoracolumbosacral orthosis

• Used to stabilize trunk and prevent scoliosis.
• Reduce compression on intervertebral
• reduces LBP
• S/P Scoliosis surgery usually worn 3 months
• Thoracolumbosacral flexion-extension control
  orthosis - prevents excess flex/ext
• Thoracolumbosacral flexion-extension-lateral
  control - restricts flex/ext/lateral bending