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  1. 1. Orthosis
  2. 2. Orthosis  Definition: Orthosis is an orthopedic appliance or apparatus used to support, align, prevent, or correct deformities or to improve function of movable parts of the body.  Purpose: 1. To lend stability to a weak joint. 2. Correct or maintain alignment. 3. Correct skeletal deformities, etc.
  3. 3. Principles in designing orthosis  Three point pressure.  Total contact.  Partial weight relieving.
  4. 4. Three point pressure  "The sum of the forces and the bending moments created is equal to zero.“  A single force is placed at the area of deformity; two additional counter forces act in the opposing direction.  During "quiet" standing, line of gravity (weight line) passes through: ◦ posterior to hip joint ◦ anterior to knee joint and ◦ anterior to ankle joint
  5. 5. Total contact  “Pressure is equal to the total force per unit area. “  The greater the area of a pad of an orthosis, the less force will be placed on the skin.  P = force Area of application
  6. 6. Partial weight relieving  “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.”  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.
  7. 7. Types of orthosis  Upper limb orthosis.  Lower limb orthosis.
  8. 8. Lower limb orthosis  Purpose: For supporting lower limbs.  Materials used: ◦ Plastic (recently in demand). e.g. polypropylene, polyethylene. ◦ Metal: aluminum-light weight, stainless steel, etc.
  9. 9. Materials used  Metal ◦ Traditional orthosis were made from metal. ◦ Metals like aluminum-light wt, stainless steel-durable.  Plastic ◦ Plastic orthosis are formed from a single piece of thermoplastic. ◦ Plastic components like polypropylene, polyethylene.
  10. 10. Types of lower limb orthosis  Ankle foot orthosis (AFO)  Knee ankle foot orthosis (KAFO)  Knee orthosis (KO)  Hip knee ankle foot orthosis (HKAFO)  Hip orthosis (HO)
  11. 11. AFO  Ankle-foot orthosis is a brace, usually plastic, worn on the lower leg and foot to support the ankle, hold the foot and ankle in the correct position, and correct foot drop.  Purpose: ◦ To control alignment and motion of the joints of foot and ankle. ◦ For patients affected with muscular dystrophy, cerebral palsy, etc.  Construction: ◦ Consists of a shoe attachment, ankle control, uprights and a proximal leg band.
  12. 12.  Parts: ◦ Calf bands ◦ Metal uprights ◦ Ankle joint ◦ Shoe attachments ◦ Stirrup Calf band Metal upright Ankle joint Shoe attachments Stirrup
  13. 13. Types of AFO  Dorsiflexion assist AFO: ◦ In case of moderate foot drop.  Plantar flexion assist AFO:  Posterior leaf spring AFO:  Patellar tendon bearing AFO:  Spiral AFO:  Solid AFO: ◦ In case of severe foot drop.
  14. 14. Knee Ankle Foot Orthosis (KAFO)  A KAFO is a long-leg orthosis that spans the knee, the ankle, and the foot in an effort to stabilize the joints and assist the muscles of the leg.  Material for fabrication: metals, plastics, fabrics, and leather.
  15. 15. Parts Hip joints and locks  Controls for abduction, adduction and rotation.  Controls for hip flexion when locked.  2 position hip locks are also available.  Pelvic band  To stabilize the hip joint.  There are two types unilateral pelvic band and bilateral pelvic band.  It adds weight and increases overall energy expenditure during ambulation.
  16. 16. Types of KAFO  Supracondylar plastic orthosis.  Scott-Craig orthosis.
  17. 17. Knee orthosis  A knee orthosis (KO) extends above and below the knee joint.  Design to control the ligament deficiencies around the knee.  Provide functional support and rehabilitation after injury & surgery of the knee.  Parts:  Double uprights  Free or adjustable knee joint  Thigh and calf cuffs
  18. 18. Types of knee orthosis  Dynamic patellar orthosis:  It consist of an elastic sleeve with patellar cutout.  Its purpose is to prevent the dislocation of patella.  Traditional knee orthosis  It consists of leather thigh, calf cuffs and metal side bars.  Pressure pad may be applied to generate medial or lateral forces.  Swedish knee cage  It used in the management of knee hyperextension.  Two anterior pads and adjustable posterior pressure pad at the attachment to the upright .
  19. 19. Types of knee joints  Free motion knee joint: allows unrestricted flexion & extension.  Off-set knee joint: the hinge is located posterior to the knee joint stabilize knee during stance.
  20. 20. Hip Knee Ankle Foot Orthosis (HKAFO)  Hip joint and pelvic band attached to the lateral upright of a KAFO converts it to a HKAFO.  Purpose: ◦ Hip flexion/extension instability ◦ Hip adduction/abduction weakness ◦ Hip internal rotation/external rotation instability
  21. 21.  Parts: ◦ Sole plate extending to the metatarsal heads with a crossbar added to the metatarsal heads area for mediolateral stabilization. ◦ Ankle joint set at 10° of dorsiflexion ◦ Anterior rigid tibial band (patellar tendon strap) ◦ Offset knee joint with bail lock ◦ Proximal posterior thigh band
  22. 22. Types of HKAFO  Reciprocal Gait Orthosis (RGO)  It is used for upper lumbar paralysis in which active hip flexion is preserved.  RGO consists of bilateral HKAFO with offset knee joints, knee drop locks, posterior plastic AFO, thigh pieces, custom molded pelvic girdle, hip joints, and a thoracic extension with Velcro® straps, in addition to the control mechanism
  23. 23. Hip orthosis  Purpose: ◦ To resist femoral adduction. ◦ Mostly in elderly patients who have had total hip joint replacement.  Parts: ◦ Two position lock which permits full extension and 95 degree of hip flexion and adjustable adduction stop.