Orthosis The aim of orthotics is to increase the efficiency of function during acute or long-term injury. This includes soft-tissue and bony injury, as well as changes as a result of neurological changes. They can be an effective adjunct alongside physiotherapy techniques such as muscle strengthening and stretches, gait and balance retraining and reach and grasp strategies. Definition :An orthosis is generally an individually designed or customised device, which is applied to the external part of the body to provide support and protection for that particular area of the body. It uses integrates biomechanical principles to realign joints and reduce pain. The design, materials and function of the orthosis are based on a patient assessment, including their medical history, biomechanical principles and the individual needs of the user. Commonly prescribed orthoses include: Foot Orthoses (FOs), for various foot, leg or postural problems; there is significant variety in terms of their design and manufacturing methods[1][2] Ankle Orthoses (AOs) and Knee Orthoses (KOs), for joint protection, pain reduction or support after surgery Ankle-Foot Orthoses (AFOs) and Knee-Ankle-Foot Orthoses (KAFOs), to improve mobility, support rehabilitation and biomechanical goals Various upper-limb orthoses, to provide positional and functional support to the upper limb Fracture orthoses, modern alternative to plaster or fibreglass casts Spinal Orthoses, to correct or control spinal deformities and injuries and to provide immobilisation or support to spinal injuries Advantages Lower limb: Influence both swing and stance phase of gait[10]. Prevent or correct deformity and reduce pain during weight-bearing Improve the efficiency of gait and maintain balance Improve base of support / lateral support Reduce need for compensation of ipsilateral and contralateral limbs and secondary pain To facilitate training in skills Upper limbs: Can be used after an injury to prevent further injury, or reduce pain by supporting an injured limb. Prevent or correct deformity reducing pain and maximising function in reach and grasp tasks. Improve the efficiency of reach and grasp tasks Offload an injured limb to allow healing Reduce need for compensation of ipsilateral and contralateral limbs and secondary pain Improve role of the upper limb in maintaining balance Spine: Stabilise spinal fractures to allow the patient to return to some normal activities (although they may be restricted) and protect the spinal cord And It's Principles Classification of Orthosis Types Of Orthosis Upper Limb Orthosis Spinal Orthosis Lower Limb Orthosis Possible Complications Loss of sensation (check skin regularly- risk of pressure areas) Compensations in ipsilateral or contralateral limbs. Impact on spasticity (is the patient utilising spasticity to allow some function in absence of muscle strength?) Complications of casting at incorrect angle: Foot deformitie, increased knee flexion in stanc

1. By
Rebin K Raji
4th Year Bpt

2. An Orthosis (Orthotic) is an orthopedic
appliance or apparatus used to support, align, prevent, or
correct deformities or to improve function of movable parts
of the body.
The word Orthosis is derived from Ortho , meaning Straight.
Brace: is a device that corrects irrigularities.
Splint: usually used after surgry and does not allow
for movement.
The Orthotist is the person who designs, fabricates and
repair the
orthotic device.
An Orthosis (Orthotic) is an orthopedic
appliance or apparatus used to support, align, prevent, or
correct deformities or to improve function of movable parts of
the body.
The word Orthosis is derived from Ortho , meaning Straight.
Brace: is a device that corrects irrigularities.
Splint: usually used after surgry and does not allow
for movement.
The Orthotist is the person who designs, fabricates and
repair the
orthotic device.

3. Indications for recommending
orthotic devices:

To relief pain.

To limit motion,

immobilization after surgery

immobilization after traumatic injury

Compression fracture management

Kinesthetic reminder to avoid certain movements.

To correct deformity e.g. Scoliosis management

To relieve symptoms of a disease by supporting or
assisting the musculo-neuro-skeletal system.

To reduce axial loading, mechanical unloading

To improve function in a certain segment of the
body.

4. 
To Assist and improve movement and
function.

To reduce muscle tone.

To protect against injury.

To povide proprioceptive feedback.

To Provide rest to the body part.

To Assist and improve movement and
function.

To reduce muscle tone.

To protect against injury.

To povide proprioceptive feedback.

To Provide rest to the body part.

5. Design characteristics of an orthotic
device:
Most important features include the following:

Weight of the orthosis

Adjustability

Functional use

Cosmoses

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 moisture

6. Effects of the orthosis may lead to:

Decrease pain

Increase strength

Improve function

Increase proprioception

Improve posture

Correct of spinal curve deformity

Protect against spinal instability

Minimize complications

Assist healing of ligaments and bones

7. Duration of orthotic use:

It is determined by the individual situation.

In situations where instability is not an issue, recommend
use of an orthosis until the patient can tolerate discomfort
without the brace.

When used for stabilization after surgery or acute fractures,
allow 6-12 weeks to permit ligaments and bones to heal.

8. Associated drawbacks of the use of an
orthotic device:

Discomfort

Local pain

Skin breakdown

Nerve compression

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

Poor patient compliance

9. Principles and consideration for orthoses:
Orthosis should :

provide support and stability to the hip, knee and ankle joints.

be designed to permit safe and effective ambulation by patients.

Provide the need and requirements of the patient to support or to mobilize.

Correlate to the findings of tests & measurements.

Correlate with pateint personality and the impact of device upon him.

Prevent the development of deformity and require modifications in design.

Orthosis is only one component of the treatment and is not the whole
treatment.

Conserve the time and energy of the patient.

The materials used should be light, sturdy and resistance to wear.

It should meet the functional requirements of the client.
So each client should be evaluated individually.

10. Role of physical therapist

Identify functional problems of the patient.

Determine orthotic needs.

Prescribe the orthoses according to each patient
problems and requirements.

Evaluate orthotic adequacy.

Teach the patient to don and doff the orthoses.

Train the patient for proper use of the orthoses.

11. Orthosis should be simple and durable as
possible.

Patient should be taught for:

Cleaning the leather.

Oiling the joints.

Wash the orthosis if possible.
Maintenance of orthosis:

12. 
An orthosis can be constructed from
metal, plastic, leather, synthetic fabrics,
or any combination. Plastic materials,
such as thermosetting and
thermoplastics, are the materials most
commonly used in the orthotic industry.

13. General Types Of Orthoses

Temporarily orthoses: Used for certain time
after injury or operation.

Permanent orthoses: Used for ever when
there is muscle weakness, paralysis or
deformity cannot be corrected.

Static orthosis: does not allow movement.
Dynamic orthosis:allows movement.

14. Types of orthosis
Upper limb orthosis
Trunk
orthosis Lower limb orthosis

15. Upper limb orthotics are external devices that
are specifically designed to improve the
function and structure of various areas in the
upper limb. These can include braces, slings
and splints and are often made from
thermoplastics, casting and metal.

17. Hand Orthosis
There are various types of hand Orthoses, They Are:-
a) Static Orthosis
Static orthosis is stiff and holds
the specific part in a safe
position. It helps to stabilize and
support the injured part by
immobilizing and restricting
motion at a joint. It doesn't create
any over-pressure or stretch to
part it supports

18. Dynamic orthosis can be used to
increase motion and for
function.Dynamic orthosis that is
used for increasing motion works
by providing continuous stretch to
one direction and allows movement
in opposite direction.Dynamic
orthosis that is used for function
woks by allowing movement at
specific part of the hand. It supports
the part of hand through allowing
motion that may be lost due to
injury, surgery or various other
condition
b) Dynamic Orthosis

19. These orthotics encompass the
forearm and the palm. They are
primarily used to support weak
muscles and/or immobilize or limit
the motion of the wrist while allowing
the fingers to move. These devices
may be suitable for individuals with:
Osteoarthritis.
Wrist Orthosis (WO)

20. An elbow orthosis is a custom-
molded or prefabricated plastic
shell that provides support and
corrections to the elbow. Your
orthosis may have joints that can
be changed in order to increase
or decrease motion of your elbow
following surgery or during
rehabilitation.
Elbow Orthosis
(EO)

21. Shoulder Orthoses. Most
shoulder orthoses (SOs) are
intended to protect the
glenohumeral joint from
subluxation caused by flaccid
hemiplegia or injury to the
shoulder joint capsule. The
simplest and most widely used
SO is a sling.
Shoulder Orthosis (SO)

22. Wrist-Hand Orthosis (WH0)
These orthotics encompass the forearm and
the palm. They are primarily used to support
weak muscles and/or immobilize or limit the
motion of the wrist while allowing the fingers to
move.
These devices may be suitable for individuals
with:
Osteoarthritis
Rheumatoid arthritis
Carpal Tunnel Syndrome
Ligamentous injury to wrist
Radial nerve palsy

23. Elbow Wrist Hand Orthosis(EWHO)
These devices are often used to prevent loss of
range of motion across the elbow, wrist, and
hand. EWHOs may have joints at the elbow or
wrist to allow for adjustments.
These devices may be suitable for individuals
with:
Cerebral Palsy (CP)
Stroke
Multiple Sclerosis (MS)
Traumatic brain injury
Spinal cord injury
Conditions that require contracture management

24. Shoulder Elbow Orthosis (SEO)
SEOs support 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 through assisting
shoulder and elbow motion by
supporting the weight of the arm and
reducing the effects of gravity. These
devices are commonly used in a seated
position (often in a wheelchair)

25. Shoulder Elbow Wrist Hand
Orthosis (SEWHO)
SEWHOs are used post-
operatively in rotator cuff and
anterior-posterior capsular
repairs to relieve tension on the
deltoid and rotator cuff.
SEWOs externally rotate the
glenohumeral joint and stretch
the shoulder internal rotators
while protecting soft tissue and
preventing contractures.3

26. Lower limb orthotics are specialist external
devices that are be used in certain areas of the
lower limb to correct an abnormal alignment
Lower limb orthoses serve multiple purposes, such as
reducing pain in arthritic joints, improving gait, and
controlling abnormal movements. They can be
composed of a variety of materials such as plastics,
metal, and leather.

28. •
Footwear Adaptations -
Adaptations are made to either
compensate for a limb length
discrepancy (LLD) or to alter the
angles of the feet when walking.
•
Insoles - These are used to
help cushion the feet, reduce
high pressure areas or alter the
biomechanics of the feet are
abnormally shaped so do not fit
ordinary footwear.

29. Knee Braces
A knee brace is one tool in managing the discomfort of knee
osteoarthritis. A brace might help reduce pain by shifting your
weight off the most damaged portion of your knee. Wearing a
brace can improve your ability to get around and help you walk
farther comfortably.

30. Ankle Foot Orthosis (AFO)
Ankle-foot orthosis (AFO) is a commonly used orthosis in
patients having weakness in the ankle dorsiflexor or
plantarflexor muscles due to several disorders such as
stroke, cerebral palsy, spinal cord injury, and peripheral
nerve injury, also used in controlling foot drop Or Stabilising
an osteoarthritic ankle

31. Knee Ankle Foot Orthoses (KAFO)
A Knee Ankle Foot Orthosis (KAFO) is a long-leg orthosis that spans the
entire leg in an effort to stabilize the joints and assist the muscles of the leg.
While there are several common indications for such an Orthosis, muscle
weakness and paralysis of the leg are the ones most frequently identified.
The most common causes of muscle weakness and paralysis include:
Poliomyelitis
Muscular Dystrophy
Multiple Sclerosis
Spinal Cord Injury

32. Hip Knee Ankle Foot Orthosis
(HKAFO)
The HKAFO is a custom-molded
plastic shell with contoured metal
uprights and a pelvic band that
provides support and correction to the
hip, knee, ankle and foot. An HKAFO
improves body alignment and
posture, increases bone and muscle
strength, and enhances
independence and self-esteem.

33. The RGO is a custom-molded plastic shell with contoured
uprights and a special pelvic band with hip joints
interconnected by cables. The RGO provides support and
mobility to the hip, knee, ankle and foot. It improves body
alignment and posture, increases bone and muscle strength,
and enhances independence and self-esteem.
Reciprocating Gait Orthosis
(RGO)

34. A Spinal orthosis/Trunk Orthosis :-is an external aid that is used to
correct and support the spine. The spine is a complex anatomical
structure and is key to our function. It is not possible to treat all spinal
conditions with orthotics alone. However, a multidisciplinary team
approach that includes orthotists, surgeons, and physiotherapists and
considers the patient'sThey can be made from various materials, such
as rigid plastic or flexible elastic, depending on the condition and need.
They can be made to suit an individual needs perspectives can have
positive results. A thorough assessment, appropriate goal setting and
clear expectations will result in a well-designed and appropriate orthotic
device which is comfortable and functional and meets the user's needs
They can be made from various materials, such as rigid plastic or
flexible elastic, depending on the condition and need. They can be
made to suit an individual needs

35. How do trunk orthotics help?
Trunk orthotics have benefits including:
¬Compression and support
¬Some heat retention for therapeutic warmth
¬Rigidity to prevent movement
¬Flexibility to allow movement
¬Made to fit the individual

36. There are several conditions that can
respond well to trunk orthotics. These
include:
¬Strains and weakness of the abdominal
muscles
¬Post natal damage/weakness
¬Post surgical damage/weakness
¬Spinal conditions
¬Pregnancy
Who benefits from trunk orthotics?

37. 1)Cervical Orthosis
2)Cervical-Thoracic Orthosis (CTO)
3)Thoracic-lumbar Orthosis (TLO)
4)Lumbo-Sacral Orthosis (LSO)
5)Sacroiliac Orthosis (SIO)

38. Soft-
Collar
Hard-Collar
CERVICAL ORTHOSIS
Philadelphia-Collar
-Moderate Neck Pain
Neck Sprain
_
-Severe Neck Pain
Cervical Fracture
-Used In RTA Caused Cervical
Fracture

39. Sterno-occipital-mandibular-
immobilizer(SOMI)
4-poster Brace Halo-Device
CERVICAL-THORACIC ORTHOSIS (CTO)
-Used In Spinal
Fractures(Cervical-Thoracic
Region)
Used in Chronic cervical
pain and Rheumatoid
Arthritis (RA)
-Used In Case of Vertebral
Immoblization iis Needed.

40. THORACIC-LUMBAR ORTHOSIS (TLO)
Cruciform Anterior Spinal
Hyperextension (CASH) Brace
Used For Posture Correction,
Promote Healing After Surgery

41. Used in :- crushed fractures,
spondyloarthrosis, lumbo
sciatica,post op management of
lower vertebrae , cruciform
anterior spinal hyperextension
Jewett Hyperextension Brace

42. Used For Scoliosis
Correction & TB spine
Knight-Taylor Brace

43. Used In :- spinal fractures
and scoliosis
Custom-Molded Plastic Body Jacket
(Clamshell)

44. LUMBO-SACRAL
ORTHOSIS(LSO)
Rigid LSO
Used in SpinalFractures
(Lumbar&Sacral Region) and
osteoporosis, LBP, After
Laminectomy

45. Standard LSO Corset
Used in piriformis syndrome and
pelvic fracture

46. Used in spondylosis
and spondylolysthesis
Williams Brace

47. Used in compression
fractures and disc
herniation
Chairback Brace

48. SACROILIAC ORTHOSIS
(SIO)
Sacroiliac Belt
Sacroiliac Corset
Used For :-Sacroilitis,
Sciatica Pain
To Provide Assistance To Pelvis