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Orthosis

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Orthosis

  1. 1. Orthotics Used In Neurological Dysfunction Presenter: Sana Rai (MPT 1st Year) Guide: Dr. Suvarna Ganvir (PhD) Department of Neurophysiotherapy D.V.V.P.F’s College of Physiotherapy, Ahmednagar
  2. 2. Objectives  Introduction .  Definition.  Classification of orthoses .  Uses of orthotic devices.  Orthosis used for different conditions. 1. Stroke and brain injury 2. Spinal cord injury 3. Peripheral nerve injury 4. Cerebral Palsy
  3. 3. Introduction Modern orthotic devices play a vital role in the field of orthopaedic and neurological rehabilitation. They are given to improve function, restrict or enforce motion, or increase support to a part of the body, like the spine or lower limbs.
  4. 4. Definition An orthosis is a mechanical device fitted to the body to maintain it in an anatomical or functional position.
  5. 5. Classification of orthoses Static Orthoses: These devices do not allow motion. Dynamic/Functional Orthoses: These devices permit motion. Progressive Orthoses: ROM of the affected joint gradually the amount of stretch created in the joint. Serial Orthoses: These devices are used in a series to gradually the ROM of a joint.
  6. 6. Uses of orthotic devices. 1. Correcting a mobile deformity. 2. Fixed deformity. 3. Limitation of movements. 4. Maintaining limb in position. 5. Functional aids.
  7. 7. Stroke and brain injury Stroke and brain injury are often complicated by the development of upper motor neuron syndrome. Upper motor neuron syndrome is characterized by impairment of motor control, spasticity, muscle weakness, and stereotypical patterns of movement (synergy).
  8. 8. Shoulder orthosis Shoulder subluxation is one of the major complications experienced among stroke survivors. It may occur early on in the hemiplegic arm due to flaccid supporting shoulder musculature and can be exacerbated by external forces. In the case of a shoulder orthosis for the neutralization of subluxation it is sufficient to consider only static forces acting on the paralysed arm.
  9. 9. Nadler et al. (2017) conduced a study on shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. • Conclusion: observational studies suggest that orthoses reduce vertical subluxation. • Available evidence from heterogeneous studies after stroke suggests that orthoses may reduce pain and are well-tolerated with prolonged use. • No studies have tested whether subluxation and pain can be prevented by immediate post-stroke application of orthoses.
  10. 10. Wrist and hand orthosis • Of all stroke survivors, more than half experience impairments of the upper limb in the chronic phase, including loss of strength and dexterity, spasticity, muscle contracture, pain, and edema. • The evidence of clinical effort to reduce spasticity as well as muscle contracture by applying resting hand splint is that it is possible through applying low-load intensity to hypertonic muscle in a fixed posture or prolonged stretching.
  11. 11. Jong-Bae Choi et al (2016) conducted a study on The Effect of Different Types of Resting Hand Splints on Spasticity and Hand Function among Patients with Stroke. They concluded that dorsal resting hand splint was more effective in the reduction of wrist spasticity and improving AROM than volar resting hand splint in stroke patients.
  12. 12. Dorsal hand splint Volar hand splint
  13. 13. Lower limb orthosis  An ankle-foot orthosis (AFO) is a brace that is worn on the lower leg and foot. It helps to support the ankle and foot in the correct position, preventing the foot from dragging along the ground. Ankle foot orthoses (AFO) are prescribed to facilitate ankle control in cases of equinus and/or varus foot, provide mediolateral stability of the ankle in the stance phase, facilitate gait in the swing phase, and reduce energy expenditure while walking.
  14. 14. Ankle foot orthoses
  15. 15. Kannit Pongpipatpaiboon et al (2018) conducted a study on The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross- sectional study. • They concluded that AFO use increased the extent of toe clearance and limb shortening during the swing phase, while reducing compensatory movements. • Improved joint motions and decreased compensatory movement when using AFOs could potentially contribute to efficient gait and promote walking activity in hemiparetic patients.
  16. 16. Spinal cord injury The spinal cord is the major means through which motor, sensory, automatic, and conscious information travels between the brain and the body. Spinal cord injury (SCI) interrupts the conduction of both sensory and motor signals and, based on the level of the injury, results in varying degrees of motor and sensory loss.
  17. 17. Lower limb orthosis 1. Ankle foot orthosis:  The AFO orthoses are usually designed to permit safe and effective ambulation of SCI individuals with lesions between L4 and S2.  To prevent a plantarflexion contracture, the ankle should be held in a neutral position, which is easily accomplished using a prefabricated antifootdrop orthosis.
  18. 18. 2. Knee–ankle–foot orthosis: The KAFO orthoses are prescribed for SCI individuals with lesions below T10. Various kinds of KAFO orthoses, with different types of knee joints and locking mechanisms have been designed for paraplegic subjects.  It typically is prescribed for individuals who have little to no quadriceps strength.
  19. 19. Knee ankle foot orthosis
  20. 20. 3. Hip–knee–ankle–foot orthosis: A hip–knee–ankle–foot orthosis (HKAFO) is an orthosis whose components stabilize or lock the hip, knee, and ankle. The HKAFO orthoses are used to control the selected motions of the hip joint using various kinds of hip hinges, which are inserted between a pelvic band or spinal rigid orthosis and the KAFO segments.
  21. 21. Peripheral nerve injury  The effects of peripheral nerve injuries are vary depending on the cause and severity of the injury.  These are: 1. Pain (ranging from a tingling to intense burning pain), 2. numbness or altered sensations, 3. muscle weakness in the affected body part, 4. loss of function (eg. a hand or leg being difficult to use whilst performing tasks), 5. Loss of active movement (eg. wrist drop and foot drop) joint stiffness and skin sores.
  22. 22. 1. Radial nerve palsy:  A radial nerve palsy occurs when the radial nerve has been damaged in the arm - typically by compression or laceration, sometimes by fracture of the humerus.  Nerve damage then results in an inability to extend (lift) the wrist or to straighten the fingers/thumb.  The injured hand is floppy, able to grip (because the flexors are still innervated) but unable to grasp effectively due to poor wrist position (Wrist Drop).
  23. 23. Cantero-Téllez Raque et al (2016) conducted a study on Effects on Upper-Limb Function with Dynamic and Static Orthosis Use for Radial Nerve Injury: A Randomized Trial. • They concluded that Results were significantly better for the static orthosis/splint group than for the dynamic splint group. • Treatment with static orthosis produces further improvement in function compared to the treatment with dynamic orthosis.
  24. 24. 2. Ulnar nerve palsy: Ulnar nerve palsy are more commonly caused from trauma to the elbow  The symptoms associated with ulnar nerve palsy include: i. a loss of sensation in your hand, ii. especially in your ring and little fingers. iii. a loss of coordination in your fingers. iv. a tingling or burning sensation in your hand.
  25. 25. Knuckle Bender Splint: The Knuckle Bender Splint is a finger flexion splint designed for use by individuals with disabilities of the fingers.  This splint simultaneously flexes the metacarpal phalangeal (MCP) joints of all digits without blocking interphalangeal (IP) or wrist motion.
  26. 26. Cerebral Palsy  By definition, the impairment known as cerebral palsy (CP) describes damage to the immature brain resulting in problems with balance, coordination, and movement.  The aims of lower limb orthotic management of CP were identified by the consensus conference convened by the International Society of Prostheticsand Orthotics: i. To correct and/or prevent deformity ii. To provide a base of support iii. To facilitate training in skills iv. To improve the efficiency of gait
  27. 27. Lower limb orthosis 1. A leaf-spring AFO  Helps overcome mild equinus spasticity and can improve ground clearance during ambulation swing phase  It is not normally rigid enough to control stance phase equinus.  Limited, resisted, planterflexion and dorsiflexion, with only a few degrees of motion, posterior trim line behind malleolus, giving it thin posterior heel support that widens into a calf band
  28. 28. 2. The solid-ankle AFO:  One of the most commonly used designs for the C.P. population, essentially prevents dorsiflexion and plantarflexion as well as varus or valgus deviations of the ankle and hindfoot.  The solid AFO allows no ankle motion, it covers the back of the leg completely and extends form just below the fibular head to metatarsal heads.
  29. 29. • This design is a primary choice for controlling equinus in both stance and swing phase and for contracture prevention. •It is prescribed to children's with CP when there is: i. Moderate to high tone in the gastrocneminus muscles. ii. A requirement to provide proximal control at knee and hip joint.
  30. 30. 3. An Articulating AFO:  Which typically incorporates medial and lateral joints to allow plantarflexion-dorsiflexion, can be beneficial for C.P.  patients who require increased ankle motion for higher-level balance and functional activities, including walking and sit-to- stand transitions.  Stops can be incorporated to restrict plantarflexion and/or dorsiflexion beyond optimal limits.
  31. 31.  With a plantarflexion stop, for example, the ankle can be maintained in neutral from heelstrike through midstance, then allowed to dorsiflex from midstance through toeoff.
  32. 32. • Half of all children with CP in Sweden use AFOs to improve function and/or to maintain or improve range of motion. • In this study, three quarters of the children treated with AFO attained the treatment goals, i.e. improved function and/or maintained/improved range of motion. • A higher proportion of the children with a lower range of motion at baseline improved their ankle dorsiflexion using AFOs compared to children with a higher initial range of motion. Maria Wingstrand et al (2014) conducted a study on Ankle-foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children.
  33. 33. Summary  Introduction.  Classification of orthoses.  Uses of orthotic devices.  Orthosis used for different conditions. 1. Stroke and brain injury 2. Spinal cord injury 3. Peripheral nerve injury 4. Cerebral Palsy
  34. 34. References  Atlas Of Orthosis And Assistive Device 4th edition by JD Hsu, J Michael, J Fisk .  Textbook of Rehabilitation 3rd edition by S Sunder.  Physical Rehabilitation 5th edition by Susan B. O’sullivan.  Nadler M, Pauls MM. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. Clinical rehabilitation.2017 Apr;31(4):444-53.  Cantero-Téllez R, Miguel GM, Cristina LT. Effects on Upper-Limb Function with Dynamic and Static Orthosis Use for Radial Nerve Injury: A Randomized Trial. J Neurol Disord. 2016;4(265):2.
  35. 35.  Wingstrand M, Hägglund G, Rodby-Bousquet E. Ankle-foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children. BMC musculoskeletal disorders. 2014 Dec;15(1):327.  Pongpipatpaiboon K, Mukaino M, Matsuda F, Ohtsuka K, Tanikawa H, Yamada J, Tsuchiyama K, Saitoh E. The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross- sectional study. Journal of neuroengineering and rehabilitation. 2018 Dec;15(1):41.  Choi JB, Yang JE, Song BK. The effect of different types of resting hand splints on spasticity and hand function among patients with stroke. Journal of Ecophysiology and Occupational Health. 2017 Jun 7;16(1-2):42-51.

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