In this ppt we have included stroke and its types and causes and advanced orthotic management of stroke for upper extrimity. like shoulder orthosis, elbow orthosis, wrist and hand orthosis and also electrical stimulation. also the biomechanics of shoulder orthosis and elbow and wrist hand orthosis also included.
Lower limb orthoses assist with gait, reduce pain, decrease weight bearing, control movement, and minimize deformities. They include foot orthoses and ankle-foot orthoses. Foot orthoses affect ground forces and gait rotation, and are used to treat various foot conditions like pes planus, pes cavus, metatarsalgia, and heel pain. Ankle-foot orthoses control ankle motion and provide stability, and include metal and plastic designs with options for plantar stops, dorsiflexion stops, and dorsiflexion assists.
This orthosis is biomechanically and neuro-physiologically (facilliation and inhibition) effective ankle foot orthosis which is basically indicated for central narvous system disorder and it will provide dynamic ankle dorsiflexion and plantarflexion. It provides independent movement of ankle knee and hip.
This document discusses upper extremity orthotics for restoring mobility and quality of life. It covers common orthotic components for the shoulder, elbow, wrist, fingers and thumb. Static orthoses are used for positioning and prevention of deformities while functional orthoses provide assistance for tasks using internal or external power sources. Fracture/post-operative orthoses provide compression and positioning for proper healing. The document reviews specific orthotic designs for various conditions like carpal tunnel syndrome.
Lower Limb Orthotics - Dr Rajendra Sharmamrinal joshi
This document provides information on lower limb orthotics. It defines an orthosis and describes their clinical objectives in treating conditions like pain, deformities, abnormal range of motion, etc. It discusses different types of orthoses like foot, ankle-foot, knee-ankle-foot orthoses. Principles of bracing like distributing forces over large areas and applying forces to control joints are covered. Characteristics of an ideal orthosis in terms of function, comfort, cost are outlined. The document also discusses shoes, foot orthoses, ankle-foot orthoses made of plastic, metal and patellar tendon bearing designs.
Tone is a normal characteristic of muscle physiology and defined as “ normal degree of vigour and tension: in muscle, the resistance to passive elongation or stretch”. Increase in tone known as hypertonocity. The problem like C.P and stroke are basically suffer hypertonicity. The orthoses help to reduce the tone is known as tone reducing orthoses. These orthosis are follows the principles of NDT mechanism and neurophysiology, so its also known as neurophysiological AFO.
This document discusses transfemoral prostheses. It begins with an introduction to transfemoral amputation, which is the amputation of the leg between the knee and hip. It then covers the rehabilitation process for individuals with a transfemoral amputation, including exercises and management of the residual limb. Finally, it describes the components of transfemoral prostheses, including different socket designs, suspension methods, knee and foot options. The goal of rehabilitation and prosthetic training is to help individuals regain mobility and independence.
This document discusses various orthoses used for the shoulder, elbow, and forearm. It begins by outlining the main objectives of upper limb orthosis as protection, correction, and assistance. It then describes different types of orthoses categorized by joint covered, function provided, condition treated, appearance, and designer. Examples of specific orthoses are provided like figure-8 axilla orthosis, lateral trunk shoulder-elbow-wrist orthosis, and static shoulder-elbow-wrist sling. Design variations are also covered such as static, serial static, and dynamic. The document provides details on several orthosis like Wilmer carrying orthosis and its standard and hands-free units.
Lower limb orthoses assist with gait, reduce pain, decrease weight bearing, control movement, and minimize deformities. They include foot orthoses and ankle-foot orthoses. Foot orthoses affect ground forces and gait rotation, and are used to treat various foot conditions like pes planus, pes cavus, metatarsalgia, and heel pain. Ankle-foot orthoses control ankle motion and provide stability, and include metal and plastic designs with options for plantar stops, dorsiflexion stops, and dorsiflexion assists.
This orthosis is biomechanically and neuro-physiologically (facilliation and inhibition) effective ankle foot orthosis which is basically indicated for central narvous system disorder and it will provide dynamic ankle dorsiflexion and plantarflexion. It provides independent movement of ankle knee and hip.
This document discusses upper extremity orthotics for restoring mobility and quality of life. It covers common orthotic components for the shoulder, elbow, wrist, fingers and thumb. Static orthoses are used for positioning and prevention of deformities while functional orthoses provide assistance for tasks using internal or external power sources. Fracture/post-operative orthoses provide compression and positioning for proper healing. The document reviews specific orthotic designs for various conditions like carpal tunnel syndrome.
Lower Limb Orthotics - Dr Rajendra Sharmamrinal joshi
This document provides information on lower limb orthotics. It defines an orthosis and describes their clinical objectives in treating conditions like pain, deformities, abnormal range of motion, etc. It discusses different types of orthoses like foot, ankle-foot, knee-ankle-foot orthoses. Principles of bracing like distributing forces over large areas and applying forces to control joints are covered. Characteristics of an ideal orthosis in terms of function, comfort, cost are outlined. The document also discusses shoes, foot orthoses, ankle-foot orthoses made of plastic, metal and patellar tendon bearing designs.
Tone is a normal characteristic of muscle physiology and defined as “ normal degree of vigour and tension: in muscle, the resistance to passive elongation or stretch”. Increase in tone known as hypertonocity. The problem like C.P and stroke are basically suffer hypertonicity. The orthoses help to reduce the tone is known as tone reducing orthoses. These orthosis are follows the principles of NDT mechanism and neurophysiology, so its also known as neurophysiological AFO.
This document discusses transfemoral prostheses. It begins with an introduction to transfemoral amputation, which is the amputation of the leg between the knee and hip. It then covers the rehabilitation process for individuals with a transfemoral amputation, including exercises and management of the residual limb. Finally, it describes the components of transfemoral prostheses, including different socket designs, suspension methods, knee and foot options. The goal of rehabilitation and prosthetic training is to help individuals regain mobility and independence.
This document discusses various orthoses used for the shoulder, elbow, and forearm. It begins by outlining the main objectives of upper limb orthosis as protection, correction, and assistance. It then describes different types of orthoses categorized by joint covered, function provided, condition treated, appearance, and designer. Examples of specific orthoses are provided like figure-8 axilla orthosis, lateral trunk shoulder-elbow-wrist orthosis, and static shoulder-elbow-wrist sling. Design variations are also covered such as static, serial static, and dynamic. The document provides details on several orthosis like Wilmer carrying orthosis and its standard and hands-free units.
An orthosis is an external device that is applied to the body to improve function, provide support, reduce pain, correct deformities, and prevent progression of fixed deformities. Lower limb orthoses include foot orthoses, ankle-foot orthoses, knee orthoses, knee-ankle-foot orthoses, and hip-knee-ankle-foot orthoses. The goals of lower limb orthoses are to maintain or correct body segment alignment, assist or resist joint motion, provide axial loading and relieve distal weight bearing forces, and protect against injury. Orthoses can be static devices that hold body parts in position or dynamic devices that facilitate motion.
1. An ankle-foot orthosis (AFO) is an externally applied brace that controls and supports the ankle and foot. AFOs are commonly used after ankle injuries to immobilize or support the joint during rehabilitation.
2. AFOs can be custom-fit or pre-fabricated. Custom AFOs are molded specifically for each individual while pre-fabricated AFOs come in standard sizes. The document discusses various types of AFOs including solid, hinged, and air-stirrup designs.
3. AFOs are used to treat acute ankle injuries, during rehabilitation to prevent re-injury, prophylactically in high-risk patients or activities, and
Classified according to design characteristics
Minimal motion control ……. Collars that encircle the neck with fabric, resilient foam, or rigid plastic.
The Philadelphia collar has mandibular and occipital extensions; sometimes used for upper cervical injuries
Maximum orthotic control of neck
Orthotic management of stroke for mobility --- Madeshanaika (India)CRP
This PPT was made to teach about the Orhtotic management of stroke for Mobility purpose when i was working in Bangladesh .And design was done by considering the sponsors for the programme. If this PPT is useful please go ahed and i am happy if you use this information for teaching....Madesh
Prosthetic management of symes and partial foot amputationSmita Nayak
prosthetic management of partial foot and syme's amputation is a very challenging task. Now a days the availability of advanced technology some how fulfilling the need of the amputee but not the fully.
Biomechanical principle of hand spliningPOLY GHOSH
Hand splinting are provided to people who need protection and support for painful, swollen or weak joints and their surrounding structures. Their designs make sure you position your wrist and hands correctly. There are two types of hand or wrist splint: splints used for resting joints of the wrist and hand.
This document discusses different types of prosthetic knee joints, including mechanical single-axis and polycentric knees, and computerized knees that use microchips, hydraulics, or pneumatics to control motion. It describes the evolution of prosthetic knees from simple pendulums to advanced mechanisms with microprocessor control. Key factors in prescribing the appropriate knee include the user's ability to control stability, flex the knee in swing phase, and walk at different speeds.
This document describes various types of lower limb prostheses. It discusses partial foot prostheses, Syme's prosthesis, transtibial prostheses, transfemoral prostheses, knee disarticulation, and hip disarticulation prostheses. For transtibial prostheses, it outlines the components which include the foot-ankle assembly, socket, shank, and suspension. It also describes the types and purposes of various prosthetic feet and knees. For transfemoral prostheses, it discusses the components of the prosthesis and types of sockets and suspension systems.
Biomechanics of spinal orthotics (MD.Nayeem hasan)Md. Nayeem Hasan
This document discusses the biomechanics of the spine and spinal orthotics. It begins by outlining the objectives of understanding spine biomechanics and orthotic biomechanics. It then provides information on normal spine biomechanics, noting compressive forces and load distribution. abnormal biomechanics associated with conditions like scoliosis are also examined. The principles of orthotic design for different spinal pathologies are explained, including mechanisms of action for cervicothoracic curves, lordosis, and lumbar kyphosis. Intra-abdominal pressure in orthotics and its positive and negative effects are also summarized.
Prosthetic Management of Different Types of Partial Foot AmputationRohan Gupta
This document discusses different types of partial foot amputations and their prosthetic management. It describes 7 types of partial foot amputations ranging from toe amputations to Syme's amputation, which is an ankle disarticulation. For each amputation type, it discusses the bones and joints involved, potential complications, prosthetic goals in managing the condition, and examples of prosthetic solutions used. The document provides an overview of evaluating each partial foot amputation case and designing an appropriate prosthesis to address the patient's functional requirements and minimize complications.
This document discusses spinal orthosis and cervical orthosis. It provides information on the principles and indications of orthotic devices. Some key points include: orthotic devices are prescribed to improve function, relieve pain, and prevent/correct deformities. Proper fitting is important for comfort. Orthoses can immobilize joints and reduce weight bearing to aid healing. Cervical orthoses specifically are used to limit neck movement and muscle spasm after injuries or surgeries. Common types of cervical orthoses include soft collars, Philadelphia orthosis, and halo vest.
Orthotic assessment & orthotic aids in sciPOLY GHOSH
This document provides an overview of spinal cord injuries (SCI), including epidemiology, etiology, assessment, classification, outcomes, rehabilitation, and orthotic management. Some key points:
- Annual SCI incidence is around 15,000 cases in India with a prevalence of 150,000. Most are due to trauma like vehicle accidents or falls.
- Assessment includes level and severity of injury, neurological classification scales, and measures of body function, activity, and participation.
- Treatment involves splinting, bracing, wheelchairs, and assistive devices tailored to injury level and functional abilities with a goal of maximizing mobility and independence. Outcomes depend on injury characteristics and rehabilitation.
Over the past decade, technology and research have greatly expanded the functionality and aesthetics of prosthetic feet. Today, amputees have a wide array of feet from which to choose. Various models are designed for activities ranging from walking, dancing and running to cycling, golfing, swimming and even snow skiing.
In this ppt, there is various types of hip orthoses were disscussed according to various types of hip pathologies like developmental dysplasia of hip, legg calve perthes disease, spina bifida, cerebral palsy, lower extremity weakness and paralysis, torsional deformities.
also various types hip orthoses with HKAFOS were discussed from the conventional design to most advanced design like post operative hip orthoses for hip reconstruction surgery etc.
This document provides information about transtibial (below the knee) amputations and prosthetics. It discusses the history and advancement of CAD-CAM technology for prosthetic socket design. It outlines principles for prosthetic alignment and construction. Biomechanics of the residual limb and socket interface are described. Assessment of the stump condition, range of motion, joint integrity, and muscle strength are discussed as important factors in prosthetic fitting and design.
The document discusses dynamic response feet (DRF), which are prosthetic feet that store and release energy during walking to provide a more natural gait. It begins by describing the anatomy and function of human feet. It then discusses the history and development of DRFs since their introduction in 1984. The document outlines various DRF designs and classifications, including early models like Flex Foot and more advanced designs. It also examines the structural and functional mechanisms of DRFs and factors considered in selecting a DRF.
The term Spinal Cord Injury is used to refer to neurological damage of the spinal cord
Any lesion involving the spinal cord result a syndrome called a “myelopathy”
Spinal cord injuries are defined as complete or incomplete according to the International Standards for the Neurological Classifification of SCI and the American Spinal Injuries Association Impairment Scale (AIS)
Complete lesions are defifined as AIS A, and incomplete lesions are defifined as AIS B, AIS C, AIS D or AIS E (Harvey, 2016)
Unit 1_ Orthopedic Nursing^J Educational Platform copy.pptxRawalRafiqLeghari
The document discusses several common musculoskeletal conditions including sprains, strains, fractures, carpal tunnel syndrome, osteoarthritis, rheumatoid arthritis, gout, and amputations. It provides information on the etiology, pathophysiology, signs and symptoms, diagnosis, and treatment including nursing considerations for each condition.
An orthosis is an external device that is applied to the body to improve function, provide support, reduce pain, correct deformities, and prevent progression of fixed deformities. Lower limb orthoses include foot orthoses, ankle-foot orthoses, knee orthoses, knee-ankle-foot orthoses, and hip-knee-ankle-foot orthoses. The goals of lower limb orthoses are to maintain or correct body segment alignment, assist or resist joint motion, provide axial loading and relieve distal weight bearing forces, and protect against injury. Orthoses can be static devices that hold body parts in position or dynamic devices that facilitate motion.
1. An ankle-foot orthosis (AFO) is an externally applied brace that controls and supports the ankle and foot. AFOs are commonly used after ankle injuries to immobilize or support the joint during rehabilitation.
2. AFOs can be custom-fit or pre-fabricated. Custom AFOs are molded specifically for each individual while pre-fabricated AFOs come in standard sizes. The document discusses various types of AFOs including solid, hinged, and air-stirrup designs.
3. AFOs are used to treat acute ankle injuries, during rehabilitation to prevent re-injury, prophylactically in high-risk patients or activities, and
Classified according to design characteristics
Minimal motion control ……. Collars that encircle the neck with fabric, resilient foam, or rigid plastic.
The Philadelphia collar has mandibular and occipital extensions; sometimes used for upper cervical injuries
Maximum orthotic control of neck
Orthotic management of stroke for mobility --- Madeshanaika (India)CRP
This PPT was made to teach about the Orhtotic management of stroke for Mobility purpose when i was working in Bangladesh .And design was done by considering the sponsors for the programme. If this PPT is useful please go ahed and i am happy if you use this information for teaching....Madesh
Prosthetic management of symes and partial foot amputationSmita Nayak
prosthetic management of partial foot and syme's amputation is a very challenging task. Now a days the availability of advanced technology some how fulfilling the need of the amputee but not the fully.
Biomechanical principle of hand spliningPOLY GHOSH
Hand splinting are provided to people who need protection and support for painful, swollen or weak joints and their surrounding structures. Their designs make sure you position your wrist and hands correctly. There are two types of hand or wrist splint: splints used for resting joints of the wrist and hand.
This document discusses different types of prosthetic knee joints, including mechanical single-axis and polycentric knees, and computerized knees that use microchips, hydraulics, or pneumatics to control motion. It describes the evolution of prosthetic knees from simple pendulums to advanced mechanisms with microprocessor control. Key factors in prescribing the appropriate knee include the user's ability to control stability, flex the knee in swing phase, and walk at different speeds.
This document describes various types of lower limb prostheses. It discusses partial foot prostheses, Syme's prosthesis, transtibial prostheses, transfemoral prostheses, knee disarticulation, and hip disarticulation prostheses. For transtibial prostheses, it outlines the components which include the foot-ankle assembly, socket, shank, and suspension. It also describes the types and purposes of various prosthetic feet and knees. For transfemoral prostheses, it discusses the components of the prosthesis and types of sockets and suspension systems.
Biomechanics of spinal orthotics (MD.Nayeem hasan)Md. Nayeem Hasan
This document discusses the biomechanics of the spine and spinal orthotics. It begins by outlining the objectives of understanding spine biomechanics and orthotic biomechanics. It then provides information on normal spine biomechanics, noting compressive forces and load distribution. abnormal biomechanics associated with conditions like scoliosis are also examined. The principles of orthotic design for different spinal pathologies are explained, including mechanisms of action for cervicothoracic curves, lordosis, and lumbar kyphosis. Intra-abdominal pressure in orthotics and its positive and negative effects are also summarized.
Prosthetic Management of Different Types of Partial Foot AmputationRohan Gupta
This document discusses different types of partial foot amputations and their prosthetic management. It describes 7 types of partial foot amputations ranging from toe amputations to Syme's amputation, which is an ankle disarticulation. For each amputation type, it discusses the bones and joints involved, potential complications, prosthetic goals in managing the condition, and examples of prosthetic solutions used. The document provides an overview of evaluating each partial foot amputation case and designing an appropriate prosthesis to address the patient's functional requirements and minimize complications.
This document discusses spinal orthosis and cervical orthosis. It provides information on the principles and indications of orthotic devices. Some key points include: orthotic devices are prescribed to improve function, relieve pain, and prevent/correct deformities. Proper fitting is important for comfort. Orthoses can immobilize joints and reduce weight bearing to aid healing. Cervical orthoses specifically are used to limit neck movement and muscle spasm after injuries or surgeries. Common types of cervical orthoses include soft collars, Philadelphia orthosis, and halo vest.
Orthotic assessment & orthotic aids in sciPOLY GHOSH
This document provides an overview of spinal cord injuries (SCI), including epidemiology, etiology, assessment, classification, outcomes, rehabilitation, and orthotic management. Some key points:
- Annual SCI incidence is around 15,000 cases in India with a prevalence of 150,000. Most are due to trauma like vehicle accidents or falls.
- Assessment includes level and severity of injury, neurological classification scales, and measures of body function, activity, and participation.
- Treatment involves splinting, bracing, wheelchairs, and assistive devices tailored to injury level and functional abilities with a goal of maximizing mobility and independence. Outcomes depend on injury characteristics and rehabilitation.
Over the past decade, technology and research have greatly expanded the functionality and aesthetics of prosthetic feet. Today, amputees have a wide array of feet from which to choose. Various models are designed for activities ranging from walking, dancing and running to cycling, golfing, swimming and even snow skiing.
In this ppt, there is various types of hip orthoses were disscussed according to various types of hip pathologies like developmental dysplasia of hip, legg calve perthes disease, spina bifida, cerebral palsy, lower extremity weakness and paralysis, torsional deformities.
also various types hip orthoses with HKAFOS were discussed from the conventional design to most advanced design like post operative hip orthoses for hip reconstruction surgery etc.
This document provides information about transtibial (below the knee) amputations and prosthetics. It discusses the history and advancement of CAD-CAM technology for prosthetic socket design. It outlines principles for prosthetic alignment and construction. Biomechanics of the residual limb and socket interface are described. Assessment of the stump condition, range of motion, joint integrity, and muscle strength are discussed as important factors in prosthetic fitting and design.
The document discusses dynamic response feet (DRF), which are prosthetic feet that store and release energy during walking to provide a more natural gait. It begins by describing the anatomy and function of human feet. It then discusses the history and development of DRFs since their introduction in 1984. The document outlines various DRF designs and classifications, including early models like Flex Foot and more advanced designs. It also examines the structural and functional mechanisms of DRFs and factors considered in selecting a DRF.
The term Spinal Cord Injury is used to refer to neurological damage of the spinal cord
Any lesion involving the spinal cord result a syndrome called a “myelopathy”
Spinal cord injuries are defined as complete or incomplete according to the International Standards for the Neurological Classifification of SCI and the American Spinal Injuries Association Impairment Scale (AIS)
Complete lesions are defifined as AIS A, and incomplete lesions are defifined as AIS B, AIS C, AIS D or AIS E (Harvey, 2016)
Unit 1_ Orthopedic Nursing^J Educational Platform copy.pptxRawalRafiqLeghari
The document discusses several common musculoskeletal conditions including sprains, strains, fractures, carpal tunnel syndrome, osteoarthritis, rheumatoid arthritis, gout, and amputations. It provides information on the etiology, pathophysiology, signs and symptoms, diagnosis, and treatment including nursing considerations for each condition.
A mangled extremity refers to severe limb injury where viability is questionable. Emergent management prioritizes life-saving care. The decision to salvage or amputate is complex, considering scoring systems, nerve function, bone/joint integrity, and patient factors. If salvaged, options include debridement, fixation, flaps, and bone reconstruction. Amputation may provide better function than some salvaged limbs, especially with vascular/major injuries. The child's growth is also a key consideration.
- A bursa is a fluid-filled sac that acts as a cushion between bones, muscles, and ligaments near joints. Injury to a bursa can cause pain, limited motion, and decreased mobility.
- The cervical vertebrae are the smallest and most movable part of the spine. Injuries can occur from direct or indirect trauma and include fractures, dislocations, and ligament injuries.
- Treatment depends on the injury but may include immobilization, traction, steroids, and surgery to stabilize or fuse the spine to preserve neurological function and spinal stability.
This document discusses spinal orthosis and cervical orthosis. It provides an overview of the principles and indications for orthotic devices. Specifically, it outlines the functions of orthosis in relieving pain, immobilizing joints, reducing weight bearing, preventing and correcting deformities, and improving function. It also describes different types of cervical orthosis including soft collars, Philadelphia collars, and halo vests. The key objectives of spinal orthosis are to control spinal position, apply corrective forces, and aid stability.
The document provides information on the musculoskeletal system including:
1. It describes the key components of the musculoskeletal system including bones, muscles, ligaments, tendons and cartilage.
2. It discusses bone cells and their functions in bone formation and resorption.
3. Common musculoskeletal injuries and disorders like strains, sprains, fractures and dislocations are described along with their signs, symptoms and management.
4. Diagnostic tests and nursing management of musculoskeletal conditions including casting, traction and surgery are summarized.
The document discusses spinal canal stenosis, including:
1. It describes spinal canal stenosis as the narrowing of the spinal canal and compression of the spinal cord and nerve roots, most commonly occurring in the lumbar vertebrae.
2. Symptoms include back pain radiating into the legs, numbness, and weakness that is relieved by bending forward and made worse by standing upright or walking.
3. Treatment options range from non-surgical approaches like medication, physical therapy, and epidural injections for mild-to-moderate cases to surgical decompression like laminectomy or the X-STOP implant for more severe cases.
MSK INJURY Bsc,Nurse_121638.ppt for nursesMelakuSintayhu
The document reviews musculoskeletal injuries, including causes, classifications, clinical manifestations, assessment approaches, diagnosis, and management of common injuries such as fractures, dislocations, sprains and strains. It provides details on anatomy of the musculoskeletal system and discusses evaluation and treatment of various musculoskeletal traumas including splinting techniques.
Knee dislocation powerpoint for medical studentsCasualityShift
Knee dislocations are high-energy traumatic injuries that often involve ruptures of three or more major ligaments of the knee. They require emergent treatment due to the risk of neurovascular injury. The most common type is anterior dislocation from hyperextension. A thorough clinical exam is needed to assess ligament stability and neurovascular status before and after reduction. Vascular injury occurs in 20-60% of cases and requires revascularization within 8 hours to prevent limb loss. Immediate surgical exploration is indicated if pulses do not return after reduction.
This document provides information about dislocations and subluxations, including their causes, risk factors, symptoms, diagnosis, treatment, prevention, and nursing management. It defines a dislocation as an injury where the bones are forced from their normal positions in a joint, while a subluxation is a minor or incomplete dislocation where the joint surfaces still touch. The document outlines the pathology, clinical features, diagnostic approaches including x-rays, and various treatment options for dislocations such as manipulation, immobilization, medication, surgery, and rehabilitation. It also lists preventive measures and discusses the nursing assessment and interventions for patients with dislocations.
This document provides information on spine and extremity injuries, including fractures, compartment syndrome, traumatic amputations, and spinal injuries. It describes the types, clinical features, investigations, management principles, and complications of these conditions. Fractures are classified as open or closed. Compartment syndrome results from increased pressure compromising circulation. Amputations require urgent wound care and resuscitation. Spinal injuries can damage the vertebrae and spinal cord, and require immobilization, imaging, and multidisciplinary management.
Physiotherapy management in fracture complications (Rsd/myositis ossificans)Ashish kumar Sharma
This document discusses fracture complications and the role of physiotherapy in management. It defines fractures and lists types of fractures and potential causes. Regarding physiotherapy management, it outlines the SOAP assessment process and common treatment approaches, including soft tissue work, scar management, exercises, and manual therapy. Potential complications from fractures are categorized as immediate/early (e.g. hypovolemic shock, nerve injury), delayed (e.g. ARDS, infection), and late (e.g. malunion, RSD). Risk factors and basic prevention principles are also covered.
This document provides an overview of the management of musculoskeletal trauma and problems. It discusses various topics including fractures, joint dislocations, contusions, sprains, strains, osteomyelitis, and low back pain. For fractures specifically, it describes the types of fractures, clinical manifestations, diagnostic tests, management including reduction, immobilization, and nursing care. It also discusses complications that can arise from fractures like infection, compartment syndrome, venous thrombosis, and fat embolism syndrome. Treatment for hip fractures is also outlined.
This document discusses anesthesia considerations for total hip replacement (THR) and total knee replacement (TKR) surgeries. It covers preoperative evaluation and optimization of comorbidities. Regional anesthesia techniques like spinal, epidural and peripheral nerve blocks are preferred due to advantages like less blood loss, better pain control and early mobility. General anesthesia is an option as well. Intraoperative monitoring, fluid management and prevention of complications like venous thromboembolism and cement implantation syndrome are discussed. Early mobilization and multimodal analgesia are emphasized for postoperative care.
Understanding Spinal Cord Injury and Lesions.pptxalyemerem7
The spinal cord is a bundle of nerves that extends from the brain down the back and transmits signals between the brain and body to control movement, sensation, and bodily functions. Spinal cord injuries can result from traumatic events like car accidents and falls or medical conditions like tumors and infections. There are two types of spinal cord injuries - complete injuries that cause total paralysis and loss of sensation below the injury, and incomplete injuries that cause partial paralysis and loss of sensation depending on severity. Symptoms include paralysis of the legs or entire body below the injury and loss of sensation. Diagnosis involves imaging tests and treatment may involve surgery, physical therapy focuses on improving mobility and strength, and assistive devices help regain independence.
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
The document discusses amputation, including definitions, indications, common causes, types of amputation, levels of amputation for lower limbs, complications, and goals of physiotherapy. It defines amputation and disarticulation. Common causes include trauma, peripheral vascular insufficiency, malignant tumors, nerve injuries/infections, congenital anomalies, and extreme heat/cold. Types include closed and open amputation. Levels for lower limbs range from hip disarticulation to toe amputation. Complications include hematomas, infections, necrosis, and phantom sensation. Physiotherapy aims to achieve independence and mobility, preventing contractures postoperatively.
Pelvic fractures are caused by high-energy trauma and can be stable or unstable depending on the fracture pattern. Stable fractures involve a single break while unstable fractures have multiple breaks or displacement of bones. Treatment depends on factors like fracture pattern and displacement, and may involve nonsurgical or surgical methods. Recovery requires medications, physical therapy, and weight restrictions to regain mobility and prevent complications like blood clots.
This document discusses surgical procedures and postoperative management for joint injuries and diseases of the elbow. It describes common fractures of the elbow region including the radial head. Surgical options for fractures include open reduction and internal fixation, arthroscopic techniques, and radial head excision. The goals of surgery and rehabilitation are to relieve pain, restore alignment and stability, and regain strength and range of motion. Postoperative management involves immobilization, progressive range of motion and strengthening exercises. Total elbow arthroplasty is an option for severe arthritis.
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The binding of cosmological structures by massless topological defectsSérgio Sacani
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
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Current Ms word generated power point presentation covers major details about the micronuclei test. It's significance and assays to conduct it. It is used to detect the micronuclei formation inside the cells of nearly every multicellular organism. It's formation takes place during chromosomal sepration at metaphase.
The use of Nauplii and metanauplii artemia in aquaculture (brine shrimp).pptxMAGOTI ERNEST
Although Artemia has been known to man for centuries, its use as a food for the culture of larval organisms apparently began only in the 1930s, when several investigators found that it made an excellent food for newly hatched fish larvae (Litvinenko et al., 2023). As aquaculture developed in the 1960s and ‘70s, the use of Artemia also became more widespread, due both to its convenience and to its nutritional value for larval organisms (Arenas-Pardo et al., 2024). The fact that Artemia dormant cysts can be stored for long periods in cans, and then used as an off-the-shelf food requiring only 24 h of incubation makes them the most convenient, least labor-intensive, live food available for aquaculture (Sorgeloos & Roubach, 2021). The nutritional value of Artemia, especially for marine organisms, is not constant, but varies both geographically and temporally. During the last decade, however, both the causes of Artemia nutritional variability and methods to improve poorquality Artemia have been identified (Loufi et al., 2024).
Brine shrimp (Artemia spp.) are used in marine aquaculture worldwide. Annually, more than 2,000 metric tons of dry cysts are used for cultivation of fish, crustacean, and shellfish larva. Brine shrimp are important to aquaculture because newly hatched brine shrimp nauplii (larvae) provide a food source for many fish fry (Mozanzadeh et al., 2021). Culture and harvesting of brine shrimp eggs represents another aspect of the aquaculture industry. Nauplii and metanauplii of Artemia, commonly known as brine shrimp, play a crucial role in aquaculture due to their nutritional value and suitability as live feed for many aquatic species, particularly in larval stages (Sorgeloos & Roubach, 2021).
Unlocking the mysteries of reproduction: Exploring fecundity and gonadosomati...AbdullaAlAsif1
The pygmy halfbeak Dermogenys colletei, is known for its viviparous nature, this presents an intriguing case of relatively low fecundity, raising questions about potential compensatory reproductive strategies employed by this species. Our study delves into the examination of fecundity and the Gonadosomatic Index (GSI) in the Pygmy Halfbeak, D. colletei (Meisner, 2001), an intriguing viviparous fish indigenous to Sarawak, Borneo. We hypothesize that the Pygmy halfbeak, D. colletei, may exhibit unique reproductive adaptations to offset its low fecundity, thus enhancing its survival and fitness. To address this, we conducted a comprehensive study utilizing 28 mature female specimens of D. colletei, carefully measuring fecundity and GSI to shed light on the reproductive adaptations of this species. Our findings reveal that D. colletei indeed exhibits low fecundity, with a mean of 16.76 ± 2.01, and a mean GSI of 12.83 ± 1.27, providing crucial insights into the reproductive mechanisms at play in this species. These results underscore the existence of unique reproductive strategies in D. colletei, enabling its adaptation and persistence in Borneo's diverse aquatic ecosystems, and call for further ecological research to elucidate these mechanisms. This study lends to a better understanding of viviparous fish in Borneo and contributes to the broader field of aquatic ecology, enhancing our knowledge of species adaptations to unique ecological challenges.
Comparing Evolved Extractive Text Summary Scores of Bidirectional Encoder Rep...University of Maribor
Slides from:
11th International Conference on Electrical, Electronics and Computer Engineering (IcETRAN), Niš, 3-6 June 2024
Track: Artificial Intelligence
https://www.etran.rs/2024/en/home-english/
The ability to recreate computational results with minimal effort and actionable metrics provides a solid foundation for scientific research and software development. When people can replicate an analysis at the touch of a button using open-source software, open data, and methods to assess and compare proposals, it significantly eases verification of results, engagement with a diverse range of contributors, and progress. However, we have yet to fully achieve this; there are still many sociotechnical frictions.
Inspired by David Donoho's vision, this talk aims to revisit the three crucial pillars of frictionless reproducibility (data sharing, code sharing, and competitive challenges) with the perspective of deep software variability.
Our observation is that multiple layers — hardware, operating systems, third-party libraries, software versions, input data, compile-time options, and parameters — are subject to variability that exacerbates frictions but is also essential for achieving robust, generalizable results and fostering innovation. I will first review the literature, providing evidence of how the complex variability interactions across these layers affect qualitative and quantitative software properties, thereby complicating the reproduction and replication of scientific studies in various fields.
I will then present some software engineering and AI techniques that can support the strategic exploration of variability spaces. These include the use of abstractions and models (e.g., feature models), sampling strategies (e.g., uniform, random), cost-effective measurements (e.g., incremental build of software configurations), and dimensionality reduction methods (e.g., transfer learning, feature selection, software debloating).
I will finally argue that deep variability is both the problem and solution of frictionless reproducibility, calling the software science community to develop new methods and tools to manage variability and foster reproducibility in software systems.
Exposé invité Journées Nationales du GDR GPL 2024
Or: Beyond linear.
Abstract: Equivariant neural networks are neural networks that incorporate symmetries. The nonlinear activation functions in these networks result in interesting nonlinear equivariant maps between simple representations, and motivate the key player of this talk: piecewise linear representation theory.
Disclaimer: No one is perfect, so please mind that there might be mistakes and typos.
dtubbenhauer@gmail.com
Corrected slides: dtubbenhauer.com/talks.html
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
Phenomics assisted breeding in crop improvementIshaGoswami9
As the population is increasing and will reach about 9 billion upto 2050. Also due to climate change, it is difficult to meet the food requirement of such a large population. Facing the challenges presented by resource shortages, climate
change, and increasing global population, crop yield and quality need to be improved in a sustainable way over the coming decades. Genetic improvement by breeding is the best way to increase crop productivity. With the rapid progression of functional
genomics, an increasing number of crop genomes have been sequenced and dozens of genes influencing key agronomic traits have been identified. However, current genome sequence information has not been adequately exploited for understanding
the complex characteristics of multiple gene, owing to a lack of crop phenotypic data. Efficient, automatic, and accurate technologies and platforms that can capture phenotypic data that can
be linked to genomics information for crop improvement at all growth stages have become as important as genotyping. Thus,
high-throughput phenotyping has become the major bottleneck restricting crop breeding. Plant phenomics has been defined as the high-throughput, accurate acquisition and analysis of multi-dimensional phenotypes
during crop growing stages at the organism level, including the cell, tissue, organ, individual plant, plot, and field levels. With the rapid development of novel sensors, imaging technology,
and analysis methods, numerous infrastructure platforms have been developed for phenotyping.
ESPP presentation to EU Waste Water Network, 4th June 2024 “EU policies driving nutrient removal and recycling
and the revised UWWTD (Urban Waste Water Treatment Directive)”
This presentation explores a brief idea about the structural and functional attributes of nucleotides, the structure and function of genetic materials along with the impact of UV rays and pH upon them.
2. Contents
• Definition
• Risk factors of stroke
• Aetiology
• Classification
• Signs and symptoms
• Diagnosis
• Treatment
• Limb synergy
• Orthotic management
• Role of orthosis
• Orthotic classification
• Biomechanics
• Advancement in orthosis
• Robotics in stroke management
• Adaptations
• References
3. Definition
Stroke, or cerebrovascular accident (CVA),
describes a variety of disorders characterized
by the sudden onset of neurological deficits
caused by vascular injury to the brain.
4.
5. Aetiology
• There are 3 main causes of stroke:
a blocked artery (ischemic stroke)
leaking or bursting of a blood vessel
(hemorrhagic stroke).
temporary disruption of blood flow to the
brain, known as a transient ischemic attack
(TIA).
6. Classification
• Strokes are usually classified by the
mechanism and location of the vascular
damage.
• The two broad types are
Ischemic
Hemorrhagic
7.
8. Ischemic stroke
• Ischemic stroke is the most common form of stroke, mostly 85%.
• This type of stroke is caused by blockage or narrowing of the
arteries that provide blood to the brain, resulting in
ischemia“severely reduced blood flow”
Causation:-
• These blockages are caused by the blood clots and clots can be
caused by the fatty deposits within the arteries called plaque.
9. Haemorraghic stroke
• Hemorrhagic strokes result from a rupture of a weakened cerebral blood
vessel.
• Hemorrhagic strokes are either
intracerebral (bleeding into the brain itself) or
subarachnoid (bleeding into an area surrounding the brain)
Causation:
• Uncontrolled high blood pressure
• Overtreatment with blood thinners (anticoagulants)
• Bulges at weak spots in blood vessel walls (aneurysms)
• Trauma (such as a car accident)
• Protein deposits in blood vessel walls that lead to weakness in the vessel
wall (cerebral amyloid angiopathy)
• Ischemic stroke leading to hemorrhage.
10.
11. Transient ischemic attack
• It is sometimes known as a ministroke - is a temporary period of symptoms
similar to those in a stroke.
• A TIA doesn't cause permanent damage.
Causation:-
• A TIA is caused by a temporary decrease in blood supply to part of the brain,
which may last as little as five minutes.
• Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks
blood flow to part of the nervous system
12. SIGNS & SYMPTOMS OF STROKE
• Sudden numbness or weakness in the face, arm, or leg,
especially on one side of the body.
• Sudden confusion, trouble speaking, or difficulty
understanding speech.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance, or lack of
coordination.
• Sudden severe headache with no known cause.
13. DIAGNOSIS
• Stroke happens fast and will often occur before an
individual can be seen by a doctor for a proper
diagnosis.
• B.E.F.A.S.T is the way to remember the signs of stroke
and can help identify the onset of stroke more quickly:
14. Medical diagnosis:-
After seeing the preliminary signs & symptoms of stroke patient is shifted
immediately to the hospital for further investigation to rule out the cause of stroke.
1.Physical examination:
Blood pressure(BP)
Heart rate(HR)
Neurological tests
2.Blood tests
3.Computerized Tomography(CT)Scan
4.Magnetic resonance imagaing(MRI)
5.Carotid ultrasound
6.Cerebral angiogram
7.Echocardiogram
15. TREATMENT
1.MEDICAL MANAGEMENT
Supportive management
-Maintenance of airways and ventilation
-Temperature
-Blood sugar
-Cardiac assessment
Thrombolysis
-Intravenous/Intra-arterial
Administration of anti platelet and anticoagulant drugs
Hemodilution
Neuroprotective Agents
Edema reduction
Use of anasthetic nerve blocks and phenol nerve blocks
Chemodenervation
Spasticity release
16. 2.Surgical Management
• Removal of a clot or shunting of ventricular fluid.
• Intracranial or extra cranial bypass surgery.
• Surgical decompression of cerebellar hematoma.
3.Therpeutic management
• Techniques of Treatment: Approximately 48 hours after stroke, if patient is
medically stable and alert, and there is no progression of the deficit, bedside
physical and occupational therapy may be started. The program depends on
the level of recovery of the patient.
17. WHAT ARE THE BRUNNSTROM STAGES OF
STROKE RECOVERY?
• The brunnstrom stages is one of the most well-known stroke
recovery stages which is also known as the Brunnstrom approach.
• Developed by physical therapist Signe Brunnstrom in the 1960’s.
• This approach describes the sequence of motor development and
reorganization of the brain after stroke.
18.
19. • Basic Limb Synergies
Synergy is a pattern of muscles contracting in a stereotyped predictable pattern
in hemiplegics or cerebral palsy patients due to loss of inhibitory control
normally exerted by higher centers in the brain.
In the upper limb the flexor synergy and in the lower limb the extensor synergy
patterns are commoner.
• The patterns are as follows:
Upper Limb Synergy Patterns: Flexor Synergy
Scapular retraction/elevation
Elbow flexion
Wrist and fingers flexion
Lower Limb Synergy Pattern: Extensor Synergy
Hip extension
Hip adduction & internal rotation
Knee extension
Ankle plantar flexion and inversion, tending to equinovarus
Toe plantar flexion
22. Orthotic management
The use of orthotics is one set of tools in the effort to:-
Restore range of motion
Soft tissue flexibility
Agonist–antagonist muscle balance
Improves function of the upper extremity
Orthotic designs ranges from robust immobilization to incremental
facilitation of range of motion on a joint-by-joint basis.
Robust immobilization, such as casting, is used early and has the benefits of
Overcoming severe spasticity.
Decreasing the amount of user error by the wearer or caregiver.
23. BASIC ROLE OF ORTHOSIS
• Use to maintain or increase the length of the soft tissues by
preventing or lengthening shortened tissues.
• Used to correct biomechanical malalignment, restoring muscles to
normal resting length and protecting joint integrity.
• Used to position the hand to assist in functional activities.
• Used to promote independence in specific areas of occupation.
• Compensate for weakness by providing external support .
24. USES OF ORTHOTIC DEVICES
• Contracture Prevention
• Orthoses as Reinforcements after Chemodenervation
• Contracture correction
• Maintaining limb position
• Functional aids
25. a) Contracture Prevention
Neurogenic shock often occurs directly after stroke or brain injury. Over the
following few weeks, spasticity develops in parallel with neurologic recovery.
• In this period, a combination of oral antispasmodics, peripheral nerve blocks,
and casting or splinting techniques are commonly used to give temporary relief
of spasticity.
• Positioning a limb in a desired position is important.
• Casting maintains muscle fiber length, protects the limb, and diminishes
muscle tone by decreasing sensory input.
• Cast are commonly used to treat pressure sore.
26. b) Orthoses as Reinforcements After
Chemodenervation
• When a botulinum toxin injection is injected, an orthotic device can be
used to maintain the injected muscles in a stretched position to enhance the
effect of BT .
• In this case, progressive or serial orthosis used to increase the amount of
stretch.
• The use of injection and orthosis can be an intermediate and transitory
phase before surgery.
27. c) Contracture correction
•Restoration of joint range of motion or contracture correction can be achieved
with serial casting at weekly intervals.
•Surgical management helps in manipulating the joint under anesthesia beyond
soft tissue endpoints.
•After this, a cast may be applied to allow the limb to heal in its new position.
• A major correction in joint position can be achieved directly through manipulation
and application of orthosis.
28. d) Maintaining Limb Position
• When the desired limb position has been achieved by serial or
dropout casts, bivalved casts are frequently used.
• Bivalved cast or splint is important because it is more comfortable
than a traditional circular cast and can be removed several times a day
to perform joint range of motion and skin care.
• Bivalved casts or splints are inadequate for severe spasticity because
they do not have enough inherent stability and may increase the risk
for skin and soft tissue injury.
29. e)Functional aids
•Orthotics can be used to improve or assist function by positioning
the limb for use.
• Lap boards, arm slings, and other positioning devices should be
considered as well as more conventional orthoses.
•These devices are usually very practical and often improve patient
comfort.
30. Orthotic classification
Function Region
Static Orthoses
Dynamic /Functional Orthoses
Static progressive Orthoses
Serial cast/Serial Orthoses
Shoulder Orthoses
Elbow Orthoses
Wrist and Hand Orthoses
Finger and Thumb Orthoss
31. 1. Static orthosis
Rigidly immobilize one or more joints
and do not allow any motion.
Used for fractures and nerve injuries in
the postsurgical phase.
Able to overcome severe spasticity
Distribute pressure equally along all
contact points.
Facilitates attachment point for
assistive devices (eating utensils, pens)
32. 2. Dynamic /Functional Orthoses
Allow a prescribed amount of motion across
one or more joints.
Design- Hinged and
may or may not have a spring or
elastic force
Encourages rotation about the joint.
Use
- Assist movement of relatively weak
muscles.
- Provide a corrective force across a joint
to encourage normal movement
patterns.
- Agonist–antagonist muscle balance.
33. 3. Static progressive Orthoses
Incorporate non-elastic components to apply force across a joint to hold it
at its end range position to improve passive joint range of motion.
Allow incremental changes in joint position as the end range of the
affected joint improves over time.
34. 4. Serial cast/Serial Orthoses
These are static casts or splints applied
over time.
Accomplishes a prolonged passive stretch
over time and blends the durability and
reliability of casting.
35. HOW STROKE AFFECTS SHOULDER
• Hemiplegia from stroke causes significant impairment of the shoulder
girdle.
• Painful shoulder syndromes, called hemiplegic shoulder pain (HSP) are
more common in post stroke.
• The weight of the hanging arm can cause shoulder to sublux inferiorly.
• In the subacute to chronic phase of stroke, spasticity commonly develops,
especially in the shoulder internal rotators and adductors.
36.
37. SHOULDER ORTHOSES
1. Lap Board
2. Arm Support
3. Sling
4. Humeral Cuff
5. Abduction pillow
6. Electrical stimulation
38. Lap boards are placed over the arms of a
wheelchair.
Indication:-
Post stroke patients using wheel chair.
Advantages:-
• Provide protection and ensure proper
positioning of the hemiparetic shoulder and
arm.
• Assists the patient in maintaining an
upright posture while sitting.
1. LAP BOARD
39. A forearm trough device can be used to support and position the
arm.
Indication:-
• This is useful when there is a mild-to-moderate degree of
spasticity in the adductor and internal rotator muscles of the
shoulder.
• Patient using wheel chair .
Location:-
• The device can be attached directly to the arm of a wheelchair.
• A forearm trough can be attached to a hinged mobile support
on the arm of the chair.
Advantages:-
• The trough is used to statically position a non functional arm.
• The patient’s forearm can be secured in position with padded
straps.
• This allows the arm to be placed in a variety of positions for
functional use or training of the hand.
• Positions the arm in slight abduction and neutral rotation.
2.Arm Supports
40. It is a simplest and most common orthotic device to
position the arm
Indication:-
Ambulatory hemiplegic patients.
Contraindiaction:-
Bilateral use.
Advantages:-
• It can be removed periodically to allow ROM,
exercises of the shoulder and elbow.
• Low cost
• Easy to use
• Lightweight
• Portable
3.SLING
41. BIOMECHANICAL DISADVANTAGES
The simple sling is an inefficient
method for exerting an upward
force on the humerus because it
exerts its force along the whole
length of the forearm, wrist and
hand rather than a single fulcrum
point.
42. Biomechanics
• The action line of the effective
suspension force of a shoulder
sling or a hemisling lies distal to
the center of gravity of the bent
arm.
• Therefore, no subluxation
correcting force can exist.
43. • Displacement of the action line of the
suspension force proximal to the center of
gravity results in an attractive orthosis
structure. The total system acts like a
balanced arm. The forearm and hand
together force the upper arm upwards into
the shoulder joint
47. • The subsystems of forearm and
upper arm are combined to the
system of the complete arm. The
force in the elbow is now an internal
force of the system.
• The resulting gravity force of the
complete arm acts distally of the
suspension force.
• The reaction force in the shoulder
ensures the equilibrium of forces
and indicates the successful
neutralization of the subluxation.
Patient with orthosis, 1-textile tension band; 2-
leather suspension strip; 3-stainless steel brace; 4-
textile or leather shoulder cap.
48. • A cuff applied circumferentially around the
proximal humerus can be attached to a shoulder
harness.
Indication:-
Hemiplegic patients with shoulder subluxation.
Advantages:-
• The cuff has the advantage of leaving the elbow
and hand free.
• It also allows motion of the glenohumeral joint
with limited flexion, abduction, and rotation while
maintaining adequate glenohumeral reduction
4. HUMERAL CUFFS
49. Indication:-
• A bed-bound patient with paralysis or
spasticity of the shoulder musculature is prone
to develop an adduction and internal rotation
contracture of the shoulder from prolonged
immobility.
Advantages:-
• A foam pillow is useful for positioning the
shoulder in slight abduction and neutral
rotation.
• This position facilitates care and prevents
contractures and hygiene difficulties in axilla.
5.ABDUCTION PILLOW
50. • Electrical stimulation units can be
considered dynamic orthotic device
Indication:-
• If the muscle weakness is believed to be
transient, electrical stimulation of the deltoid
and supraspinatus muscles can be used to
prevent shoulder subluxation
• Treatment of chronic subluxation .
Advantages:-
• Decrease pain and increase range of motion.
• Facilitates functional use of the affected
limb.
Disadvantages:-
• Current intensity and frequency can cause
an electrical buzzing discomfort to the
patient
6. ELECTRICAL STIMULATION
51. HOW STROKE AFFECTS ELBOW
• Flexor spasticity is common &
frequently severe in stroke.
• Flexion contracture are common.
• Painful elbow lead to maceration of
anticubital skin
• Compression neuropathy of the ulnar
nerve is seen in 10% of patient with
stroke.
52. ELBOW ORTHOSES
1. Long arm cast
2. Drop out cast
3. Bivalved long arm cast
4. Dynamic elbow orthosis
53. Indication
• It is an excellent static orthosis for positioning the
elbow & used for correcting flexion contracture.
Procedure of application
• After spasticity has been diminished by neurolytic or
surgical techniques, the elbow is casted in maximum
extension.
• The cast used in a serial manner to gain further ROM
• The cast is changed every 5-7 days
Trimlines
• The cast is applied at the midhumerus and extends to
the metacarpophalangeal joints with the wrist in
neutral rotation.
• Once full extension has been achieved the cast is
bivalved and a clamshell splint is fabricated to allow
periodic removal of the splint and daily range-of-
motion exercises
1.LONG ARM CAST
54. It can be used as a dynamic orthosis controlling
therapeutic range of motion of the elbow.
Indication
Patient in an upright position for much of the day.
Features
• It is a modified long arm cast in which the
posterior portion of the cast above the elbow has
been removed, allowing for full extension but
limiting flexion .
• This cast is purposely made heavy, or weights are
added at the wrist to encourage elbow extension.
• The cast is changed periodically as elbow
extension is gained.
2. DROPOUT CAST
55. • It is another modification of long arm cast in which two longitudinal cuts are
made from the biceps to radial styloid and from the triceps to distal ulna
• The clamshell cast is lined with stockinette to provide smooth inner surface
• Straps are added to secure anterior & posterior halves of the cast together.
• It can be removed several times daily to allow active/passive joint motion of
elbow to prevent stiffness
Contraindication:-
• It can not be used in severe spasticity.
3.BIVALVED LONG ARM CAST/CLAM SHELL
CAST/ORTHOSIS
56. • A dynamic elbow orthosis creates a rotational force across the joint to increase
joint motion
Indication
• This is particularly useful when high-energy trauma results in both brain injury
and lower motor neuron injury of the upper extremity.
Contraindication
• Severe spasticity
Mechanism of action
• It has elastic or spring-assisted mechanism to increase intended range of motion,
biasing either flexion or extension.
Function
• Assist or substitute for weak muscles.
4.DYNAMIC ELBOW ORTHOSES
57. 5.PRESSURE ORTHOSIS (AIR ORTHOSIS)
• It reduces tone.
• Facilitate muscle activity
around a joint.
• Facilitate sensory input.
• Control edema, and reduce
pain.
58. 6.TONE AND POSITIONING ORTHOSIS
Function
• It supports the thumb in
abduction and extension with a
neoprene glove.
• It includes an elastic strap that
is wrapped spirally up the
forearm, providing a dynamic
assist into pronation and
supination of wrist.
59. WRIST & HAND ORTHOSIS
• Spastic forearm flexor muscles causing wrist and finger flexion
deformities are common.
Boutonniere Deformity
Swan neck Deformity
• Cast & orthotic devices are used to correct residual contracture or to
position the wrist & hand.
• Specific type of forearm WHO include
- Cast
- Static wrist & hand splints
- Dynamic wrist orthosis & finger orthosis.
60. Indication
• Wrist flexion contracture .
Timlines
• It usually starts 2 cm distal to the lateral upper condyle and extends to just before
the metacarpophalangeal joints, leaving the thumb in neutral opposition and
abduction.
• The wrist is casted in a neutral position.
Procedure of application
• The cast is changed every 7 days. With each change, the wrist is gently manipulated
into further extension.
• The cast can be bivalved and a clamshell splint fabricated once full extension has
been achieved.
• The wrist should remain immobilized in full extension for an additional 4 weeks to
prevent recurrent deformity.
1.SHORT ARM CAST
61. 2.BIVALVED SHORT ARM CAST
• It is a modification of a short arm cast.
• Lined with stockinette to provide a smoother inner surface.
• Straps are added to secure the ant. & post. halves of the cast together.
Contraindication
Severe spasticity of wrist and hand.
62. Indication
• Surgical lengthening of spastic extrinsic finger flexor muscles in a
hand.
Contraindication
• Patient with severe flexion deformity.
Advantages
• Useful for maintaining the wrist in extended position.
• By holding the wrist in slight extension, patient can perform
occupational therapy & functional training of finger motion.
3.VOLAR WRIST ORTHOSIS
Volar cock up splint
63. Resting wrist–hand orthoses are one of the most commonly used static intermediate
devices.
Features
• It can be premade or custom fabricated out of many different types of materials.
• It immobilize the wrist alone or more often can include the thumb and fingers.
• The raised lateral palmer ridges of orthosis prevent radial or ulnar deviation &
reinforce the orthosis to accommodate muscle tone & spasticity.
4.RESTING WRIST–HAND ORTHOSES
64. Indication
• Patient with a relatively flexible wrist flexion deformity.
Function
• Dynamic wrist–hand orthoses provide greater functional movement and are often
better tolerated by patients compared with static orthoses.
5.DYNAMIC WRIST ORTHOSES
65. 6.SERPENTINE ORTHOSIS
• It provides sufficient thumb
abduction support, positions
the hand and wrist in a more
optimal position for
function.
• It allows active wrist
function in the child with
moderately increased tone.
66. 7.INFLATABLE HAND ORTHOSIS
• This orthosis consists of an adjustable
volar-based wrist support that is easily
adjusted to achieve the desired range of
extension.
• The palmar aspect of the orthosis is an
air bladder that can be inflated or
deflated easily, depending on the
desired stretch and level of contracture.
• It is easily donned and is comfortable.
67. • Finger positioning devices can be static or dynamic & it can be
used for maintaining a position or enhancing functional use of
the hand
• Electrical stimulation devices are available & used mainly as
training aids.
FINGER & THUMB ORTHOSIS
68. 1.Static Hand Splints
• Used to maintain the position of the fingers
and provide protection.
• They are less useful for improving the arc of
motion.
• Soft hand rolls or splints are useful for
preventing contracture.
-Absorbs perspiration
-Prevents nail bed infection
-Avoids worsening of contracture
70. 2.Dynamic Hand Splints
• Many stroke patients regain active finger flexion and are capable of
grasping objects.
• Chemodenervation or surgical lengthening can restore relaxation of
excessive finger flexor tone and allow weak extensors to open the hand.
• Finger extension can be supplied by dynamic orthoses with elastic
mechanisms.
• Mainly it is categorised into 2 varieties:-
Outrigger splint
Leaf spring glove
71. A) OUTRIGGER SPLINT
Mechanism of action
• It uses elastic mechanisms i.e rubber
bands or slings placed beneath the
proximal phalanx of the thumb and finger.
• This elastic tension causes the fingers to be
held in an open position with the thumb
abducted.
• The patient can more easily position the
hand to grasp an object
72. • Consists of flexible strips
incorporated into the glove
overlying the extensor surface of
each finger.
• These strips provide active finger
extension while allowing the
patient to grasp actively.
• The fingertips of the glove are
removed to improve sensation.
B) LEAF SPRING GLOVE
73. 3.THUMB SPICA CAST
Indication
Thumb in palm deformity and contracture.
Role
• It is an excellent orthotic device for positioning the thumb in abduction.
• The cast initially is applied as a circular device and later can be serially
recasted or modified to a bivalved splint.
74. Indication
Swan neck Deformity
Boutonniere Deformity
Function
Increase coordinated grip strength.
Advantages
• Low profile
• Well ventilated
• Lightweight
• Easy to don
• Well tolerated by patients.
4.SPLIT RING ORTHOSES
75. Indication
Thumb in palm deformity.
Function
• It is lightweight splint that holds
the thumb metacarpal in an
abducted and slightly opposed
position
• It can be used to improve thumb
function and pinch.
• Improves the opposition position.
5.THUMB ABDUCTION SPLINT
76. 6.THUMB LOOPAND THUMB ABDUCTION ORTHOSIS
• It is a semi dynamic orthosis.
Role
Positioning of the thumb and
wrist alignment.
The strapping material used in
the fabrication of this orthosis
positions the thumb in abduction
& aligns the wrist in a position
of slight radial wrist extension.
The hand is placed in a position
that enhances prehension,
manipulation, and release of
objects.
77. 7.FINGER SPREADER (FINGER ABDUCTION ORTHOSIS)
• It is a fabricated of foam rubber and
positions the fingers and thumb in
abduction.
Function
• According to Bobath the purpose of
the orthosis is to “obtain extension
of wrist and fingers”.
• It reduces the possibility of edema.
78. 8.HAND-BASED THUMB ABDUCTION ORTHOSIS
• The orthosis is custom
fabricated from
thermoplastic material.
• It positions the thumb in an
enhanced prehension pattern
for manipulation of objects
during grasp and release
activities.
79. 9.MACKINNON ORTHOSIS
• It includes a dorsal-based forearm
support(orthokinetic cuff) that wraps 3/4th
of the distal half of the forearm
• A dowel placed in the palm of the hand to
provide pressure on the MCP heads
• Rubber tubing attaching the dowel to the
dorsal forearm support the fingers are left
free to assume functional patterns.
80. 10.BELLY GUTTER ORTHOSIS
Indication
Effective for flexion contractures of
the PIP joint from approximately 15
degrees of contracture to 35 degrees
of contracture.
Function
• The belly gutter orthosis provides the
90-degree angle pull by incorporating
a convex belly in the middle of the
gutter.
• It is used at the beginning of
treatment for 1 hour on and 1 hour
off.
• Gradually, as the contracture
decreases, the time may be extended
to as much as 4 hours.
81. Advancements in orthosis for stroke
STUDY-1
Long-Term Use of a Static Hand-Wrist Orthosis in Chronic Stroke Patients: A Pilot Study
Objective
Evaluating long-term use of static WHO and experienced comfort in chronic stroke patients.
Conclusion
Number of chronic stroke patients cannot tolerate a static orthosis for at least 8 hours per day
during a long-term period of at least one year.
Without appropriate treatment opportunities, these patients will remain at risk of developing a
clenched fist and will experience problems with daily activities and hygiene maintenance.
Prefabricated static hand-wrist orthosis
Journal-Stroke research and
management(January 2013)
82. • STUDY-2
Combining virtual reality and a myoelectric limb orthosis to
restore active movement after stroke: a pilot study
(International journal of disability and human development -2014)
Diagram of the developed virtual reality and robotic limb orthosis training
paradigm showing the role of each technological component
83. Prototype of the myoelectric-based interactive system for rehabilitation.
Left panel: an adaptive training in the form of a game defines the training
parameters for a bimanual coordination motor task.
The training offers augmented feedback on performance, sustains motivation,
and automatically modifies the level of motor assistance offered by the limb
orthosis.
Right panel: the different components of the system (robotic device, tracking
setup, and training game task) while being used by a stroke patient.
84. • STUDY-3
Therapy Incorporating a Dynamic Wrist-Hand
Orthosis Versus Manual Assistance in Chronic Stroke
A Pilot Study
(Journal of Neurologic Physical Therapy-2012)
Objective:
To compare the effect of therapy using a wrist-hand
orthosis (WHO) vs manual-assisted therapy (MAT) for
individuals with chronic, moderate-to-severe
hemiparesis. Dynamic wrist-hand orthosis
(SaeboFlex).
85. • Conclusion
Small improvements in function and perception of recovery
were observed in both the groups.
Adds to the evidence that individuals with chronic stroke can
improve arm use with therapy incorporating functional hand
training.
86. • STUDY-4
Effects of Robot-Assisted Therapy on Upper Limb Recovery
After Stroke: A Systematic Review
(Neurorehabilitation and neural repair-2008)
Objective
To present a systematic review of studies that investigates the effects of
robot assisted therapy on motor and functioanl recovery in patients with
stroke.
Conclusion
No overall significant effect in favour of robot assisted therapy was found
in the meta analysis.
Sensitivity analysis showed a significant improvement in upper limb motor
function after stroke for upper arm robotics.
No significant improvement was found in ADL functions.
87. Robotics in stroke rehabilitation
• Robotic devices appear to be suitable for application under
certain conditions and modalities that allow:
• i) individually adjust the rehabilitative training protocol with
due accuracy,
• ii) obtain replication and congruity with residual motor
function and treatment targets
• iii) quantitatively assess baseline conditions and monitor
changes during training.
88. • A robotic system traditionally comprises some
major components:-
a mechanical structure with degrees of freedom consistent with the tasks
to be executed
joint-controlling actuators, either electric or pneumatic;
Proprioceptive and exteroceptive sensors providing information on the
machine functional status and interaction with environment
sequences of tasks to be executed as detailed by the system computer in
suitable language
a computer generating the signals that control the robot joints, processing
the signals transmitted by the sensors and instructing the motor controllers
man/machine interface receiving information/instructions from users
(therapist/patient) and providing online feedback
89. • . According to the control strategy, robots can
be programmed to assist patient’s motion in
different modes:
i) passive- the robot moves patient’s arm
ii) active unassisted-the subject executes the exercise and the robot provide no
help
iii) active assisted: the subject attempts to move and the robot provides
assistance when there 208 Muscles, Ligaments and Tendons are some
voluntary but inadequate movements,
iv) resistive: the subjects is required to perform an exercise against an
antagonist force provided by the robot.
90. • According to their mechanical characteristics,
robots can be classified into, at least, three
main groups
a) exoskeletons
b) end-effectors (also called “operational type
machines” or “manipulators”)
c) and cable-driven.
91. Armeo® Spring: an
ergonomic arm
exoskeleton with
integrated springs
Armeo® Power:
an exoskeleton
based on the
ARMin
technology
92. Armeo® Boom: a simplified cable-
driven manipulator designed for out-
patient clinics and home settings
93. • STUDY-5
A Novel Functional Electrical Stimulation Treatment for Recovery of Hand
Function in Hemiplegia: 12-Week Pilot Study
(Neurorehabilitation and Neural Repair-2009)
Objective:-
This study aimed to evaluate the feasibility of achieving greater and more
persistent gains with CCFES(Contralaterally controlled functional electrical
stimulation) by increasing the treatment period to 12 weeks.
CCFES uses neuromuscular electrical stimulation to open the paretic hand in
direct proportion to the degree of volitional opening of the unimpaired contral-
ateral hand, which is detected by an instrumented glove.
Conclusion:-
Greater reductions in hand impairment were achieved by extending the
treatment period.
The effect and its longevity may be related to baseline impairment level.
94. (CCFES)
Volitional Opening of the Unaffected Hand
Produces a Proportional Intensity of Stimulation
to the Paretic Hand Extensors
98. REFERENCES
• Webster B.Joseph,Murphy P Douglash,Atlas of orthoses and assistive devices(5th
Edition),Chapter-13(Upper Limb Orthoses for the Stroke- and Brain-Injured Patient)
• Fess,Gettele,Phillips,Jason,Hand and upper extremity splinting Principles and
Methods(3rd Edition),Chapter-19(Splinting for Patients with UpperExtremity Spasticity)
• Stroke Rehabilitation Function-Based Approach Glen Gillen, EdD, OTR, FAOTA
• Hunter,Mackin,Callahan, Rehabilitation of the hand and upper extremity,5th Edition,
Chapter-8(Clinical evaluation of hand ),Chapter-9(Diagnosis imaging of the upper extremity)
• Catherine A.Trombly,Mary Vining Radomski,(Occupational therapy for physical
dysfunction),5TH Edition, Section-4,Chapter-42(Hand Impairments)
• S Sunder, Text book of rehabilitation,Chapter-18,Stroke rehabilitation
• Robotics in shoulder rehabilitation(Review article)
• Combining virtual reality and a myoelectric limborthosis to restore active movement after
stroke:a pilot study
• Biomechanics of orthoses for the subluxed shoulder,J. C. Cool