An orthosis is an externally applied device that modifies the structural characteristics of the neuromuscular and skeletal systems to make something straight. An orthotist is trained to assess patients and design, measure, and fit orthoses. Orthoses aim to stabilize weak areas, support damaged joints, control abnormal movements, and prevent deformities. A thorough evaluation involves multiple specialists. Prescriptions consider biomechanics, materials, tissue tolerance, and classification. Patient assessments evaluate history, examination findings, and functional ability. Specific conditions require targeted tests and evaluations to identify deformities and guide treatment.
Jesse Jhaj: Building Relationships with Patients as a Doctor or Healthcare Wo...
Assessment of lower extermity for prescription of orthoses
1. Presenter- Om Prasad Biswal
M.P.O 1st Year, 3rd Batch
Pt. Deendayal Upadhyaya National Institute for
Persons with Physical Disabilities (Divyangjan)
2. What is an orthosis and
Orthotist??
It’s a Latin word derived from “Orthogan”.
Ortho means to make something straight. So
orthosis is defined as an externally applied
device used to modify and align the structural
and functional characteristic of neuromuscular
and skeletal systems.
Orthotist is defined as a person who has
completed an approved course of education and
training and is authorized to assess the patient
and design, measure and fit the orthosis.
3. Lower Extremity Orthotic Goals:
Stabilize weak or paralyzed segments and muscle
groups.
Support damaged or diseased joints or segments.
Unload distal segments.
Control abnormal or spastic or involuntary
movements.
Limit or augment motion across joints.
Prevention of mal-alignments and contractures or
correcting deformity
4. Orthotic Evaluation
Comprehensive team evaluation including PMR
(Physiatrist), Orthopedic surgeons, Prosthetist and
Orthotist, Physiotherapist, Occupational therapist,
Patient and patient’s family.
Establish the orthotic and rehab goals early.
Educate the patient.
Clarify the limitations of the orthosis.
Order appropriate therapy for the device.
Follow up with the patient.
5. Orthotic Issues to consider:
Biomechanics of the device :
o Principle of Jordan
o Control of rotational moments across a joint
o Control of axial forces around a joint
o Control of translational forces around a joint
o Control of line of action of the GRF
Durability of the materials
Tissue tolerance to pressure( Total contact or even
pressure distribution)
Partial weight relieving.
7. Prescription Criteria
Patient Evaluation
Demographic Data
Chief Complaint
Medical History
On Observation
On Palpation
On Examination
Other Assessment
8. Patient Assessment and Evaluation
Demographic Data:
Patient Name
Father
Mother
Address
Age
Sex
Height
Weight
9. Cont.…
Chief Complaint(C/C): A/c to patient’s language or
through direct encounter with the patient; the reason
for presenting the problem.
History:
a) Patient History
• Diagnosis
• Cause
• Segment and Side Involved
• Period of Occurrence
• Duration
10. Cont.…
b) Family History
• No. of member
• No. of earning member
• Marital Status
• No. of child
c) Education History
• Qualification/education of patient
• % of educated members in the family
d) Occupation History
• Past Job
• Present Job
11. Cont.
e) Environmental History
• Type of environment (rural/urban)
f) Medical History
• Past History
1. Prenatal: Mother age & Immunization
2.Perinatal: Baby wt., cry, type of delivery
3.Postnatal:Immunization and illness
4. Developmental Milestones
5. Trauma: Date & Place of occurrence & treatment
6. Previous aids and appliances
• Present History
Drugs and medications, therapies, surgeries, use of any
aids or appliances etc.
12. Cont.
On Observation:
• External aid/appliance
• Postural Alignment
• Segment Involved
• Body structure
• Gait
On Palpation:
• Tenderness
• Pain
• Temperature
• Swelling
• Skin Texture(Smooth/Rough)
13. Cont.
ON EXAMINATION:
• Manual Muscle Testing:
Right Left
Flexion - -
Hip Extension - -
Abduction - -
Adduction - -
Knee Flexion - -
Extension - -
Ankle Dorsiflexion - -
Plantar
Flexion
- -
14.
15. Cont.
Active RoM Passive RoM
Flexion - 0-120
Hip Extension - 0-30
Adduction - 0-30
Abduction - 0-45
Knee Flexion - 0-135
Extension - 135-0
Ankle Plantar Flexion - 0-50
Dorsiflexion - 0-20
• Range of Motion:
16. Cont.
Motor Examination:
Muscles Tone:
• Fast and passive movement
• Hypotonic, Normal, Hypertonic
• Modified Ashworth Scale ( MAS Scale): The scale was
elaborated and applied by Bohannon and Smith in 1987.
23. Birth History: Prenatal Perinatal Postnatal
ON EXAMINATION:
MMT Grading
RoM
MAS Scale
Balance
Higher Motor Functions
Functional Evaluation
24. Voluntary Motor Control (VMC):
1+ Gravity eliminated plane with 1/3rd
movement possible
1++ Gravity eliminated plane with 2/3rd
movement possible
1+++ Gravity eliminated plane with full range
of motion
2+ Against Gravity 1/3rd movement possible
2++ Against gravity 2/3rd movement possible
2+++ Against gravity full RoM
3+ Against gravity with resistance 1/3rd
movement possible
3++ Against gravity with resistance 2/3rd
movement possible
3+++ Against gravity with resistance full RoM
4 Skilled movement
26. Clonus:
It’s a condition that results in involuntary muscle
spasms.
27. Plantar Reflex: Flexor Type /Extensor Type
(Babinski’s sign) /Indifferent
28. Sensory Integrity and Integration:
• Superficial- Crude touch and Fine touch
• Deep- Pressure, Kinesthesia, Vibration
• Cortical- Tactile localization and stereo gnosis
29. Common Deformities in CP (In
Lower Extremities)
Hip Flexion, adduction and internal
rotation
Knee Flexion / Hyperextension
Ankle/Foot Plantar flexion, inversion and forefoot
adduction, valgus and collapsed arches
31. RoM: Joint Integrity and mobility
Manual Muscle Testing(MMT)
Modified Ashworth Scale (MAS):For tone and
reflexes
DTR
Voluntary Motor Control (VMC)
Sensory Integration Tests: Proprioception
0 – The sensation is absent
1 – The sensation is present but impaired
2 – The sensation is normal
Postural Control and Balance: Postural Assessment
Scale for Stroke (PASS)
32.
33.
34. Spinal Injury!
Complete or Incomplete?
The injury is complete if there is:
o No voluntary anal contraction
o S4-5 sensory scores = 0
o no anal sensation
Otherwise, the injury is incomplete.
35. Complications in Lower Extremities
following Stroke:
Pelvis Weak hip extensors, Flexion
contracture
Insufficient forward pelvic rotation
Hip Trendlenburg limp, Scissoring
Spastic quadriceps
Knee Flexion contracture, weak hip and knee
extensors, genu-recurvatum
Spastic quadriceps and spastic
hamstrings
Ankle/Foot Equinus, Varus, Hammer Toe
40. Age of presentation matters:
Brought during early
infancy
Brought during early
childhood
Brought during late
childhood
41. Examination and evaluation
Foot examination:
o B/L foot deformity in 60% cases
o Size of the foot is small (U/L)
o Equinus, varus , adduction: Inability to bring the foot
in the opposite direction.
o In late presentation: Cavus
o Heel: Small in size, calcaneus can be felt with great
difficulty
o Deep skin creases on the back of the heel and medial
side of the sole.
42. o Bony prominences: On the lateral side of the foot,
head of the talus, medial side of the sole
o The outer side of the foot is gently convex and dimples
may be present over the outer aspect of ankle.
o On attempted correction, one can feel the tight
structures posteriorly(TA) and plantar fascia.
45. Treatment Plan
After manipulation and serial corrective plaster casts,
correction is maintained by D.B splint till 1 ½ years.
AFO Splint at night, shoes during day after 1 ½ years
Follow up till 10-12 years