Orthosis introduction

1. Introduction in orthoses
Mahmoud Samir Mohamed
Lecture 1

2. orthosis
may be defined as any device, applied
to the external surface of an extremity,
that provides better positioning,
immobilizes, prevents deformities,
maintains correction, relieves pain,
mobilizes joints, exercises parts, or
assists or supports weakened or
paralyzed parts

3. Articular and
Nonarticular Orthoses
Articular Orthoses
Are Those That Cross A Joint
Or Series Of Joints.
Examples Of Articular
Orthoses Include A Wrist
Immobilization Orthosis,
Proximal Interphalangeal
(PIP) Joint Extension
Mobilization Orthosis, And
Elbow Flexion Restriction
Orthosis
Nonarticular Orthoses
Do not cross a joint;
instead, they stabilize the
body segment to which
they are applied.

4. Purpose of Orthosis

5. Immobilization
• The purpose of an immobilization orthosis is
simply to place a structure in its anatomical or
most comfortable resting position.
Immobilization orthoses are perhaps the most
common and simple form, although it can be
used for complex injuries. Immobilization
orthoses immobilize the joints they cross.

6. Mobilization
• The effectiveness of mobilization does not rely on
stretching tissue but rather on the facilitation of cell
growth. The target tissue lengthens when the living
cells of the contracted tissues are stimulated (by the
application of force) to grow. This stimulation occurs
when steady tension is applied through the orthosis
over a specific period of time.
• There are three choices of orthotic design to mobilize
tissue, including serial static, static progressive, and
dynamic orthoses.

7. Restriction
• Restriction orthoses restrict or block an
aspect of joint motion. These are generally
simple orthoses applied in such a way that
they limit motion. Therapists can
construct static orthoses, dynamic
orthoses, and forms of taping to become
types of restrictive orthoses because they
can be made to restrict some portion of
joint motion while allowing full motion in
the opposite direction.

8. A- The PIP joint is immobilized in a comfortable resting
position to allow the involved structures to heal,
commonly used for a PIP ligament sprain.
B-The PIP flexion mobilization orthosis stretches the PIP
joint into flexion to address a PIP extension contracture
(using a static progressive approach)
C- The PIP joint is restricted from full extension but
allowed to flex fully within the boundaries of the PIP
extension restriction orthosis, which is commonly used
for swan neck deformities when the PIP joint pulls into
hyperextension

9. Choices of
Orthotic Designs

10. 1- Static Orthoses
Static orthoses have a rigid base, immobilizing
the joints they traverse
A static orthosis provides stabilization,
protection, and support to a body segment such
as the elbow, wrist, or finger. Static orthoses are
perhaps the most common orthoses made.
They can be used as an adjunct to treatment, an
exercise device, by blocking a distal or proximal
joint to increase glide of another joint or improve
tendon excursion.

11. 2- Serial Static Orthoses
• Tissue held in this end-range
position should react and
accommodate by stretching
into the desired direction of
correction.
• Serial static orthoses or casts
are applied with the joints,
soft tissue, or
musculotendinous units they
cross in a lengthened position

12. 3- Dynamic Orthoses
Dynamic orthoses use an elastic-type force to
mobilize specific tissues to achieve increases in
ROM .
The mobilizing forces applied through a dynamic
orthosis are elastic (stretchy) in nature, such as
rubber bands, springs, or wrapped elastic cord.
The dynamic force applied continues as long as
the elastic component can contract, even when
the tissue reaches the end of its elastic boundary

13. 4- Static Progressive Orthoses
• Static progressive orthoses achieve
tissue mobilization by applying low-load
force to the tissue's end range in one
direction over a long period of time
• The goal is that the tissue will eventually
accommodate to this position.
• The fabrication of a static progressive
orthosis is like a dynamic orthosis, but
the force applied is static or nonelastic.

14. Objectives for Orthotic
Intervention

15. The key objective for orthotic fabrication may
not always be straightforward. The objectives for
orthotic intervention may be multiple, as in a wrist and
hand immobilization orthosis (resting hand orthosis)
used on a patient with rheumatoid arthritis. The
orthosis may be constructed to immobilize inflamed
arthritic joints yet place the metacarpophalangeal
(MP) joints serially in a gently extended and radially
deviated position to minimize ulnar drift and
periarticular deformity.

16. Immobilization Orthoses
Orthoses designed to hold or immobilize a joint or limb segment can be
used to do the following
• Provide symptom relief
• Protect and position edematous structures
• Aid in maximizing functional use
• Maintain tissue length
• Protect healing structures and surgical procedures
• Provide support and protection for soft tissue healing
• Maintain and protect reduction of fracture
• Improve and preserve joint alignment
• Block and transfer muscle and tendon forces
• Influence a spastic muscle
• Prevent possible contracture development

17. Mobilization Orthoses
• Remodel long-
standing, dense, mature
scar
• Elongate soft tissue
contractures,
adhesions, and
musculotendinous
tightness
• Increase passive joint
ROM
• Realign or maintain
joint and ligament
profile
• Substitute for weak or
absent motion
• Maintain reduction of
an intraarticular
fracture with
preservation of joint mobility
• Provide resistance for
exercise

18. Restriction Orthoses • Limit motion after nerve injury
or repair
• Limit motion after tendon
injury or repair
• Limit motion after bone or
ligament injury or repair
• Provide and improve joint
stability and alignment
• Assist in functional use of the
hand
Orthoses designed to
restrict or limit motion
may be used to do the
following:-